Changes In Cancer Survivors Research Articles

Living lab modelling as a pilot study assessing the potential psychological health benefits of forest environment for cancer survivors.

To evaluate the physiological and psychological changes in cancer survivors who engage in repeated forest therapy in a living environment. This study included stay-based forest therapy for female cancer survivors aged ≥40 years. The program was conducted in two cycles, each spanning 3 weeks and consisting of a 2-night, 3-day stay, followed by daily life integration. The cycles were repeated from July 2, 2022, to August 18, 2022. Participant assessment included standard physical health parameters and a questionnaire on general characteristics, lifestyle habits, stress levels, and health status. Thirty-seven female cancer survivors participated in the forest healing program, 56.8% of whom had a history of breast cancer. The median body mass index (BMI) was 23.80 kg/m2 (range, 21.00-25.60). More than half of the patients reported mild-to-moderate fatigue, chronic pain, and mild-to-moderate depression (81%, 65%, and 73%, respectively). After two cycles of forest therapy, no significant differences were observed in terms of fatigue, pain, or BMI levels. However, significant improvements were found in quality of life measures, particularly the psychological quality of life (mean score 12.54 at baseline vs. 13.48 after cycle 2; P=0.007). Positive improvements were also observed in terms of stress (mean score 17.03 vs. 13.76; P=0.002) and depression (mean score 8.35 vs. 6.11; P=0.002) levels. Our forest-healing program demonstrated that nature-based therapies improve the mental health and quality of life of female cancer survivors, suggesting the need for further research on nature-based interventions to better support cancer survivors.

Effects of Resilience and Emotion Regulation on Perceptions of Positive and Negative Life Changes in Cancer Survivors: A Longitudinal Study.

While many studies have investigated the sociodemographic, clinical, and psychosocial factors associated with perceived positive change after cancer, longitudinal work examining how emotion regulation, and resilience impact perceptions of life change among newly diagnosed cancer survivors is lacking. This study examined the prevalence of perceived positive and negative life changes following cancer and explored the role of emotion regulation and resilience on perceived change over 6 months. Data from 534 recent survivors of breast, prostate, or colorectal cancer (Mage = 59.3, 36.5% male) collected at baseline (Time 1) and 6-month follow-up (Time 2) were analyzed. Multivariate linear regressions were estimated separately to examine if resilience or emotion regulation were associated with perceived change at Time 2 after controlling for relevant sociodemographic and psychosocial measures. At both time points, greater than 90% of participants reported at least one perceived positive change while fewer than a third reported a negative change. Indices of emotion regulation and resilience were positively related to perceived positive change at both time points and negatively related to perceived negative change at Time 1. Emotion regulation but not resilience was negatively associated with perceived negative change at Time 2. Findings suggest that cancer survivors who are less resilient and struggle with emotion regulation are more susceptible to perceptions of fewer positive and greater negative life changes after cancer. As such, psychosocial interventions should be developed to promote resilience and emotional regulation in cancer survivors.

Prospective study of dietary changes in cancer survivors for five years including pre- and post- diagnosis compared with those in cancer-free participants

The number of long-term survivors after a cancer diagnosis is increasing. Few investigations have compared survivors’ diets to their original pre-diagnosis dietary pattern or with the patterns of cancer-free controls. We examined the dietary changes in survivors for five years (i.e. before to after diagnosis) in cancer survivors, comparing them with cancer-free controls in a prospective cohort study in Japan. Using 1995–1998 for the baseline and 2000–2003 for the follow-up survey, a validated food frequency questionnaire was administered to 33,643 men and 39,549 women aged 45–74 years. During the follow-up period, 886 men and 646 women had developed cancer. Participants that had not been diagnosed with cancer served as controls. There was a greater decrease in the calorie intake (median change: − 168 kcal/d [Interquartile range: − 640, 278]) in male cancer survivors compared to controls (− 33 kcal/d [− 453, 380], P < .001). On comparison with cancer-free controls, multiple linear regression analysis revealed a significantly larger reduction in energy-adjusted ethanol intake for male cancer survivors (β = − 0.36). There was no difference in changes in fruit and vegetable or red meat intake and no other significant differences in dietary changes between survivors and controls for either gender. This suggests that most dietary changes in survivors after cancer diagnosis are not systematically different from those that occur in people without a cancer diagnosis.

