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Do cancer survivors develop healthier lifestyle behaviors than the cancer-free population in the PLCO study?

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Abstract

Background

Current studies report mixed results in health status and health behaviors after a diagnosis of cancer. The aim of our study is to investigate potential differences in lifestyle factors among cancer survivors and cancer-free individuals in a prospective cohort study conducted in the United States.

Methods

Using data from the Prostate, Lung, Colorectal and Ovarian (PLCO) Trial, 10,133 cancer survivors were identified and compared to 81,992 participants without cancer to evaluate differences in body mass index (BMI), smoking, NSAID use, and physical activity.

Results

Cancer survivors, compared to the cancer-free, were significantly less likely to engage in physical activity (odds ratio (OR) = 0.82, 95% CI = 0.77–0.88). Compared to those who were obese at baseline, cancer survivors were more likely to be at normal BMI at follow-up compared to the cancer-free (OR = 1.90, 95% CI = 1.42–2.54). Cancer survivors were less likely to report regular aspirin use as compared to the cancer-free population (OR = 0.86, 95 % CI = 0.82–0.92). Of the current smokers, cancer survivors were more likely to be former smokers at follow-up compared to the cancer-free (OR = 1.50, 95% CI = 1.30–1.74).

Conclusion

Upon stratification by baseline health markers, cancer survivors practice healthier lifestyle habits such as smoking cessation and maintenance of a healthy weight. However, cancer survivors are less likely to be physically active as compared to cancer-free individuals, regardless of baseline practices.

Implications for cancer survivors

For cancer survivors who reported poor health status and behaviors at baseline, a cancer diagnosis may encourage the practice of healthier lifestyle behaviors.

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References

  1. Underwood JM, Townsend JS, Stewart SL, Buchannan N, Ekwueme DU, Hawkins NA, et al. Surveillance of demographic characteristics and health behaviors among adult cancer survivors--behavioral risk factor surveillance system, United States, 2009. MMWR Surveill Summ. 2012;61(1):1–23.

  2. American Cancer Society. Cancer statistics, 2015. CA Cancer J Clin [Internet] Atlanta. 2015;65(1):5–29.

    Article  Google Scholar 

  3. DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA cancer J Clin [internet]. Atlanta. 2014;64(4):252–71.

    Google Scholar 

  4. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin [Internet]. 2012;62(4):242–74. Available from: http://doi.wiley.com/10.3322/caac.21142

    Article  Google Scholar 

  5. Mayer DK, Terrin NC, Menon U, Kreps GL, McCance K, Parsons SK, et al. Health behaviors in cancer survivors. Oncol Nurs Forum. 2007;34(3):643–51.

    Article  PubMed  Google Scholar 

  6. Buchanan ND, King JB, Rodriguez JL, White A, Trivers KF, Forsythe LP, et al. Changes among US cancer survivors: comparing demographic, diagnostic, and health care findings from the 1992 and 2010 National Health Interview Surveys. ISRN Oncol. 2013;2013(4):1–9.

  7. Low CA, Beckjord E, Bovbjerg DH, Dew MA, Posluszny DM, Schmidt JE, et al. Correlates of positive health behaviors in cancer survivors: results from the 2010 LIVESTRONG survey. J Psychosoc Oncol [Internet]. 2014;32(6):678–95. Available from: http://www.tandfonline.com/doi/abs/10.1080/07347332.2014.955243

    Article  Google Scholar 

  8. Beckjord EB, Reynolds KA, van Londen GJ, Burns R, Singh R, Arvey SR, et al. Population-level trends in post-treatment cancer survivors’ concerns and associated receipt of care: results from the 2006 and 2010 LIVESTRONG surveys. J Psychosoc Oncol [Internet]. 2013;32(2):125–51.

    Article  Google Scholar 

  9. Eakin EG, Youlden DR, Baade PD, Lawler SP, Reeves MM, Heyworth JS, et al. Health behaviors of cancer survivors: data from an Australian population-based survey. Cancer Causes Control. 2007;18(8):881–94.

