Health Behaviors Of Survivors Research Articles

Associations between perceived cancer impact and measures of health behavior in survivors of childhood cancer.

Perceived cancer impact (PCI) is the degree to which one feels cancer has impacted one's life. It is unknown if PCI is associated with health behaviors. The aim of this study is to determine associations between PCI and health behaviors in childhood cancer survivors. Participants were ≥ 5-year survivors enrolled in the St. Jude Lifetime (SJLIFE) cohort. The Brief Cancer Impact (BCIA) assessed PCI across four domains (caregiving/finances, diet/exercise, social/emotional functioning, religiosity). Responses were categorized as negative, neutral, or positive impact. Smoking, risky drinking, illicit drug use, and diet quality data were obtained via self-report. Physical activity (PA) was assessed via self-report and actigraphy. Cross-sectional and longitudinal associations between PCI and health behaviors were evaluated via multivariable logistic regression. A total of 3623 participants (mean age 30.4 ± 8.3years, 49.6% female, 81.5% NH White) were included in baseline cross-sectional analysis; 1709 had a second visit 5.0 ± 1.4years later and were included in longitudinal analysis. At baseline, the percentage of participants who endorsed cancer as having a negative impact on caregiving/finances was 37.5%, diet/exercise 30.5%, social/emotional functioning 40.6%, and religiosity 8.7%. Negative and neutral PCI across all four domains were cross-sectionally associated with all behaviors except illicit drug use. Negative and neutral PCI at the first time point across all four domains were associated with smoking, diet quality, and PA (ORs ranging from 1.35 to 2.41) in longitudinal analyses. Endorsing negative or neutral PCI is associated with adverse health behaviors. Promoting optimal health behavior should include addressing PCI.

Psychological Symptoms, Social Outcomes, Socioeconomic Attainment, and Health Behaviors Among Survivors of Childhood Cancer: Current State of the Literature.

The diagnosis, treatment, and medical late effects of childhood cancer may alter the psychosocial trajectory of survivors across their life course. This review of the literature focuses on mental health symptoms, achievement of social milestones, socioeconomic attainment, and risky health behaviors in survivors of childhood cancer. Results suggest that although most survivors are psychologically well adjusted, survivors are at risk for anxiety and depression compared with siblings. Although the absolute risk of suicide ideation and post-traumatic stress symptoms is low, adult survivors are at increased risk compared with controls. Moreover, young adult survivors are at risk for delayed psychosexual development, lower rates of marriage or cohabitation, and nonindependent living. Survivors' socioeconomic attainment also is reduced, with fewer survivors graduating college and gaining full-time employment. Despite risk for late health-related complications, survivors of childhood cancer generally engage in risky health behaviors at rates similar to or only slightly lower than siblings and peers. CNS tumors and CNS-directed therapies are salient risk factors for poor psychosocial outcomes. In addition, physical health morbidities resulting from cancer-directed therapies are associated with worse psychosocial functioning. Several studies support the effectiveness of cognitive and behavioral interventions to treat psychological symptoms as well as to modify health behaviors. Additional randomized controlled trials are needed to evaluate the efficacy and long-term outcomes of intervention efforts. Future research should focus on the identification of potential genetic predispositions related to psychosocial outcomes to provide opportunities for preventive interventions among survivors of childhood cancer.

Quality-of-Life and Health Behaviors in Survivors of Acute Leukemia Compared with the General Population: A Population-Based Matched Case-Control Study

