Abstract
Survival rates for certain types of cancer have improved over the past few decades. Changing unhealthy behaviors such as smoking, poor diet, and sedentary life-style among individuals who have been diagnosed with cancer may help to reduce cancer treatment sequelae, possibly reduce risk of recurrence for specific types of cancer, and reduce risk for other common diseases such as cardiovascular disease, obesity, and hypertension. This article reports the prevalence of each of these behaviors among those diagnosed with cancer and reviews interventions that have targeted these risk behaviors. There is considerable variation in the type of research questions asked, the methodologic quality of the research, sample sizes, and the outcomes observed across studies focusing on changing the three health risk behaviors. In the final section, we provide guidelines for researchers in developing health behavior interventions for individuals diagnosed with cancer and highlight challenges that should be addressed.
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Garfinkel L: Cancer statistics and trends. In Murphy GP, Lawrence W, Lenhard RE (eds),American Cancer Society Textbook of Clinical Oncology (2nd Ed.). Atlanta, GA: American Cancer Society, 1995.
Wingo PA, Tony T, Bolden S: Cancer statistics, 1995.CA: A Cancer Journal for Clinicians. 1995,45: 8–30.
Andersen BL: Psychological interventions for cancer patients to enhance the quality of life.Journal of Consulting and Clinical Psychology. 1992,60: 552–568.
Fawzy FI, Fawzy NW, Arndt LA, Pasnau RO: Critical review of psychosocial interventions in cancer care.Archives of General Psychiatry. 1995,52: 100–113.
Krupnick JL, Rowland JH, Goldberg RL, Daniel UV: Professionallyled support groups for cancer patients: An intervention in search of a model.International Journal of Psychiatry in Medicine. 1993,23: 275–294.
Trijsburg RW, Van Knippenberg FC, Rijpma SE: Effects of psychological treatment on cancer patients: A critical review.Psychosomatic Medicine. 1992,54: 489–517.
Andersen BL: Surviving cancer.Cancer. 1994,74: 1484–1495.
Irvine D, Vincent L, Graydon JE, Bubela N, Thompson L: The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy.Cancer Nursing. 1994,17(5): 367–378.
Cohen RE, Blanchard EB, Ruckdeschel JC, Smolen RC: Prevalence and correlates of posttreatment and anticipatory nausea and vomiting in cancer chemotherapy.Journal of Psychosomatic Research. 1986,30: 643–654.
Gritz ER: Smoking and smoking cessation in cancer patients.British Journal of Addiction. 1991,86: 549–554.
Spitz MR, Fueger JJ, Eriksen MP, Newell GR: Cigarette smoking patterns of cancer patients. In Engstrom PF, Rimer B, Mortensen LE (eds),Advances in Cancer Control: Screening and Prevention Research. New York: Wiley-Liss, 1990, 73–82.
Orleans CT, Lindblad A, Davis S, et al: The need for brief physician-initiated quit smoking strategies in CCOP settings. The 14th Annual Meeting of the American Society of Preventive Oncology. Bethesda, MD: March, 1990.
Johnston-Early A, Cohen MH, Minna JD, et al: Smoking abstinence and small cell lung cancer survival.Journal of the American Medical Association. 1980,244: 2175–2179.
Gail MH, Eagan RT, Feld R, et al: Prognostic factors in patients with resected Stage I non-small cell lung cancer, a report from the Lung Study Group.Cancer. 1984,54: 1802–1813.
Moore C: Cigarette smoking and cancer of the mouth, pharynx, and larynx.Journal of the American Medical Association. 1971,218(4): 553–558.
Stevens MH, Gardner JW, Parkin JL, Johnson KP: Head and neck cancer survival and lifestyle change.Archives of Otolaryngology. 1983,109: 746–749.
Castigliano SG: Influence of continued smoking on the incidence of second primary cancers involving mouth, pharynx, and larynx.Journal of the American Dental Association. 1968,77: 580–585.
Davison G, Duffy M: Smoking habits of long-term survivors of surgery for lung cancer.Thorax. 1982,37: 331–333.
Knudsen N, Schulman S, Van Den Hoek J, Fowler R: Insights on how to quit smoking: A survey of patients with lung cancer.Cancer Nursing. 1985,8(3): 145–150.
Corkery JC, Li FP, McDonald JA: Kids who really shouldn’t smoke.New England Journal of Medicine. 1979,300: 1279.
Haupt R, Byrne J, Connelly RR, et al: Smoking habits in survivors of childhood and adolescent cancer.Medical and Pediatric Oncology. 1992,20: 301–306.
Troyer H, Homes GE: Cigarette smoking among childhood cancer survivors.American Journal of Diseases of Children. 1988,142: 123.
Tyc VL, Hudson MM, Hinds P, Elliott V, Kibby MY: Tobacco use among pediatric cancer patients: Recommendations for developing clinical smoking interventions.Journal of Clinical Oncology. 1997,15: 2194–2204.
Tao ML, Guo MD, Weiss R, et al: Smoking in adult survivors of childhood acute lymphoblastic leukemia.Journal of the National Cancer Institute. 1998,90(3): 219–225.
Shaw NJ, Tweeddale PM, Eden OB: Pulmonary function in childhood leukaemia survivors.Medical and Pediatric Oncology. 1989,17: 149–154.
Lipshultz SE, Colan SD, Gelber RD, et al: Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood.New England Journal of Medicine. 1991,324: 808–815.
Gritz ER, Carr CR, Rapkin D, et al: Predictors of long-term smoking cessation in head and neck cancer patients.Cancer Epidemiology, Biomarkers and Prevention. 1993,2: 261–270.
