Lifestyle-Based Approaches to Cancer Prevention and Treatment: Diet, Physical Activity, and Integrative Strategies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study titled “Lifestyle-Based Approaches to Cancer Prevention and Treatment: Diet, Physical Activity, and Integrative Strategies” aimed to synthesize evidence on lifestyle-based interventions influencing cancer risk, treatment tolerance, and survivorship. The topic is interesting; however, several substantive concerns remain to be addressed.

1. This manuscript is classified as a Review; however, the authors have adopted an approach resembling that of a systematic review without adhering to PRISMA guidelines. Moreover, a Results section is absent. We recommend restructuring it as a traditional narrative review.

2. The Introduction should begin by outlining current cancer-prevention and treatment strategies. Against this backdrop, the authors should then highlight the advantages of their proposed integrative approach—centered on Diet, Physical Activity, and Integrative Strategies—over existing paradigms, thereby establishing the rationale for the present study.

3. In the Introduction, the justification for proposing Diet, Physical Activity, and Integrative Strategies as cancer-prevention and treatment modalities is insufficient; substantially more supporting literature must be added.

4. For all studies that met the inclusion criteria, did the authors consider the issue of study quality?

5. Since the study focuses on cancerprevention and treatment strategies, namely Diet, Physical Activity, and Integrative Strategies, we recommend reorganizing the manuscript so that each of these three pillars is discussed separately, with clear sections detailing their respective roles in cancer prevention and treatment.

6. As the authors note, the impact of a given strategy may differ across cancer types; therefore, within each of the three pillars(Diet, Physical Activity, and Integrative Strategies), the manuscript should separately address their effects on distinct cancers (at least the most common ones).

7. It is odd that the authors devote a separate section to “8. Carcinogenic Exposures: Tobacco and Ultraviolet (UV) Radiation”,which is only loosely related to the manuscript’s stated theme. If cancer-risk factors are to be included, they should be presented before the Diet, Physical Activity, and Integrative Strategies sections, and the discussion should acknowledge differences among cancer types.

8. Is “9. Complementary and Mind–Body Approaches” intended to cover Integrative Strategies? If so, the content is insufficient and should be expanded following the structure recommended earlier—namely, separate discussions for each cancer type.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Comments to authors

The manuscript reviews how lifestyle changes can prevent cancer and improve treatment tolerance. It also analyzes the role of smoking cessation, reducing radiation exposure, and the use of complementary therapies in cancer survival. Despite being reasonably well written and interesting, it requires some improvements, which I outline below.

 

Abstract

 

A structured abstract is appreciated. Typically, these types of reviews are unstructured, including the objective at the end of the abstract, which prevents the abstract from truly summarizing the article.

 

• That said, I have a question: why did the authors narrow the search from 2001 to 2025? I haven't gotten around to methods yet, but I'm surprised there's a time limit.

 

Introduction

 

• “The role of carotenoid intake, 55 particularly β-carotene and vitamin A, in cancer prevention has been explored, with find- 56 ings indicating a notable inverse relationship between their consumption and cancer risk, 57 including lung cancer [3].”: In lung cancer, it would be unwise to claim that there is an inverse association between vitamin A intake and lung cancer risk, since there are studies that show that vitamin A supplementation increases the risk of this cancer, especially among smokers.

 

• “Specific lifestyle recommendations for preventing melanoma include consistent sun- 53 screen use, wearing protective clothing, seeking shade, limiting sun exposure during peak 54 hours (10 a.m. to 2 p.m.), and avoiding indoor tanning [2].” These hours will depend on the country the person is in. There are countries where it's recommended not to expose yourself to the sun until 4 p.m., for example. At 2 p.m., the angle at which the sun shines is practically perpendicular.

 

• The review would be enriched by the mention of other dietary factors that have not been named, such as the intake of dietary AGEs. There are recent studies that is of interest (https://pubmed.ncbi.nlm.nih.gov/40431378/, https://pubmed.ncbi.nlm.nih.gov/39479627/, https://pubmed.ncbi.nlm.nih.gov/32169887/). Although the overall effect of dietary AGEs on overall cancer risk is unclear, they do appear to increase the risk of some tumors, such as breast cancer.

 

Methods

 

• Authors should indicate why they searched for articles from the last 25 years. Typically, there are no search restrictions unless the subject matter requires it. This decision must be justified.

 

• I suggest including the search strategy in supplementary material or, if you decide to include it in the main manuscript, including it in a table would make it clearer.

 

• “and studies in high-impact journals”: How was this taken into account? Articles published in JCR? Or Q1 or Q2? I have to assume the authors are referring to articles that had a JCR, but if it's included, it should be specified.

 

• Some exclusion criteria need to be reconsidered. For example, if an inclusion criterion is that the article was published between 2001 and 2025, an exclusion criteria cannot be that it was written before 2001; it's redundant. Exclusion criteria should be complementary to inclusion criteria, not the opposite.

 

3. Intermittent and Periodic Energy Restriction (IF/FMD)

 

• It is suggested to include a results table (author and year [reference], sample size, design, tumor, outcomes, results).

 

4. Ketogenic Strategies in Oncologic Metabolism (LC/KD)

 

• Include a table as indicated above. This applies to the rest of the sections.

 

• I would also add a paragraph on safety issues related to the ketogenic diet and possible contraindications.

 

5. Vitamin D, Carotenoids and Signaling Axes

 

• The authors rely heavily on association/correlation studies. These types of studies should be accompanied by cohort studies or clinical trials to confirm the hypotheses that can be raised with correlation studies. Therefore, caution must be exercised in the evidence provided, given that it comes from study designs with weak validity.

 

6. Physical Activity and Sedentary Behavior 576

 

• As I've mentioned before, a table summarizing the findings would be especially useful in this section. Unlike nutraceutical supplementation, which can have safety issues, physical activity and exercise are not subject to restriction unless health prohibits it. This is therefore a particularly relevant section. Furthermore, the prescription of exercise for people with cancer is a current topic.

 

7. Adiposity and Metabolic Health

 

• It is Ok (but summary table is needed).

 

8. Carcinogenic Exposures: Tobacco and Ultraviolet (UV) Radiation

 

• It is Ok (but summary table is needed).

 

9. Complementary and Mind–Body Approaches 783

 

• It should be mentioned that these types of therapies should be supervised by a professional, since the use of some medicinal plants could interfere with other medications, and include some examples of this.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Comments to authors

 

The authors addressed most of the comments correctly, although a couple of minor issues remain to be resolved:

 

• Table 2: delete the column of “Reference”, and include a column to the left of the table including author and year [reference[.

 

• “Despite notable advances in cancer detection and treatment”: Uncited paragraph. A full paragraph cannot be left unquoted if it includes third-party information.

 

• “Ongoing research is now focusing on developing”: Uncited paragraph. A full paragraph cannot be left unquoted if it includes third-party information.

 

• “Despite these promising findings, the limited”: Uncited paragraph. A full paragraph cannot be left unquoted if it includes third-party information.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf