Skip to main content
SpringerLink
Log in

Health behaviors and patient–practitioner communication in cancer patients and the general population: an analysis of the National Health and Nutrition Examination Survey (NHANES) 2005–2014

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study was to investigate the prevalence of poor health behaviors (low dietary quality, low physical activity (PA), and high body mass index (BMI)) in cancer patients and the general population and its relationship with receipt of patient–physician recommendations.

Methods

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005–2014 to compare 1846 patients with a history of cancer to 16,641 with no cancer history. BMI was measured during physical exam. Dietary quality and PA were obtained from a questionnaire, along with receipt of physician recommendations for each behavior.

Results

Cancer patients had dietary quality that “needs improvement,” were not meeting PA recommendations, and were overweight. Compared to the general population, dietary quality (54 vs. 54, p = .80), prevalence of physical inactivity (34% vs. 31%, p = .01), and BMI (28 vs. 28, p < .01) were similar. Among cancer patients, prevalence of physician recommendations to improve dietary quality (33.5%), increase PA or exercise (47.7%), and lose or control weight (32.1%) were low. Physicians recommended health behavior change to cancer patients more frequently than the general population (p < .01). Overweight and physically inactive cancer patients were more likely to receive physician recommendations (ps < .01). Physician recommendations were not associated with dietary quality (p = .65).

Conclusions

Prevalence of poor diet, physical inactivity, and obesity is high in both populations with less than 50% of patients receiving physician health behavior recommendations. These findings underscore the need for increased frequency and efficacy of patient–physician health behavior recommendations, especially in cancer patients, to improve patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data are included as supplementary material.

References

  1. Heron M (2019) Deaths: leading causes for 2017. Natl Vital Stat Rep 68(6):1–76 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18092547

    PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69(1):7–34

    Article  Google Scholar 

  3. American Cancer Society (2019) Cancer facts & figures 2019. American Cancer Society. Atlanta. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf

  4. Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ, McCullough M, Patel AV, Ma J, Soerjomataram I, Flanders WD, Brawley OW, Gapstur SM, Jemal A (2018) Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin 68(1):31–54

    Article  Google Scholar 

  5. Blanchard CM, Courneya KS, Stein K (2008) 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 26(13):2198–2204

  6. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, Holick CN, Hampton JM, Stampfer MJ, Willett WC, Newcomb PA (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomark Prev 18(5):1403–1409

    Article  Google Scholar 

  7. Borch KB, Braaten T, Lund E, Weiderpass E (2015) Physical activity before and after breast cancer diagnosis and survival - the Norwegian women and cancer cohort study. BMC Cancer 15(967):1–10. Available from:. https://doi.org/10.1186/s12885-015-1971-9

    Article  Google Scholar 

  8. Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123(3):627–635

    Article  Google Scholar 

  9. Playdon MC, Bracken MB, Sanft TB, Ligibel JA, Harrigan M, Irwin ML (2015) Weight gain after breast cancer diagnosis and all-cause mortality: systematic review and meta-analysis. J Natl Cancer Inst 107(12):djv275

    Article  Google Scholar 

  10. Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomark Prev 14(8):2009–2014

    Article  Google Scholar 

  11. Ibrahim EM, Al-Homaidh A (2011) Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol 28(3):753–765

    Article  Google Scholar 

  12. Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ, Baron JA, Egan KM, Willett WC (2008) Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomark Prev 17(2):379–386

    Article  Google Scholar 

  13. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA (2005) Physical activity and survival after breast cancer diagnosis. J Am Med Assoociation 293(20):2479–2486 Available from: http://jama.jamanetwork.com/article.aspx?articleid=200955

  14. Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, al-Delaimy WK, Thomson CA, Kealey S, Hajek R, Parker BA, Newman VA, Caan B, Rock CL (2007) Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 25(17):2345–2351

  15. Deshmukh AA, Shirvani SM, Likhacheva A, Chhatwal, Chiao EY, Sonawane K (2018) The association between dietary quality and overall and cancer-specific mortality among cancer survivors, NHANES III. JNCI J Natl Cancer Inst pky022:1–4

    Google Scholar 

  16. Schwingshackl L, Bogensberger B, Hoffmann G (2018) Diet quality as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: an updated systematic review and meta-analysis of cohort studies. J Acad Nutr Diet 118(1):74–100.e11. Available from:. https://doi.org/10.1016/j.jand.2017.08.024