IntroductionAlthough most of the studies about health related quality of life (HRQoL) focuses on acute leukemia survivors, few studies compared the HRQoL in acute leukemia survivors with that of the general population. The objective of the present study was to evaluate the HRQoL of acute leukemia survivors in a case-control study using The Sixth Korean National Health and Nutrition Examination Survey (KNHANES VI).MethodWe enrolled 149 acute leukemia survivors from three Korean tertiary care centers from 1983 through 2014. Survivors completed a set of questionnaires which included the EuroQOL five dimensions questionnaire (EQ-5D), the EORTC Quality of Life Core Questionnaire (QLQ-C30), Brief Fatigue Inventory (BFI), Hospital Anxiety and Depression Scale for Korean (HADS-K), Brief Encounter Psychosocial Instrument (BEPSI), Abbreviated Dyadic Adjustment Score (ADAS), and Family APGAR. We identified 447 control subjects matched for age, sex, education status, marital status, and presence of any comorbidity from KNHANES VI database. The scores for EQ-5D and health behaviors regarding rate of smoking, drinking, health medical examination, cancer screening, and vaccination were compared with the general population. Other survey results including EORTC QLQ-C30 were analyzed among the leukemia survivors, to evaluate the impact on QoL of postremission treatment strategy (SCT or chemotherapy). We compared the adjusted QoL mean across groups by analysis of covariance.ResultMedian age of the study participants was 44 years (range, 16 - 78), and there were 75 men (50%) and 74 women (50%). Majority of the patients had acute myeloid leukemia (n = 121); others had acute lymphoblastic leukemia (n = 24) and acute biphenotypic leukemia (n = 4). Among the survivors, 93 received chemotherapy and 56 received SCT as postremission treatment. Median duration of time between treatment completion and the study survey was 59 months.Examination of each of the five dimensions of the EQ-5D showed that the acute leukemia survivor group was having more difficulties or problems compared with the general population. More than twice as many respondents with leukemia survivors reported having problems with usual activities (14.6% vs. 4.6%, p < 0.001), and anxiety or depression (23.6% vs. 9.1%, p < 0.001). Furthermore, a significant proportion of patients reported pain compared with their matched population (34.7% vs. 20.3%, p= 0.002).Among the survivors, SCT group had clinically significantly worse problems with role functioning, fatigue, and insomnia than chemotherapy group, measured by the QLQ-C30. SCT group also had statistically significantly worse problems with global health status/QoL, physical and emotional functioning, pain, dyspnea, and appetite loss. Depression was higher in the SCT patients compared with the chemotherapy patients (mean HADS-depression score 4.99 vs. 6.56, p= 0.024). There was no difference in the HADS-anxiety score, BFI, BEPSI, dyadic adjustment and family function between the subgroups.In terms of health behaviors, acute leukemia survivor group had lower rate of smoking (5.6% vs. 25.3%, p < 0.001) and drinking in recent 1 year (41.7% vs. 76.7%, p < 0.001), and higher rate of influenza vaccination (63.6% vs. 35.4%, p < 0.001). Only 17% of the leukemia survivors reported that they had been recommended to receive screening for other cancers from health care providers, and 27% and 40% reported that they thought they had lower risk and similar risk of other cancer than general population. However, this lack of a recommendation for second cancer screening and the misperception of second cancer risk did not have negative impact on cancer screening behaviors (cancer screening in recent 2 years, 45.9% for survivor group vs. 52.3% general population, p = 0.175; health examination, 61.0% vs. 63.2% for, p= 0.632).ConclusionThese results indicate that, compared to the general population, survivors of acute leukemia have a significantly worse long-term impact on QoL. Moreover, patients who received SCT for postremission treatment had poorer QoL than those treated with chemotherapy. Health behaviors were comparable between the survivors and the general population. These results can increase the awareness of healthcare providers to the need for counseling and interventions among acute leukemia survivors and help them improve their impaired QOL. DisclosuresYun:Janssen: Research Funding.

Health behaviors in survivors of aggressive NHL.

236 Background: Patients (pts) with aggressive lymphoma are generally treated with curative intent and many become long-term survivors. There is little data on health behaviors after lymphoma diagnosis and their effect on QOL and long-term outcomes. Methods: Lymphoma pts were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource (MER) and systematically followed. We measured QOL (FACT-G) and health behaviors (tobacco/alcohol use; diet/exercise habits) 3 years after diagnosis. For this study, “survivor” was defined as alive at 3 years from diagnosis with no active disease or treatment within the previous year. Results: From 2002-2012, 671 patients with aggressive lymphoma were enrolled, met survivor definition, and completed 3-year QOL and health behavior questionnaires. At 3-years, 31% of female (F) and 48% of male (M) reported a history of tobacco use for 6+ months. Of these, 13% of F and 7% of M were still smoking; 52% reported decreased use from baseline. 66% reported no change in alcohol intake at 3-years while 25% of F and 34% of M reported decreased intake. 60% often chose whole grains and 65% get 2+ servings of vegetables daily. 42% of F and 38% of M “somewhat” believed diet could change the course of their lymphoma. Most pts endorsed no significant change in diet as a result of diagnosis. Those who made changes did so primarily out of concern for “health problems other than cancer”. Overweight/obese responders were 72% pre- and 66% post-treatment. A desire to lose weight was reported by 55% of pts. 14% of F and 23% of M often engaged in regular physical activity (PA). Nearly 50% reported a decrease in PA. Pts with advanced stage (p = 0.006), age &gt; 60 (p = 0.001), ECOG PS &gt; 2 (p = 0.04), and worse prognostic score (p = 0.006) were more likely to report decreased PA since diagnosis. 68% of F and 61% of M intend to become more active in the next months. Regular PA (p = &lt; 0.0001) was associated with higher QOL, while increased alcohol intake was associated with lower QOL (p = 0.009) at 3 years. Conclusions: Many survivors of aggressive NHL strive to adopt healthy behaviors and these behaviors are associated with higher QOL. Interventions aimed at emphasizing these behaviors may have potential to improve long-term outcomes and QOL.

Health behaviors in family members of patients completing cancer treatment.