Mindfulness-based interventions and cognitive function in cancer survivors: a systematic review and meta-analysis

Abstract Background: Deterioration in cognitive function is common among cancer survivors undergoing treatment. These problems may persist for several years after completion of treatment and can adversely affect cancer survivors' treatment adherence and quality of life. The cause of cognitive changes in cancer survivors is unclear, although it is likely a complex interaction of disease-related, treatment-related, and psychological factors. Mindfulness-based interventions (MBIs) are one promising intervention for cancer survivors to alleviate unwanted and burdensome side effects, including disruptions in cognitive function. The aim of the current review was to synthesize the literature on MBIs and cognitive function in cancer survivors. Methods: We searched five databases from inception on May 27, 2021 (original search), and May 4, 2022 (updated search): PubMed, MEDLINE Ovid, EMBASE Ovid, PsycInfo Ovid, CINAHL EBSCO, and Web of Science. Articles were screened at the abstract and full-text level by two reviewers. Results: A total of 1916 records were retrieved, and 24 unique studies met the inclusion criteria. There was significant variability across studies regarding type of MBIs investigated, types of cognitive outcome measures used, and study assessment timelines. Eleven studies were included in a meta-analysis of self-reported cognitive function, significantly favoring MBIs over inactive controls (ie, usual care) (standardized mean difference = 0.86; 95% confidence interval = 0.32–1.41). A similar model, including four studies, compared MBIs with active controls (ie, music listening, metacognition treatment, fatigue education and support, walking program); this model also demonstrated a statistically significant pooled effect (standardized mean difference = 0.61; 95% confidence interval = 0.23–0.99). Owing to a small number of studies, meta-analysis could not be completed for objectively assessed cognitive function; a narrative summary for this outcome revealed mixed results. Conclusions: MBIs demonstrated evidence for improving cognitive function among cancer survivors and particularly self-reported cognitive function. However, most studies demonstrated a high risk of bias and significant concerns regarding study quality. Further research is needed to determine the effects of MBIs on both self-reported and objectively assessed cognitive function for cancer survivors, as well as optimal intervention structure and timing.

Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry.

Longitudinal change in patient-reported cognitive complaints (CC) in older adults with cancer is poorly understood. The purpose of this study was to evaluate early longitudinal CC and predictors among older adults with cancer. We examined early CC change on the PROMIS® Short Form4a Cognitive Function among adults ≥ 60years with GI cancer enrolled in the Cancer and Aging Resilience Evaluation (CARE) undergoing geriatric assessment (GA) at baseline and one 3-6-month follow-up. Multivariable linear regression examined associations of demographics, socioeconomics, GA domains, baseline cognitive score, and treatment toxicities on follow-up cognitive score. Bayesian analysis of covariance (ANCOVA) determined best fitting model. A total of 218 participants were included. The median follow-up was 3.7months, the mean age was 69.2 ± 7.1, and 57.3% were male. The most common cancer was colorectal (30.7%) with most stage III/IV (73.7%). About half (51.8%) had stable cognition baseline to follow-up (follow-up t-score ± 5 points of baseline), 20.6% improved (≥ 5 increase), and 27.5% declined (≥ 5 decrease). After adjustment, there were no significant baseline predictors of follow-up cognitive t-score. Baseline t-score was the best-fitting predictor of follow-up t-score. In this first study, examining early change in CC among older adults with cancer, ~ 28% exhibited cognitive decline. Baseline cognition is the most important early predictor of follow-up cognition. Longer follow-up is needed to identify long-term predictors of CC change in cancer survivors. Cognitive decline, even early, may occur in many older adults with cancer. Baseline and regular follow-up assessments of cognitive symptoms are an important component of survivorship care.

Psychosocial Determinants of Lifestyle Change after a Cancer Diagnosis: A Systematic Review of the Literature.