    Article  PubMed  Google Scholar 

  10. Mosher CE, Lipkus I, Sloane R, Snyder DC, Lobach DF, Demark-Wahnefried W. Long-term outcomes of the FRESH START trial: exploring the role of self-efficacy in cancer survivors’ maintenance of dietary practices and physical activity. Psychooncology [Internet]. 2013 Apr;22(4):876–85. doi:10.1002/pon.3089.

    Article  PubMed  Google Scholar 

  11. Karlsen RV, Bidstrup PE, Christensen J, Larsen SB, Tjønneland A, Dalton SO, et al. Men with cancer change their health behaviour: a prospective study from the Danish diet, cancer and health study. Br J Cancer [Internet]. 2012;107(1):201–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3389426&tool=pmcentrez&rendertype=abstract

    Article  CAS  Google Scholar 

  12. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA Cancer J Clin. 2012;62(1):30–67.

  13. Carmack CL, Basen-Engquist K, Gritz ER. Survivors at higher risk for adverse late outcomes due to psychosocial and behavioral risk factors. Cancer Epidemiol Biomark Prev. 2011;20(10):2068–77.

    Article  Google Scholar 

  14. Demark-Wahnefried W, Jones LW. Promoting a healthy lifestyle among cancer survivors. Hematol Oncol Clin North Am. 2008;22(2):319–42.

  15. Blanchard CM, Courneya KS, Stein K. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol. 2008;26(13):2198–204.

  16. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;8(8):CD007566.

  17. Koutoukidis DA, Knobf MT, Lanceley A. Obesity, diet, physical activity, and health-related quality of life in endometrial cancer survivors. Nutr Rev [Internet]. 2015;73(6):399–408. Available from: http://nutritionreviews.oxfordjournals.org/cgi/doi/10.1093/nutrit/nuu063

    Article  Google Scholar 

  18. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23(34):8884–93.

    Article  PubMed  Google Scholar 

  19. Yang B, Jacobs EJ, Gapstur SM, Stevens V, Campbell PT. Active smoking and mortality among colorectal cancer survivors: the cancer prevention study II nutrition cohort. J Clin Oncol. 2015;33(8):885–93.

    Article  PubMed  Google Scholar 

  20. Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol. 2015;54(5):635–54.

  21. Holmes MD, Chen WY, Li L, Hertzmark E, Spiegelman D, Hankinson SE. Aspirin intake and survival after breast cancer. J Clin Oncol. 2010;28(9):1467–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Chan AT, Ogino S, Fuchs CS. Aspirin use and survival after diagnosis of colorectal cancer. JAMA. 2009;302(6):649–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. LeMasters TJ, Madhavan SS, Sambamoorthi U, Kurian S. Health behaviors among breast, prostate, and colorectal cancer survivors: a US population-based case-control study, with comparisons by cancer type and gender. J Cancer Surviv. 2014;8(3):336–48.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bidstrup PE, Dalton SO, Christensen J, Tjonneland A, Larsen SB, Karlsen R, et al. Changes in body mass index and alcohol and tobacco consumption among breast cancer survivors and cancer-free women: a prospective study in the Danish diet, cancer and health cohort. Acta Oncol. 2013;52(2):327–35.

  25. Williams K, Steptoe A, Wardle J. Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study. Br J Cancer. 2013;108(11):2407–12.

  26. Gohagan JK, Prorok PC, Hayes RB, Kramer BS. The prostate, lung, colorectal and ovarian (PLCO) cancer screening trial of the National Cancer Institute: history, organization, and status. Control Clin Trials. 2000;21(6 Suppl):251S–72S.

    Article  CAS  PubMed  Google Scholar 

  27. Bazzi L, Lamerato EL, Varner J, Shambaugh V, Cordes JE, Ragard LR' et al. Lessons in medical record abstraction from the prostate, lung, colorectal, and ovarian (PLCO) national screening trial. Rev Recent Clin Trials. 2015;10(3):200–5.

  28. US. Bureau of the Census. Real Median Household income in the United States [MEHOINUSA672N] [Internet]. FRED, Federal Reserve Bank of St. Louis. 2016 [cited 2016 Feb 23].

  29. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing [Internet]. J R Stat Soc. Series B (Methodological). 1995. p. 289–300.

