Ready for a change or stuck in a rut: Cancer survivor attitudes and prevention practices.

CS20-01

Today in the United States, a person is diagnosed with cancer every 23 seconds. While cancer mortality is still a major concern, advances in early detection and treatment have resulted in more people being cured of this disease; currently 64% of newly diagnosed cancer patients can expect to be alive at least 5 years. These patients will join the burgeoning numbers of cancer survivors who currently total over 10 million, and who comprise 3-4% of the US population. Given associations between cancer incidence and a variety of lifestyle factors, such as smoking, overweight or obesity, physical inactivity and various components of a Western diet (or this dietary pattern overall), it can be assumed that a significant proportion of individuals diagnosed with cancer may prescribe to unhealthy lifestyle practices. Growing evidence suggests that some of the very same lifestyle factors that contribute to cancer risk, also may influence cancer progression. Additionally, many of these factors also may contribute to the significant co-morbidity observed in this high-risk population (i.e., second cancers, cardiovascular disease, diabetes, and osteoporosis), as well as make a negative impact on physical function and quality of life. Thus changes in lifestyle behaviors, either at the point of diagnosis or throughout the course of survivorship, may benefit a large proportion of this patient population. But, do cancer survivors make changes in their lifestyle practices? and more importantly, are they able to sustain them? A large number of previous studies in various populations of cancer survivors suggest that the cancer diagnosis often serves as a catalyst or a teachable moment for inciting healthful changes in behavior. However, more recent population-based surveys comparing the health behaviors of long-term cancer survivors to the population at large, show little difference between the two. While it is possible that differences in samples and methods may have led to these discrepant findings, potential explanations to justify both include the following: (1) cancer survivors may indeed change their lifestyle behaviors, but these changes may be in areas that currently are not associated with proven benefit, such as supplement-use and other forms of complementary therapy; (2) cancer survivors may change their lifestyle behaviors from more frequent practice of risky behaviors to levels that more closely resemble population norms; (3) cancer survivors may change their lifestyle behaviors soon after diagnosis, but may slip back over time to their previous lifestyle habits. Regardless of cause, the fact remains that cancer survivors are a high risk population, in whom lifestyle change could bring enormous benefit in terms of quality of life, functional status, co-morbidity and overall survival, but who may need assistance or interventions to help guide them. Fortunately, the majority of cancer survivors appear hgihly interested in lifestyle interventions. Exploration is currently underway in developing and testing various behavioral interventions that target cancer survivors in areas of smoking cessation, diet and exercise. Elements of successful interventions, i.e., theoretical basis, strategies for overcoming common barriers, timing, etc. will be reviewed. In addition, areas for future research will be defined, i.e., need for multi-component interventions, need for interventions in underserved survivor populations (e.g., childhood cancer survivors, patients with metastatic disease, long-term survivors), and need to develop interventions that have proven durability.