Cancer survivors initiate diet, exercise, and other beneficial lifestyle changes following a cancer diagnosis

An analysis of more than 100 studies of cancer survivors shows that many survivors initiate diet, exercise, and other beneficial lifestyle changes following a cancer diagnosis, but that those who are male, older, and less educated are less likely to adopt such changes. The term "cancer survivor" refers to a person who has been diagnosed with cancer.

The review, which will be published online July 25 in the Journal of Clinical Oncology (JCO), says that a cancer diagnosis often prompts immediate changes in health behavior, including significant modifications in diet and physical activity.

Using the MEDLINE and PubMed databases, lead author Wendy Demark-Wahnefried, PhD, RD, LDN, of Duke University Medical Center, and colleagues from the National Cancer Institute and Brown University identified and reviewed more than 100 studies of cancer survivors published since 1996.

Researchers found that many survivors adopt healthier behaviors, such as following a healthier diet (30-60% of survivors), quitting smoking (46-96% of smokers with tobacco-related cancers, such as lung or head and neck), abstaining from alcohol (47-59% of those with head and neck cancers, which are closely linked to alcohol use), and regular physical activity (with up to 70% of survivors reporting 30 minutes of exercise a day, at least 5 days a week). Many of these changes should be beneficial because cancer survivors are a vulnerable population, at increased risk for second cancers, osteoporosis, obesity, cardiovascular disease, and diabetes.

However, researchers noted that not all cancer patients adopted healthier behaviors, with only 25-42% of survivors consuming adequate amounts of fruits and vegetables, and roughly 70% of breast and prostate cancer survivors remaining overweight or obese. The analysis also found conflicting data on physical activity, as well as smoking status, noting that although survivors with tobacco- or alcohol-related cancers were more likely to reduce or eliminate these behaviors, 20% of survivors continue to smoke, a figure that is not much different from smoking status in the general population (24%).

In addition, researchers found that males, less educated individuals, survivors over age 65, and those who live in urban areas were less likely to initiate or maintain healthy lifestyle changes.

The study also found that while physicians are among the most powerful catalysts for promoting behavior change, only 20% of oncologists provide such guidance because of time constraints, competing treatment or health concerns, and uncertainty regarding the delivery of health behavior messages and their potential impact on a patient's outcome.

An accompanying editorial by Patricia A. Ganz, MD, of the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles, and co-chair of the ASCO Survivorship Task Force, noted that while a recent survey of ASCO members found that the majority of oncologists believe it is their role to provide ongoing medical care, "it is not yet clear how focused that care is on surveillance for cancer recurrence versus health promotion, disease prevention, and monitoring or prevention of late effects."

Dr. Ganz pointed to the transition time at the end of cancer treatment as a "teachable moment" for oncologists as well, adding, "Cancer survivors are looking for important ways to prevent a recurrence of their cancer, and to enhance the quality and length of their lives. Oncologists too are faced with a teachable moment, and have an opportunity to define what care of the cancer survivor should include, and what each survivor can expect after completing their initial curative-intent therapy."

More than 10 million cancer survivors live in the United States today, and an estimated 64% of those diagnosed with cancer can expect to be alive after five years, up from less than 50% in 1971.

"Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer." Wendy Demark-Wahnefried et al, Duke University Medical Center, Durham, NC.

"A Teachable Moment for Oncologists: Cancer Survivors, 10 Million Strong and Growing!" Patricia A. Ganz, Jonsson Comprehensive Cancer Center at University of California Los Angeles, Los Angeles, CA.