    Article  PubMed  Google Scholar 

  17. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348(17):1625–1638

    Article  Google Scholar 

  18. Chlebowski RT, Aragaki AK, Anderson GL, Thomson CA, Manson JAE, Simon MS, Howard BV, Rohan TE, Snetselar L, Lane D, Barrington W, Vitolins MZ, Womack C, Qi L, Hou L, Thomas F, Prentice RL (2017) Low-fat dietary pattern and breast cancer mortality in the Women’s Health Initiative randomized controlled trial. J Clin Oncol 35(25):2919–2926

    Article  CAS  Google Scholar 

  19. Chlebowski RT, Aragaki AK, Anderson GL, Pan K, Neuhouser ML, Manson JE et al (2020) Dietary modification and breast cancer mortality: long-term follow-up of the Women’s Health Initiative randomized trial. J Clin Oncol 38(13):1419–1428

    Article  Google Scholar 

  20. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):242–274

    Article  Google Scholar 

  21. Van Blarigan EL, Fuchs CS, Niedzwiecki D, Zhang S, Saltz LB, Mayer RJ et al (2018) Association of survival with adherence to the American Cancer Society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis the calgb 89803/alliance trial. JAMA Oncol 4(6):783–790

    Article  Google Scholar 

  22. Forsythe LP, Alfano CM, Leach CR, Ganz PA, Stefanek ME, Rowland JH (2012) Who provides psychosocial follow-up care for post-treatment cancer survivors? A survey of medical oncologists and primary care physicians. J Clin Oncol 30(23):2897–2905

    Article  Google Scholar 

  23. Keogh JWL, Olsen A, Climstein M, Sargeant S, Jones L (2017) Benefits and barriers of cancer practitioners discussing physical activity with their cancer patients. J Cancer Educ 32:11–15

    Article  Google Scholar 

  24. Sinclair J, Lawson B, Burge F (2008) Which patients receive advice on diet and exercise? Do certain characteristics affect whether they receive such advice? Can Fam Physician 54(3):404–412

    PubMed  PubMed Central  Google Scholar 

  25. Folsom T, Nagraj V (2017) hei: Calculate Healthy Eating Index (HEI) scores. J Open Source Softw 2(18):417

    Article  Google Scholar 

  26. Basiotis PP, Carlson A, Gerrior SA, Juan W, Lino M (2004) The Health Eating Index, 1999-2000: charting dietary patterns of Americans. Fam Econ Nutr Rev 16(1):39–48. Available from:. https://doi.org/10.1016/j.jaci.2012.05.050

    Article  Google Scholar 

  27. Yang L, Toriola AT (2017) Leisure-time physical activity and circulating 25-hydroxyvitamin D levels in cancer survivors: a cross-sectional analysis using data from the US National Health and Nutrition Examination Survey. BMJ Open 7(7)

  28. Aronne LJ (2002) Classification of obesity and assessment of obesity-related health risks. Obes Res 10(SUPPL. 2):105S–115S

    Article  Google Scholar 

  29. R Core Team (2019) R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. Available from: https://www.r-project.org

  30. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A, American College of Sports Medicine, American Heart Association (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 116(9):1081–1093

    Article  Google Scholar 

  31. Ory MG, Yuma PJ, Hurwicz ML, Jarvis C, Barron KL, Tai-Seale T, Tai-Seale M, Patel D, Hackethorn D, Bramson R, Street R, Cook MA (2006) Prevalence and correlates of doctor-geriatric patient lifestyle discussions: analysis of ADEPT videotapes. Prev Med (Baltim) 43(6):494–497

    Article  Google Scholar 

  32. Ligibel JA, Jones LW, Brewster AM, Clinton SK, Korde LA, Oeffinger KC, Bender CM, Tan W, Merrill JK, Katta S, Alfano CM (2019) Oncologists’ attitudes and practice of addressing diet, physical activity, and weight management with patients with cancer: findings of an ASCO survey of the oncology workforce. J Oncol Pract 15(6):e520–e528

    Article  Google Scholar 

  33. Jones LW, Courneya KS, Fairey AS, Mackey JR (2004) Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Ann Behav Med 28(2):105–113

    Article  Google Scholar 

  34. Nyrop KA, Deal AM, Williams GR, Guerard EJ, Pergolotti M, Muss HB (2016) Physical activity communication between oncology providers and patients with early-stage breast, colon, or prostate cancer. Cancer. 122:470–476

    Article  Google Scholar 

  35. Haussmann A, Ungar N, Gabrian M, Tsiouris A, Sieverding M, Wiskemann J, Steindorf K (2018) Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients. Support Care Cancer 26:4087–4096