To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change. Descriptive, cross-sectional, correlational. A National Cancer Institute-designated comprehensive cancer center in the midwestern United States. 39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment. Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone. Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness. Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors. Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition. Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.

An Enduring Somatic Threat Model of Posttraumatic Stress Disorder Due to Acute Life-Threatening Medical Events.

Posttraumatic stress disorder (PTSD) occurs in 12-25% of survivors of acute life-threatening medical events such as heart attack, stroke, and cancer, and is associated with recurrence of cardiac events and mortality in heart attack survivors. This article reviews the current state of knowledge about PTSD after such events, and proposes an Enduring Somatic Threat (EST) model of PTSD due to acute life-threatening medical events to address underappreciated differences between PTSD due to past, discrete/external traumatic events (such as combat) and PTSD due to acute manifestations of chronic disease that are enduring/internal in nature (such as heart attack and stroke). The differences include the external versus internal/somatic source of the threat, the past versus present/future temporal focus of threatening cognitions, the different types and consequences of avoidance behavior, and the different character and consequences of hyperarousal. Although important differences between the two types of PTSD exist, the EST model proposes that the underlying fear of mortality maintains PTSD symptoms due to both discrete/external and ongoing/somatic events. Finally, this article offers a research agenda for testing the EST model, with a particular focus on areas that may improve cardiovascular prognosis and health behaviors in survivors of heart attack and stroke.

Commentary: Understanding Risk Behavior Among Adolescent Cancer Survivors--Are They More Like Healthy Adolescents or is Cancer a Teachable Moment? A Commentary on Klosky and Colleagues' Article on Health Behaviors in Survivors of Childhood Cancer and Their Siblings

Commentary: Understanding Risk Behavior Among Adolescent Cancer Survivors--Are They More Like Healthy Adolescents or is Cancer a Teachable Moment? A Commentary on Klosky and Colleagues' Article on Health Behaviors in Survivors of Childhood Cancer and Their Siblings

Testis cancer survivors' health behaviors: comparison with age-matched relative and demographically matched population controls.

To determine the prevalence rate of health behaviors in testis cancer survivors and to determine whether the rate of health behaviors in survivors was significantly different than those of their age-matched relative controls and a population-based control group matched for age, sex, education, and income. The health behaviors of 162 testis cancer survivors were compared with their age-matched relative controls (n = 74) and an age-, sex-, education-, and income-matched population-based control group (n ranged from 1,123 to 9,775). Health behaviors were assessed with the telephone-administered Behavioral Risk Factor and Surveillance Survey. Nearly one in five testis cancer survivors reported current smoking and one third reported problem drinking. Only 11% reported having at least five servings of fruits and vegetables per day. Compared with their relative controls, the survivors were more likely to engage in regular exercise. For those participants who drank, survivors were twice as likely to engage in problem drinking and averaged a higher number of drinks compared to their Centers for Disease Control (CDC) controls. Survivors were also half as likely to have at least five servings of fruits and vegetables per day compared with the CDC controls. The overall picture regarding testis cancer survivors' health behaviors was mixed compared with the relative and CDC control groups. Our results suggest that reduced alcohol use and increased fruit and vegetable consumption may be important targets for future disease prevention in testis cancer survivors.

Health Behaviors and Depressive Symptoms in Testicular Cancer Survivors

Testicular cancer has one of the highest 5-year survival rates of all cancer sites. The survival period is marked by an increased risk of secondary cancer and cardiovascular events owing to treatment-related toxicities. The purposes of this cross-sectional study were to determine the prevalence of health behaviors and depressive symptoms and to assess the relationship between depression and health behaviors in survivors of testicular cancer. A total of 162 survivors of testicular cancer 2 to 10 years after their diagnosis completed a one-time telephone interview. The interview included a battery of questions from the Behavioral Risk Factor Surveillance System assessing health behaviors (smoking, physical activity, cholesterol screening, colorectal cancer screening, alcohol consumption, and fruit and vegetable intake) and the Centers for Epidemiological Studies-Depression (CES-D) questionnaire assessing depressive symptoms. The interviews revealed a low prevalence of positive health behaviors among survivors of testicular cancer. The percentage (17.5%) of survivors of testicular cancer who scored above the cutoff on the CES-D was greater than that (11%) of large-scale population-based estimates in men aged 19 to 44 years. Smoking was significantly related to depression. Depressive symptoms (CES-D score) differed significantly depending on smoking status (current smokers, mean = 15.2; former smokers, mean = 6.2, P <0.001; and never smokers, mean = 8.7, P <0.001). Given the increased risk of cancer and treatment-related morbidities of these survivors, the findings of this study suggest that healthcare professionals should encourage survivors of testicular cancer to engage in positive health behaviors and check for depressive symptoms.