Health behaviors during and after a cancer diagnosis

Abstract

With improvements in cancer survival rates, more patients with cancer are living longer, and hence, cancer is becoming viewed as a chronic illness requiring long-term management. An important aspect of patient care during and after cancer treatment is patient health behaviors. For example, sequelae from various cancer treatments, such as chemotherapy and radiotherapy (RT), can compromise health in a variety ways, including decreased immune functioning, cardiotoxic effects of chemotherapy and/or RT, and weight gain. In addition, the stress caused by a cancer diagnosis and its treatment can disrupt existing health behaviors or exacerbate unhealthy behaviors. Continued smoking or alcohol use can complicate treatment and increase risk for further malignancy. Furthermore, decreased physical activity and poor nutrition can cause weight gain, which may contribute to secondary health problems such as cardiovascular disease and diabetes. The authors reviewed the extant literature on four key health behaviors among patients with cancer and survivors: healthy diet, reduced tobacco use, reduced alcohol use, and increased physical activity. They described the prevalence of these behaviors, reviewed the effects of interventions designed to alter unhealthy behaviors, and discussed the implications and future directions for this emerging area of research. With primary prevention efforts, improved detection, and treatment, cancer incidence rates have decreased among men (Surveillance, Epidemiology, and End Results program and National Program of Cancer Registries data, 1992-1998) and overall mortality rates have decreased in both men and women.1 According to the Office of Cancer Survivorship, 2 9.6 million individuals in the U.S. have been diagnosed with cancer (a majority with breast, prostate, and colorectal cancers): 39% were diagnosed 0 to Ͻ 5 years ago, 47% were diagnosed 5 to Ͻ 20 years ago, and 14% were diagnosed Ͼ 20 years previously.With improvements in survival and the possibility that cancer may be viewed as a chronic disease, the reduction of risk behaviors such as smoking, sedentary behavior, and unhealthy diets or, conversely, the adoption and maintenance of healthy behaviors, becomes more salient. Cancer treatments are known to disrupt health behaviors. For example, retrospective reports show that patients report reduction in exercise behavior during the phase of active treatment 3 and changes in taste sensitivity associated with chemotherapy alter food preferences and nutritional intake. 4 Furthermore, the stress associated with a cancer diagnosis may disrupt health behaviors and potentially increase unhealthy behaviors. In some instances, continued unhealthy behaviors such as smoking can adversely affect responsiveness to RT (e.g., increased side effects such as oral mucosi- 2614

Physical activity, long-term symptoms, and physical health-related quality of life among breast cancer survivors: A prospective analysis

“…Numerous intervention studies and several reviews suggest that physical activity after diagnosis can be helpful in reducing cancer-related symptoms and improving HRQOL (19)(20)(21)(22)(23)(24)(25). Our results were consistent with this emerging literature.…”

“…Several recent reviews on the impact of physical activity interventions in cancer survivors both on-and off-treatment show that physical activity can have positive effects on physical symptoms such as fatigue, pain, cognition, and sleep, on fitness measures, body composition, and biological changes such as immune functioning, and on psychosocial measures including depression, anxiety, selfesteem, and multiple aspects of QOL, including HRQOL (19)(20)(21)(22)(23)(24)(25).…”

Cancer as a chronic disease

“…Despite every effort being made to minimise the medical and social hazards associated with cancer treatments, many treatments have been found to have long term consequences (Hewitt, Greenfield, & Stoval, 2006). Some of these long term effects include persistent neuropathies decreased immune functioning, cardiac toxicity and weight gain, which in turn can contribute to the development or worsening of several co-morbid conditions (Pinto & Trunzo, 2005). Some survivors of cancer experience a range of other disabling effects which impact on their day to day functioning, such as endocrine dysfunction, infertility, functional decline and psychosocial morbidity (Hewitt et al, 2006).…”

The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends

“…Despite this, many cancer survivors continue to engage in unhealthy lifestyle behaviors that could place them at risk of further health problems [38]. Several studies have examined the current prevalence of health behaviors post diagnosis [8,13,18,36].…”