Ready for action in survivorship: Reducing risk of recurrence and improving quality of life | ASCO 2026

The 2026 meeting of the American Society of Clinical Oncology (ASCO) addressed key issues and opportunities in survivorship in multiple sessions on May 30 and June 1. Doctors and advocates highlighted unmet needs and steps that breast cancer survivors can take to improve quality of life and reduce the risk of cancer coming back, including an update on the role of GLP-1 receptor agonists (weight loss drugs) in preventing cancer recurrence.

Defining community needs

According to ASCO panelist and breast cancer advocate Laura Carfang, EdD, founder and executive director of SurvivingBreastCancer.org, breast cancer survivors have a significant unmet need for support. “The survivorship burden is high, persistent, and multidimensional,” says Dr. Carfang.

A survey of 280 members of the SurvivingBreastCancer.org community found that 85% of breast cancer survivors are significantly affected by at least one lingering symptom. Symptom burden was comparable among people with early-stage and metastatic breast cancer (MBC), with those with MBC reporting feeling slightly more supported, likely due to more frequent or better communication with their care team.

Fear of recurrence is the primary unmet need in survivorship, according to this survey. Sixty-two percent of those surveyed worry “quite a bit” or “very much” about the possibility of the cancer coming back. Dr. Carfang explains, “Fear does not decrease over time without interventions. It does not fade with years of survivorship. It stays with us unless there is active intervention.”

The survey results echo Living Beyond Breast Cancer’s 2025 Community Needs Assessment findings. More than half of respondents to that survey named support for services and programs that improve quality of life and emotional support resources as solutions for their unmet needs that would have the most impace.

Respondents to SurvivingBreastCancer.org’s survey felt most supported when they had more meaningful conversations initiated by providers on topics such as sleep, nutrition, exercise, or social support. Dr. Carfang describes these as whole-person conversations. “Patients are telling us exactly what they need. We need to make sure that we are listening.”

Researching better survivorship care

Care planning

The BETTER-CARE study tested a complex follow-up care program to improve health-related quality of life in 30 German breast health centers. The results included 783 participants randomized to a study group and a control group. The study group’s approach was unique in that it adapted to participants’ needs. Participants were routinely assessed for common survivorship issues. A low score prompted a referral for additional support. For example, a participant who reported psychosocial distress was referred to a 10-week program. While no significant differences were seen in health-related quality of life after a year, participants who received the additional follow-up care saw improvements in fatigue, depression, side effects, and social functioning.

Sleep

Breast cancer survivors frequently report difficulty sleeping, often related to menopausal symptoms caused by hormone therapy. The phase 3 OASIS-4 clinical trial tested the NK1/NK3-targeted pill elinzanetant’s effect on quality of life and symptom management, including sleep disturbance, in women ages 18 to 70 taking hormone therapy for HR-positive breast cancer. This medicine, the first such drug approved by the FDA for breast cancer, treats hot flashes and other vasomotor symptoms of menopause. Study participants on elinzanetant were soon able to sleep better and saw improvements in hot flashes and other physical, psychosocial, and other symptoms of menopause. The benefit was seen regardless of the type of hormone therapy they were taking.

Questions remain about affordability as the pill is more expensive than other options. While the drug showed improvement in psychosocial health, the presenter, a psychiatrist, advised that it is not a replacement for medication for depression or anxiety.

Weight management

Many women with breast cancer gain weight after treatment, often due to endocrine therapy. Over 2/3 of premenopausal women with breast cancer gain at least 5% of their body weight after cancer treatment. This matters because weight gain of over 10% is associated with worse breast cancer prognosis and survival.

GLP1-s and breast cancer

Many clinical trials have tested lifestyle and diet changes for weight loss in breast cancer with minimal impact. It is not surprising then that GLP-1 drugs have garnered significant interest within our community. These headline-making medicines were first rolled out in diabetes and are now commonly prescribed for weight loss. Nearly 12% of adults in the U.S. have tried a GLP-1 drug. Four drugs in this class have been approved by the FDA. None have been specifically tested in cancer.

What we know about GLP-1 and breast cancer thus far mostly comes either from research in mice or from the ongoing analysis of prior GLP-1 studies. Studies in mice have shown that both GLP-medicines and a very low-calorie diet can be effective in slowing tumor growth or reducing tumor size. This research suggests that a lower-calorie diet, more than the medicine itself, might be controlling cancer growth. However, it is not as easy for a person to stay on a very low-calorie diet as it is to limit the diet of a mouse in a lab.

The retrospective studies of people with breast cancer who have taken a GLP-1 offer some insight as well. These studies look back at data that was already collected to look for patterns in groups of people, like those with breast cancer. Overall, these revealed that people with a history of breast cancer saw modest weight loss but also improvements in overall survival. Retrospective studies aren’t able to establish cause and effect, but they provide clues that researchers can use for future studies. The survival benefit may be explained by GLP-1 drugs’ association with cardiovascular and blood sugar benefits. A recent large data analysis found an association between GLP-1 use and improvements in both overall survival and recurrence-free survival among people with breast cancer.

Research has also explored GLP-1s and side effects. A study reported at the 2025 San Antonio Breast Cancer Symposium found that GLP-1 use was linked to worse joint pain, depression, hot flashes, osteoporosis, and higher risk of endometrial cancer. More results from this study are forthcoming.

The high interest in this area has resulted in new clinical trials specifically designed to explore GLP-1 use in breast cancer. The ongoing FITWISE study is testing the use of tirzepatide in people with HR-positive/HER2-negative early-stage breast cancer and higher BMI. The study primarily focuses on weight loss but will look at cancer outcomes as well. TRIM-EBC is also currently enrolling people with early-stage HR+/HER2- breast cancer eligible for weight management drugs per FDA guidelines. This study is open to people with positive ctDNA results and will track outcomes related to ctDNA.

Dr. Sherry Shen of Memorial Sloan Kettering Cancer Center, who presented this GLP-1 update, advises that these drugs are not a substitute for lifestyle changes. Doctors need to counsel patients that dietary change is important.

Mediterranean diet

The Mediterranean diet describes a way of eating that emphasizes whole grains, fruits, vegetables, and lean proteins over fatty meats and sweets. An Italian study tested the impact of this diet, vitamin D, and physical activity on breast cancer recurrence and heart/metabolic risk factors.

The phase 3 study randomized women to one of two groups: a control group that offered advice on the value of the Mediterranean diet and physical activity or a study group that received more intense dietary guidance, took vitamin D daily, and walked briskly for 30 minutes/day. After 33 months, results showed that participants in the study group lost weight and improved heart health risk factors. Participants with HR-positive breast cancer also had a lower risk of cancer returning. This reduction in risk was highest among people who followed the study program closely.