Simple SummaryAlthough cancer survivors may experience health benefits from favorable lifestyle changes, many cancer survivors do not adhere to lifestyle recommendations or make favorable lifestyle changes after cancer diagnosis. This systematic review of the literature aimed to provide an overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. It provides a structured overview of the large variety of determinants of changes in different lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) derived from the 123 included papers (71 quantitative and 52 qualitative). Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors and inform researchers and healthcare professionals about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors.The aim of this study is to provide a systematic overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. Four databases (PubMed, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were searched for relevant papers up to October 2021. Of the 9586 references yielded by the literature search, 123 papers were included: 71 quantitative and 52 qualitative papers. Findings showed a large variety of determinants influencing lifestyle change after cancer diagnosis, with differences between lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) and findings from quantitative vs. qualitative studies. Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors. In addition, findings inform researchers involved in the development of health promotion programs about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors. Favorable lifestyle changes are expected to have beneficial effects on cancer risk and overall health in cancer survivors.

Predicting physical activity change in cancer survivors: an application of the Health Action Process Approach

PurposePrevious research has not examined the utility of the Health Action Process Approach (HAPA) to predict physical activity (PA) change in cancer survivors. The aim of the study was to investigate the efficacy of a HAPA-based model in predicting temporal change in moderate-to-vigorous physical activity (MVPA) in cancer survivors.MethodsParticipants enrolled in the Wearable Activity Technology and Action Planning (WATAAP) trial completed validated questionnaires (n = 64) to assess HAPA constructs (action and maintenance self-efficacy, outcome expectancies, action planning, risk perceptions, and intention) and wore an ActiGraph to measure PA at baseline, 12 weeks, and 24 weeks later. Data were analyzed using variance-based structural equation modeling with residualized change scores for model variables.ResultsConsistent with predictions, changes in action self-efficacy (β = 0.490, p < 0.001, ES = 0.258) and risk perceptions (β = 0.312, p = 0.003, ES = 0.099) were statistically significant predictors of intention change over time. Changes in intention (β = 0.217, p = 0.029, ES = 0.040) and action planning (β = 0.234, p = 0.068, ES = 0.068) predicted changes in MVPA. Overall, the model accounted for significant variance in intention (R2 = 0.380) and MVPA (R2 = 0.228) change.ConclusionsChanges in intention and action planning were important correlates of MVPA change over 24 weeks. Further, changes in action self-efficacy and risk perceptions predicted changes in intention. Implications for cancer survivors: interventions that foster risk perceptions and self-efficacy, strengthen intentions, and promote action planning may be effective in promoting sustained PA change in cancer survivors.

The wearable activity technology and action-planning trial in cancer survivors: Physical activity maintenance post-intervention

ObjectivesThe study objective was to assess whether moderate-to-vigorous intensity physical activity (MVPA) change in cancer survivors (n = 68, mean age = 64 years) was maintained 12-weeks following the Wearable Activity Technology and Action Planning (WATAAP) intervention. Secondary aims were to assess the effects of the intervention on blood pressure (BP) and body mass index (BMI), and to explore group differences between baseline and 24-weeks. DesignRandomized controlled trial. MethodsMVPA and sedentary behaviour were assessed using an accelerometer at baseline, the end of the intervention (12-weeks), and at 24-weeks. Generalised linear mixed models with random effects were used to examine between-group and within-group changes in MVPA, sedentary behaviour, BP and BMI. ResultsMVPA was significantly higher in the intervention group compared with the control group at 24-weeks following adjustment for known confounders (141.4 min/wk. (95% CI = 9.1 to 273.8), p = 0.036). At 24-weeks participants in the intervention group had maintained their increased levels of MVPA (change from 12-weeks = 8.8 min/wk.; 95% CI = −43 to 61; p = 0.74). The reduction in MVPA in the control group over the first 12-weeks was also maintained at 24-weeks (5.4 min/wk.; 95% CI = −3.6 to 4.6; p = 0.80). Secondary outcomes did not differ between groups at 24-weeks. ConclusionsOur results suggest distance-based interventions using wearable technology produce increases in MVPA that endure at least 12-weeks after the intervention is completed.

