Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study

Abstract

Background:A healthy lifestyle following a cancer diagnosis may improve long-term outcomes. No studies have examined health behaviour change among UK cancer survivors, or tracked behaviours over time in survivors and controls. We assessed smoking, alcohol and physical activity at three times (0–2 years before a cancer diagnosis, 0–2 years post-diagnosis and 2–4 years post-diagnosis) and at matched times in a comparison group.Methods:Data were from waves 1–5 of the English Longitudinal Study of Ageing; a cohort of older adults in England. Behavioural measures were taken at each wave. Generalised estimating equations were used to examine differences by group and time, and group-by-time interactions.Results:Of the 5146 adults included in the analyses, 433 (8.4%) were diagnosed with cancer. Those with a cancer diagnosis were less likely to be physically active (P<0.01) and more likely to be sedentary (P<0.001). There were no group differences in alcohol or smoking. Smoking, alcohol and activity reduced over time in the whole group. Group-by-time interactions were not significant for smoking (P=0.17), alcohol (P=0.20), activity (P=0.17) or sedentary behaviour (P=0.86), although there were trends towards a transient improvement from pre-diagnosis to immediately post-diagnosis.Conclusion:We found little evidence that a cancer diagnosis motivates health-protective changes. Given the importance of healthy lifestyles, strategies for effective support for behaviour change in cancer survivors need to be identified.

A survey of Australian cancer nurses: The prevention and control of noncommunicable diseases (CanPaC study)

“…[6] The time-point immediately after diagnosis of cancer has been identified as optimal for individuals to seek out and adopt changes to modify health behaviors. [26] The discord between the nurses desire to influence health behavior in line with international and national health policy and the individuals capacity to adopt risk-reducing health behaviors is further impeded by the barriers identified by respondents including workload, appropriate physical environment and the availability of culturally appropriate resources that is consistent with previously reported data. [20]…”

“…[13] Moreover, it is acknowledged that the general population find it difficult to adopt appropriate health behaviors over time. [26] While nurses may use teachable moments and EBS to encourage people to adopt risk-reducing health behaviors research indicates that even the person with a cancer diagnosis finds it challenging to make the necessary changes. [6] The time-point immediately after diagnosis of cancer has been identified as optimal for individuals to seek out and adopt changes to modify health behaviors.…”

Health Behavior Change Interventions for Teenage and Young Adult Cancer Survivors: A Systematic Review

“…59,61 However, in practice, there is little evidence in adult populations that cancer survivors spontaneously adopt healthier lifestyles post diagnosis without intervention. 62 Very little is currently understood about whether the ''teachable moment'' is also a point in TYA survivorship and if this point is related to stage of treatment, age, or individual. Further investigation into the information and support preferences of young people who have had a cancer diagnosis is required to establish at what time point within the cancer journey health behavior intervention should be delivered.…”

Attitudes, challenges and needs about diet and physical activity in endometrial cancer survivors: a qualitative study

“…While they often report making health behaviour changes (Demark-Wahnefried et al, 2005), evidence of such changes is limited (Kim et al, 2013, Milliron et al, 2014, Williams et al, 2013b. Compared to survivors of other cancer sites, endometrial and breast cancer survivors have the highest comorbidity burden post-diagnosis (Leach et al, 2014) and gynaecologic (endometrial and ovarian) cancer survivors are less likely to be physically active compared to breast cancer survivors (Weaver et al, 2013).…”