  30. Lee I-M, Shiroma JE, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Impact of physical inactivity on the World’s major non-communicable diseases. Lancet. 2012;380(9838):219–29.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bauer UE, Briss PA, Goodman R A, Bowman BA. Prevention of chronic disease in the twenty-first century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet. 2014;384(9937):45–52.

    Article  PubMed  Google Scholar 

  32. De Leon SF, Shih SC. Tracking the delivery of prevention-oriented care among primary care providers who have adopted electronic health records. J Am Med Informatics Assoc. 2011;18(Supplement 1):i91–5.

  33. Hennekens CH, Sechenova O, Hollar D, Serebruany VL. Dose of aspirin in the treatment and prevention of cardiovascular disease: current and future directions. J Cardiovasc Pharmacol Ther. 2006;11(3):170–6.

    Article  CAS  PubMed  Google Scholar 

  34. Berry NM, Miller MD, Woodman RJ, Coveney J, Dollman J, Mackenzie CR, et al. Differences in chronic conditions and lifestyle behaviour between people with a history of cancer and matched controls. Med J Aust. 2014;201(2):96–100.

    Article  PubMed  Google Scholar 

  35. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.

    Article  CAS  PubMed  Google Scholar 

  36. Kim RB, Phillips A, Herrick K, Helou M, Rafie C, Anscher MS, et al. Physical activity and sedentary behavior of cancer survivors and non-cancer individuals: results from a National Survey. PLoS One. 2013;8(3):9–11.

    Google Scholar 

  37. Kwan ML, Sternfeld B, Ergas IJ, Timperi AW, Roh JM, Hong C-C, et al. Change in physical activity during active treatment in a prospective study of breast cancer survivors. Breast Cancer Res Treat. 2012;131(2):679–90.

    Article  PubMed  Google Scholar 

  38. Buffart LM, Thong MSY, Schep G, Chinapaw MJM, Brug J, de Poll-Franse LV v. Self-reported physical activity: its correlates and relationship with health-related quality of life in a large cohort of colorectal cancer survivors. Lucia a, editor. PLoS One [Internet]. 2012;7(5):e36164. Available from: http://dx.plos.org/10.1371/journal.pone.0036164

    Article  CAS  Google Scholar 

  39. Prue G, Rankin J, Allen J, Gracey J, Cramp F, appraisal C-r f: A c. Eur J Cancer. 2006;42(7):846–63.

    Article  CAS  PubMed  Google Scholar 

  40. Denlinger CS, Ligibel JA, Are M, Baker KS, Demark-Wahnefried W, Friedman DL, et al. Survivorship: fatigue, version 1.2014. J Natl Compr Canc Netw. 2014;12(6):876–87.

    PubMed  PubMed Central  Google Scholar 

  41. Brown JC, Harhay MO, Harhay MN. The prognostic importance of frailty in cancer survivors. J Am Geriatr Soc [Internet]. 2015;63(12):2538–43.

    Article  Google Scholar 

  42. Blaney JM, Lowe-Strong A, Rankin-Watt J, Campbell A, Gracey JH. Cancer survivors’ exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey. Psychooncology [Internet]. 2013;22:186–94. Available from: http://eprints.ulster.ac.uk/11010/1/Janine_survey_paper.pdf

    Article  CAS  Google Scholar 

  43. Jackson SE, Williams K, Steptoe A, Wardle J. The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US. BMC Cancer. 2014;14(1):926.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol Elsevier Ltd; 2011;12(5):489–495.

  45. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. Jama. 2014;311(8):806–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Westmaas JL, Newton CC, Stevens VL, Flanders WD, Gapstur SM, Jacobs EJ. Does a recent cancer diagnosis predict smoking cessation? An analysis from a large prospective US cohort. J Clin Oncol. 2015;33(15):1647–52.

    Article  PubMed  Google Scholar 

  47. Bassett JC, Gore JL, Chi AC, Kwan L, McCarthy W, Chamie K, et al. Impact of a bladder cancer diagnosis on smoking behavior. J Clin Oncol. 2012;30(15):1871–8.