Effect of a technology-supported physical activity intervention on health-related quality of life, sleep, and processes of behavior change in cancer survivors: A randomized controlled trial.

This pilot trial tested the effect of adding a multi-level, technology-based physical activity intervention module to a standard survivorship care plan for breast and colorectal cancer survivors. The objective of this analysis was to determine whether the physical activity module improved health-related quality of life, sleep, and factors key to lasting behavior change (eg, social support, self-efficacy). Breast and colorectal cancer survivors (n = 50) were enrolled alongside a support partner. Survivors were assigned to receive a standard survivorship care plan either alone or augmented by a 12-week multi-component physical activity module. The module included a Fitbit tracker (with the physical activity data integrated into the electronic health record for clinician review) and customized email feedback. Physical activity was measured using the ActiGraph GT3X+. Psychosocial outcomes included the SF-36, FACT, ISEL, PROMIS sleep measures, and physical activity beliefs. Data were analyzed using linear mixed modeling. Cancer survivors were aged 54.4 ± 11.2 years and were 2.0 ± 1.5 years from diagnosis. Relative to comparison, the intervention was associated with moderate-to-large improvements in physical health (effect size: d = 0.39, 95% CI = 0.0, 0.78), mental health (d = 0.59, 95% CI = 0.19, 0.99), sleep impairment (d = 0.62, 95% CI = -1.02, -0.22), and exercise self-efficacy (d = 0.60, 95% CI = 0.20, 1.0). The intervention delivered meaningful improvements in survivors' quality of life, social support, and sleep impairment. If replicated in a larger sample, adding a technology-supported physical activity module to survivorship care plans may be a practical strategy for supporting healthy survivorship. ClinicalTrials.gov#: NCT02677389.

"To be there for my family" and "Keep my independence": Metropolitan and Non-Metropolitan Cancer Survivors' Health Behaviour Motives.

Cancer survivors are at risk of comorbidities and mortality, and those living outside of metropolitan areas are particularly susceptible given poorer socioeconomic, health and support resources. As engagement in health behaviours is affected by participants' autonomous motives, investigation of the motives of cancer survivors in metropolitan and non-metropolitan areas could elucidate the values and reasons for practising health behaviours, allowing programs to be tailored to these motives. Metropolitan (n = 103) and non-metropolitan (n = 80) Australian cancer survivors completed a survey item by describing their motives for physical activity and healthy diet change. Inductive thematic analysis of responses was performed to establish themes across health behaviour motives. Analyses revealed four themes: to be able to, longevity, psychological health and appearance. Survivors primarily referred to being able to enjoy family, leisure activities, travel and staying independent, with these motives often linked to longevity. Motives were similar across locations; however, those in non-metropolitan locations reported continuation of work and pain relief more frequently. Female survivors more often reported weight loss. A predominant motive for health behaviour change in cancer survivors across geographical location was the ability to enjoy family and engage in leisure and work activities. Programs aiming to promote health behaviours in cancer survivors might consider framing interventions accordingly by emphasizing benefits of longevity and maintaining independence.

Healthy Living After Cancer Treatment: Considerations for Clinical and Community Practice.

As the number of US cancer survivors now reaches almost 16 million, understanding how to care for survivors after cancer treatment has demanded national attention. Increasingly, compelling benefits of lifestyle behaviors for cancer prevention and control have been demonstrated. In particular, physical activity is recommended as a central component of healthy living after cancer treatment. However, survivors struggle to achieve recommended physical activity and other behaviors for reasons that are still not well understood. Further, as greater than 60% of cancer survivors are older than 65 years, there is a unique opportunity to increase engagement of older adults in health programs and clinical trials. This article considers evidence from two reviews: a review on epidemiology studies of lifestyle and cancer and a review on different behavioral intervention strategies to achieve positive behavioral changes in cancer survivors. Both reviews offer important evidence on the role of lifestyle in life after cancer treatment. However, more investigation is needed on the practice of lifestyle medicine for cancer survivors, including ways to extend the reach of health promotion beyond cancer clinics, to primary care and community settings.