    Article  Google Scholar 

  36. Van Veen MR, Hoedjes M, Versteegen JJ, Van De Meulengraaf-Wilhelm N, Kampman E, Beijer S (2017) Improving oncology nurses’ knowledge about nutrition and physical activity for cancer survivors. Oncol Nurs Forum 44(4):488–496

    Article  Google Scholar 

  37. Hooker SA, Punjabi A, Justesen K, Boyle L, Sherman MD (2018) Encouraging health behavior change: eight evidence-based strategies. Fam Pract Manag 25(2):31–36

    PubMed  Google Scholar 

  38. Whitlock EP, Orleans CT, Pender N, Allan J (2002) Evaluating primary care behavioral counseling interventions. An evidence-based approach. Am J Prev Med 22(4):267–284

    Article  Google Scholar 

  39. Goldstein MG, Whitlock EP, DePue J (2004) Multiple behavioral risk factor interventions in primary care: summary of research evidence. Am J Prev Med 27(2S):61–79

    Article  Google Scholar 

  40. Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, Evans PH et al (2011) Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 11

  41. Makoul G, Dhurandhar A, Goel MS, Scholtens D, Rubin AS (2006) Communication about behavioral health risks: a study of videotaped encounters in 2 internal medicine practices. J Gen Intern Med 21(7):698–703

    Article  Google Scholar 

  42. Xu Y, Chun MM (2009) Selecting and perceiving multiple visual objects. Trends Cogn Sci 13(4):167–174

    Article  Google Scholar 

  43. Koffarnus MN, Woods JH (2013) Individual differences in discount rate are associated with demand for self-administered cocaine, but not sucrose. Addict Biol 18(1):8–18 Available from: http://search.proquest.com.er.lib.k-state.edu/docview/1324551599?accountid=11789

    Article  CAS  Google Scholar 

  44. Winger JG, Mosher CE, Rand KL, Morey MC, Snyder DC, Demark-Wahnefried W (2014) Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors. Ann Behav Med 48(2):235–245

    Article  Google Scholar 

  45. DeVoe JE, Wallace LS, Fryer GE (2009) Patient age influences perceptions about health care communication. Fam Med 41(2):126–133

    PubMed  PubMed Central  Google Scholar 

  46. Rutten LJF, Augustson E, Wanke K (2006) Factors associated with patients’ perceptions of health care providers’ communication behavior. J Health Commun 11:135–146

    Article  Google Scholar 

Download references

Summary

The results of this study demonstrate the need to increase the frequency in which physicians provide health behavior change recommendations to patients with a history of cancer. However, recommendations for behavior change should be a first step, and need to be complemented with evidence-based strategies to ensure long-term health behavior changes. Moreover, this work demonstrates a need to provide physicians with tools and strategies for effectively assisting their patients with health behavior changes.

Code availability

N/A

Author information

Authors and Affiliations

  1. Department of Psychology and Communication, Texas A&M International University, 5201 University Blvd, AIC 372, Laredo, TX, 78041, USA

    Catherine C. Steele

  2. Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS, USA

    Trevor J. Steele & Sara K. Rosenkranz

  3. Physical Activity and Nutrition Clinical Research Consortium, Kansas State University, Manhattan, KS, USA

    Trevor J. Steele, Sara K. Rosenkranz & Carl J. Ade

  4. Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA

    Jin Lee

  5. Department of Kinesiology, Kansas State University, Manhattan, KS, USA

    Carl J. Ade

  6. Johnson Cancer Research Center, Kansas State University, Manhattan, KS, 66506, USA

    Carl J. Ade

Authors
  1. Catherine C. Steele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trevor J. Steele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara K. Rosenkranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carl J. Ade
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by CCS. The first draft of the manuscript was written by CCS and all authors commented on previous versions of the manuscript. Primary supervision was provided by CJA. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Catherine C. Steele.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

N/A

Consent to participate

N/A

Consent for publication

N/A

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Presentations

This data was presented at Obesity Week 2020.

Supplementary information

ESM 1

(CSV 20338 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steele, C.C., Steele, T.J., Rosenkranz, S.K. et al. Health behaviors and patient–practitioner communication in cancer patients and the general population: an analysis of the National Health and Nutrition Examination Survey (NHANES) 2005–2014. Support Care Cancer 29, 3877–3884 (2021). https://doi.org/10.1007/s00520-020-05940-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05940-w

Keywords

Search

Navigation