Health Related Behavior Change in the Wake of Being Diagnosed with Breast Cancer – the Influence of Depressive Symptoms

Abstract

R Branstrom, L-M Petersson, F Saboonchi, A WennmanLarsen, K Alexanderson Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Red Cross University College, Stockholm, Sweden Stress Research Institute, University of Stockholm, Stockholm, Sweden Sophiahemmet University, Stockholm, Sweden Contact: richard.branstrom@ki.se Background Cancer is a major public health problem. Due to better treatments and early detection, a large proportion of cancer patients survive their initial cancer but are at increased risk of recurrence, a second primary cancer, and other diseases. As the number of survivors and the length of survival after a cancer diagnosis expands, long-term health issues specific to cancer survival are emerging as a public health concern. The time following a cancer diagnosis has been suggested as a ‘teachable moment’ where health promoting behavioral changes are more likely to occur, but the process through which behavior change happens and can be promoted is not well understood. The primary aim of the current study was to examine healthrelated behavior changes, i.e. physical activity, alcohol consumption, and smoking, during the 24 months following breast cancer surgery. The secondary aim was to explore the temporal association between depressive symptoms and health-related behaviors over time. Methods Study participants were women (20–63 years) treated for breast cancer in Stockholm between 2007 and 2009, recruited within eight weeks after surgery. We used a prospective cohort design with baseline assessments and follow-ups at 4, 8, 12, 18, and 24 months. Results The proportion of participants that were physically inactive was fairly stable over time (between 11-14%) but increased slightly at 4 months. The proportion of smokers decreased somewhat over time from 13% to 9%. The proportion of respondents reporting a high level of alcohol consumption (i.e. 9 drinks/week) was consistently low over time, approximately 2%. However, the proportion of respondents reporting binge drinking (i.e. 6 drinks at one occasion) at least monthly decreased from 9% to 4%. To assess the associations between health-related behaviors and depressive symptoms cross-lagged panel analyses were used. Depressive symptoms were negatively related to physical activity and total alcohol consumption over time. Conclusions A substantial proportion of patients participate in health detrimental behaviors after breast cancer treatment. Depression symptoms are a significant predictor of some of these behaviors over time. These results should be considered in future intervention development. Key messages A substantial proportion of patients participate in health detrimental behaviors after breast cancer treatment. Depression symptoms are a significant predictor of some health behaviors over time.