    Article  PubMed  Google Scholar 

  48. Macfarlane TV., Murchie P, Watson MC. Aspirin and other non-steroidal anti-inflammatory drug prescriptions and survival after the diagnosis of head and neck and oesophageal cancer. Cancer Epidemiol. 2015;39(6):1015–1022.

  49. Hua X, Adams S, Phipps A, Cohen S, Burnett-Hartman A, Hardikar S, et al. Pre- and post-diagnostic non-steroidal anti-inflammatory drug use and colorectal cancer survival in Seattle Colon cancer family registry. Cancer Epidemiol Biomarkers Prev 2016;25(3):559–559.

  50. Huang XZ, Gao P, Sun JX, Song YX, Tsai CC, Liu J, et al. Aspirin and nonsteroidal anti-inflammatory drugs after but not before diagnosis are associated with improved breast cancer survival: a meta-analysis. Cancer Causes Control. 2015;26(4):589–600.

    Article  PubMed  Google Scholar 

  51. Freid VM, Bernstein AB, Bush MA. Multiple chronic conditions among adults aged 45 and over: trends over the past 10 years. NCHS Data Brief. 2012;(100):1–8.

  52. McCowan C, Munro AJ, Donnan PT, Steele RJC. Use of aspirin post-diagnosis in a cohort of patients with colorectal cancer and its association with all-cause and colorectal cancer specific mortality. Eur J Cancer. 2013;49(5):1049–57.

    Article  CAS  PubMed  Google Scholar 

  53. Young A, Weltzien E, Kwan M, Castillo A, Caan B, Kroenke CH. Pre- to post-diagnosis weight change and associations with physical functional limitations in breast cancer survivors. J Cancer Surviv. 2014;8(4):539–47.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Elwood PC, Morgan G, Pickering JE, Galante J, Weightman AL, Morris D, et al. Aspirin in the treatment of cancer: reductions in metastatic spread and in mortality: a systematic review and meta-analyses of published studies. PLoS One. 2016;11(4):e0152402.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Prorok PC, Andriole GL, Bresalier RS, Buys SS, Chia D, Crawford ED, et al. Design of the Prostate, lung, colorectal and ovarian (PLCO) cancer screening trial. Control Clin Trials. 2000;21(6 Suppl):273S–309S.

    Article  CAS  PubMed  Google Scholar 

  56. Hattori A, Sturm R. The obesity epidemic and changes in self-report biases in BMI. Obesity. 2013;21(4):856–60.

  57. Prince S, Adamo K, Hamel M, Hardt J, Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.

    Article  PubMed  PubMed Central  Google Scholar 

  58. American Society of Clinical Oncology. Providing High Quality Survivorship Care in Practice: An ASCO Guide. Am Soc Clin Oncol. 2014

  59. Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv. 2015;9(2):305–38.

    Article  PubMed  Google Scholar 

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Acknowledgments

A special thanks to the National Cancer Institute for granting access to the data collected by the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

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Authors and Affiliations

  1. Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA

    Makenzie L. Hawkins, Anne C. Kirchhoff & Mia Hashibe

  2. Division of Public Health, Department of Family and Preventive Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA

    Makenzie L. Hawkins, Lisa H. Gren, Sara E. Simonsen & Mia Hashibe

  3. Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Saundra S. Buys

  4. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    Anne C. Kirchhoff

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  1. Makenzie L. Hawkins
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Correspondence to Mia Hashibe.

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Funding

NCI Extramural Program (DCP) and NCI Intramural Program (DCEG). DCP provided funding for the trial and biospecimen collection, and DCEG provided funding for biospecimen storage. This work was supported by contracts from the Division of Cancer Prevention, National Cancer Institute, NIH, DHHS under Award Number N01-CN-25524 and by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001067.

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hawkins, M.L., Buys, S.S., Gren, L.H. et al. Do cancer survivors develop healthier lifestyle behaviors than the cancer-free population in the PLCO study?. J Cancer Surviv 11, 233–245 (2017). https://doi.org/10.1007/s11764-016-0581-0

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  • DOI: https://doi.org/10.1007/s11764-016-0581-0

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