Tai Chi Qigong for survivors of breast cancer: a randomised controlled trial

BackgroundBreast cancer is the most common malignancy in Chinese women. Conventional cancer treatments can increase the survival but often cause cardiovascular complications that compromise quality of life. Findings from previous exploratory studies showed that Tai Chi Qigong (TCQ) might induce favourable cardiovascular changes in cancer survivors. We aimed to assess the efficacy of a TCQ programme in improving arterial haemodynamics and quality of life in breast cancer survivors. MethodsIn this single-blinded, randomised controlled trial, 54 Chinese women who survived breast cancer and completed conventional medical care were recruited through a cancer self-help group and a medical clinic in Hong Kong. The participants were randomly allocated to either TCQ or no training (control) using computer-generated random numbers. Participants in the TCQ group attended two 1 h sessions per week for 3 months at the Nature Health Qigong Association (Hong Kong); during these sessions participants practiced the 18 forms of Tai Chi Internal Qigong. Both groups received usual medical care. The primary outcomes were maximum systolic and minimum diastolic arterial blood flow velocities as measured by a Doppler ultrasound machine. The secondary outcomes were oxygen saturation in blood at rest (as measured by an oximeter) and quality of life measured with the Functional Assessment of Cancer Therapy–Breast (FACT-B v4). Data were collected at baseline, post-test, and 3 months (follow-up). Two-way repeated-measures analysis of variance and intention-to-treat analysis were used in data analysis. Ethical approval was obtained from the Human Research Ethics Committee of Hong Kong University. The trial was registered with ClinicalTrials.gov (NCT02420249). Written informed consent was obtained from each participant. FindingsBaseline characteristics were comparable between participants in the TCQ (n=33; mean age 52·7 years, SD 7·5 years) and control group (n=21; mean age 51·5 years, SD 8·2 years). The TCQ and control groups showed similar changes in systolic velocity (group-by-time interaction F2,102=2·118, 95% CI 14·90–18·13; p=0·126; ηp2=0·040) and diastolic velocity (group-by-time interaction2,102=1·375, 95% CI 1·49–2·33; p=0·258; ηp2=0·026). Blood oxygen saturation increased by 0·5% from baseline to follow-up test in the TCQ group (p=0·002, 95% CI −0·78 to −0·19) while no change was noted in the control group (p=0·119, 95%CI −1·03 to 0·13). The FACT-B total score decreased by 23·04 points (24·0%) between baseline and follow up in the control group only (p=0·033, 95% CI 2·12–43·97; TCQ group: p=0·427, 95%CI −8·33 to 19·22). No adverse events were reported. InterpretationThe TCQ programme improved blood oxygenation and quality of life, but it did not improve blood flow velocities in Chinese women who had survived breast cancer. Further studies could examine the mechanisms or causes of the favourable changes. FundingSeed Funding Programme for Basic Research (201410159001), the University of Hong Kong.

The perceptions of Australian oncologists about cognitive changes in cancer survivors.

Cancer-related cognitive changes (CRCC) can have a profound impact on a cancer survivor's quality of life. However, cancer survivors frequently report receiving limited information about their experience of CRCC from their oncology specialists. This qualitative study aimed to explore the perceptions of oncology specialists regarding CRCC and the potential for their views to influence their decisions about patient care. Thirteen medical oncologists and five radiation oncologists currently practising in Australia participated in this study. Data collection involved individual semi-structured interviews via telephone. Data were audio-recorded, transcribed verbatim and analysed using a thematic approach. Four key themes emerged: (1) beliefs about the impact of priming on cancer survivors' perceived cognitive function, (2) perceptions of who is more likely to raise concerns of cognitive change, (3) uncertainty of how to best manage CRCC, and (4) the perceived role of oncologists in the management of CRCC. CRCC and its impact on the cancer survivor's journey have been under-addressed by oncology specialists, and they are uncertain of potential management strategies. With cancer survival rates increasing, there is a need for specific interventions and management guidelines addressing CRCC and their effects on cancer survivors. Future exploration should focus on the survivor as central to their care and holistic approaches to CRCC management involving all members of the multidisciplinary team.

Health behaviors and perceptions of cancer survivors harvesting at an urban garden.

To gather information about perceptions of personal health behavior change in cancer survivors following participation in an urban gardening program. This qualitative study used focus groups of adult cancer survivors with an open-ended question thread format. Data were transcribed and analyzed by identifying, coding, and categorizing primary patterns/themes. Four overarching themes were identified: (1) greater dietary intake of produce; (2) improved mental and physical health; (3) enhanced sense of community and social support; and (4) challenges to long-term maintenance. Perceptions of positive behavior changes associated with harvesting at an urban garden targeting cancer survivors may inform future community and health promotion interventions aimed at improving adherence to evidence-based lifestyle behavior guidelines for cancer survivorship.

Practical clinical interventions for diet, physical activity, and weight control in cancer survivors.

Answer questions and earn CME/CNE The importance of expanding cancer treatment to include the promotion of overall long-term health is emphasized in the Institute of Medicine report on delivering quality oncology care. Weight management, physical activity, and a healthy diet are key components of tertiary prevention but may be areas in which the oncologist and/or the oncology care team may be less familiar. This article reviews current diet and physical activity guidelines, the evidence supporting those recommendations, and provides an overview of practical interventions that have resulted in favorable improvements in lifestyle behavior change in cancer survivors. It also describes current lifestyle practices among cancer survivors and the role of the oncologist in helping cancer patients and survivors embark upon changes in lifestyle behaviors, and it calls for the development of partnerships between oncology providers, primary care providers, and experts in nutrition, exercise science, and behavior change to help positively orient cancer patients toward longer and healthier lives.

Is self-management feasible and acceptable for addressing nutrition and physical activity needs of cancer survivors?

Self-management is recommended for patients with chronic conditions, but its use with cancer survivors is underexplored. Optimal strategies for achieving lifestyle changes in cancer survivors are not known. We aimed to determine feasibility, acceptability and preliminary efficacy of self-management-based nutrition and physical activity interventions for cancer survivors. Adult survivors (n = 25) during (Group 1 , n = 11) or post (Group 2, n = 14)-curative chemotherapy for solid tumours, most (n = 20, 80%) with breast cancer, were recruited prospectively from a single clinical centre. The Flinders Living Well Self-Management Program, a generic self-management care planning programme, was utilized to establish patient-led nutrition and exercise goals within a tailored 12-week intervention. Fortnightly progress reviews occurred with assessments at baseline, 6 and 12 weeks. Most participants (84%) found the intervention acceptable/very acceptable. Both groups showed a trend towards significant improvement in the self-management capability 'knowledge about changing risk factors' (P = 0.047); Group 2 showed a trend towards significantly improved 'psychological impacts' (P = 0.007). Goal ratings improved for both groups (P = 0.001). Quality of life improved for both groups for emotional functioning (P = 0.03). Physical functioning improved for Group 2 (P = 0.05); however, most symptom domains worsened for Group 1, as expected given their treatment stage. Self-management interventions are feasible for this population. In particular, building self-management capacity during the active phase of patients' cancer treatment provides health and psychosocial benefits. Larger randomized controlled trials are required to further determine efficacy. Further translational research is also needed to determine acceptability,feasibility, enablers and barriers for clinicians embedding this approach into routine cancer survivorship care.

The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US.

BackgroundObesity is a risk factor for cancer incidence and survival, but data on patterns of weight change in cancer survivors are scarce and few stratify by pre-diagnosis weight status. In two population-based cohorts of older adults, we examined weight change in cancer survivors and cancer-free controls in relation to baseline weight status.MethodsIn the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), we identified participants diagnosed with cancer who had pre- and post-diagnosis BMI data (ELSA n = 264; HRS n = 2553), and cancer-free controls (ELSA n = 1538; HRS n = 4946). Repeated-measures ANOVAs tested three-way interactions by group (cancer/control), time (pre-/post-diagnosis), and pre-diagnosis weight status (normal-weight/overweight/obese).ResultsMean BMI change was -0.07 (SD = 2.22) in cancer survivors vs. +0.14 (SD = 1.11) in cancer-free controls in ELSA, and -0.20 (SD = 2.84) vs. +0.11 (SD = 0.93) respectively in HRS. Three-way interactions were significant in both cohorts (ELSA p = .015; HRS p < .001). In ELSA, mean BMI change in normal-weight cancer survivors was +0.19 (SD = 1.53) compared with -0.33 (SD = 3.04) in obese survivors. In ELSA controls, the respective figures were +0.09 (SD = 0.81) and +0.16 (SD = 1.50). In HRS, mean change in normal-weight cancer survivors was +0.07 (SD = 2.30) compared with -0.72 (SD = 3.53) in obese survivors. In HRS controls, the respective figures were +0.003 (SD = 0.66) and +0.27 (SD = 1.27).ConclusionOver a four-year period, in two cohorts of older adults, cancer survivors lost weight relative to cancer-free controls. However, cancer survivors who were obese pre-diagnosis were more likely to lose weight than healthy-weight survivors or obese adults without a cancer diagnosis. Whether this was due to differences in clinical status or deliberate lifestyle change triggered by the cancer diagnosis is not known. Further research is needed to establish why weight loss occurs more frequently in cancer survivors who were obese at diagnosis, and whether this has favourable effects on mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-926) contains supplementary material, which is available to authorized users.

Health-related Quality Of Life Change in Cancer Survivors Participating a 12-week YMCA Exercise Program

Health-related Quality Of Life Change in Cancer Survivors Participating a 12-week YMCA Exercise Program

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

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.

Abstract 1356: Promoting dietary change in the care of long term cancer survivors: Perspectives of the clinical care team.

Abstract Improvements in the prognosis of cancer patients attributable to advances in early detection and treatment have resulted in a large number of cancer survivors who are living longer lives. There are approximately 11.7 million cancer survivors in the United States, of whom 64% survive five or more years post-diagnosis. Cancer survivors are at increased risk of cancer recurrence, a second incidence of cancer, development of other chronic diseases, and report poorer health than adults who have not had cancer. Interventions seeking to promote behavior change, such as a healthy diet or regular physical activity, have been proposed as one strategy for improving the health outcomes and quality of life of long-term cancer survivors. Although a physician recommendation has consistently been found to be an important predictor of behavior change, there is limited research exploring current practices for addressing behavior change in the care of post-treatment cancer survivors or on the clinical perceptions of the importance of promoting behavior change. We conducted in-depth, semi-structured interviews with 32 clinicians (e.g., oncologists, primary care providers, nurses, dieticians, social workers) from two clinical settings (one academic and one community) who care for prostate, breast, and/or non-Hodgkin lymphoma cancer survivors. Interview questions focused on how diet is currently addressed in care of cancer survivors and perceptions of the importance of promoting dietary change among cancer survivors. Interviews were audio recorded, transcribed verbatim and analyzed using a constant comparison approach. Varying perspectives were elicited on the relevance of behavior change in caring for cancer survivors by clinician type (e.g., primary care providers compared to oncologists) and cancer type. Among clinicians who believed that promoting a healthy diet was an important component of caring for cancer survivors, some recommended dietary change as a strategy for reducing risk of recurrence, while others recommended it to promote overall health. The majority of clinicians who thought it was important to recommend dietary changes to their patients identified someone else as a more appropriate person to provide details about healthy diet or effective intervention strategies. Oncologists presented both lack of time and lack of expertise as barriers to addressing diet with their patients. Primary care providers (PCPs) were often mentioned as appropriate clinicians to handle dietary concerns, although they too cited similar barriers to care provision. These findings suggest that while many clinicians perceive value in promoting behavior change in cancer survivors, it does not fall neatly within the remit of any core member of the current cancer care team, nor are resources for nutrition expertise easily identified. Intervention strategies should address this gap. Citation Format: Katherine C. Smith, Kisha Coa, Ann C. Klassen, Laura Caulfield, Lillie Shockney, Kathy J. Helzlsouer. Promoting dietary change in the care of long term cancer survivors: Perspectives of the clinical care team. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1356. doi:10.1158/1538-7445.AM2013-1356