Griebel B, Wewers ME, Baker CA: The effectiveness of a nurse-managed minimal smoking-cessation intervention among hospitalized patients with cancer.Oncology Nursing Forum. 1998,25(5), 897–902.
Wewers ME, Bowen JM, Stanislaw AE, Desimone VB: A nurse-delivered smoking cessation intervention among hospitalized postoperative patients—Influence of a smoking-related diagnosis: A pilot study.Heart and Lung. 1994,23(2): 151–156.
Stanislaw AE, Wewers ME: A smoking cessation intervention with hospitalized surgical cancer patients: A pilot study.Cancer Nursing. 1994,17: 81–86.
Kristal AR, Shattuck AL, Bowen DJ, Sponzo RW, Nixon DW: Feasibility of using volunteer research staff to deliver and evaluate a low-fat dietary intervention: The American Cancer Society Breast Cancer Dietary Intervention Project.Cancer Epidemiology, Biomarkers and Prevention. 1997,6: 459–467.
Chlebowski RT, Blackburn GL, Buzzard IM, et al, for the Women’s Intervention Nutrition Study: Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early stage breast cancer.Journal of Clinical Oncology. 1993,11: 2072–2080.
Nordevang E, Callmer E, Marmur A, Holm LE: Dietary intervention in breast cancer patients: Effects on food choice.European Journal of Clinical Nutrition. 1992,46: 387–396.
Pierce JP, Faerber S, Wright FA, et al: Feasibility of a randomized trial of a high-vegetable diet to prevent breast cancer recurrence.Nutrition and Cancer. 1997,28: 282–288.
Pinto BM, Maruyama NC, Engebretson TO, Thebarge RW: Exercise participation, mood, and coping in early-stage breast cancer survivors.Journal of Psychosocial Oncology. 1998,16: 45–58.
Young-McCaughan S, Sexton DL: A retrospective investigation of the relationship between aerobic exercise and quality of life in women with breast cancer.Oncology Nursing Forum. 1991,18: 751.
Courneya KS, Friedenreich CM: Determinants of exercise during colorectal cancer treatment: An application of the theory of planned behavior.Oncology Nursing Forum. 1997,24: 1715–1723.
Schwartz AL: Patterns of exercise and fatigue in physically active cancer survivors.Oncology Nursing Forum. 1998,25: 485–491.
U.S. Department of Health and Human Services:Physical Activity and Health: A Report of the Surgeon-General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
Decker WA, Turner-McGlade JT, Fehir KM: Psychosocial aspects and the physiological effects of a cardiopulmonary exercise program in patients undergoing bone marrow transplantation (BMT) for acute leukemia (AL).Transplantation Proceedings. 1989,21: 3068–3069.
Dimeo F, Bertz H, Finke J, et al: An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation.Bone Marrow Transplantation. 1996,18: 1157–1160.
Dimeo F, Rumberger BG, Keul J: Aerobic exercise as therapy for cancer fatigue.Medicine and Science in Sports and Exercise. 1998,30: 475–478.
Peters C, Lotzerich H, Niemeier B, Schule K, Uhlenbruch G: Influence of a moderate exercise training on natural killer cytotoxicity and personality traits in cancer patients.Anticancer Research. 1994,14: 1033–1036.
Dimeo FC, Tilmann MH, Bertz H, et al: Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation.Cancer. 1997,79: 1717–1722.
MacVicar MG, Winningham ML: Promoting the functional capacity of cancer patients.Cancer Bulletin. 1986,38: 235–239.
Mock V, Burke MB, Sheehan P, et al: A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy.Oncology Nursing Forum. 1994,21: 899–907.
Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J: Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy.Blood. 1997,90: 3390–3394.
Berglund G, Bolund C, Gustafsson U, Sjoden P: Starting Again—A comparison study of a group rehabilitation program for cancer patients.Acta Oncologica. 1993,32: 15–21.
Berglund G, Bolund C, Gustafsson U, Sjoden P. A randomized study of a rehabilitation program for cancer patients: The “Starting Again” Group.Psycho-Oncology. 1994,3: 109–120.
MacVicar M, Winningham ML, Nickel JL: Effects of aerobic interval training on cancer patients’ functional capacity.Nursing Research. 1989,38: 348–351.
Winningham ML, MacVicar MG, Bondoc M, Anderson J, Minton JP: Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy.Oncology Nursing Forum. 1989,16: 683–689.
Winningham ML, MacVicar MG: The effect of aerobic exercise on patient reports of nausea.Oncology Nursing Forum. 1988,15: 447–450.
Mock V, Dow KH, Meares CJ, et al: Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.Oncology Nursing Forum. 1997,24: 991–1000.
Segar ML, Katch VL, Roth RS, et al: The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors.Oncology Nursing Forum. 1998,25: 107–113.
Berglund G, Bolund C, Gustafsson U, Sjoden P: One-year follow-up of the “Starting Again” group rehabilitation program for cancer patients.European Journal of Cancer. 1994,30A: 1744–1751.
Roy C, Andrews HA:The Roy Adaptation Model. The Definitive Statement. Norwalk, CT: Appleton & Lange, 1991.
Winningham ML, Glass EC, MacVicar MG:Rhythmic Walking-Exercise for People Living with Cancer. Columbus, OH: James Cancer Hospital and Research Institute, Ohio State University, 1990.
Pinto BM, Maruyama NC: Exercise in the rehabilitation of breast cancer patients.Psycho-Oncology. 1999,8: 191–206.
Gritz ER, Ward PH, Beumer J, Carr CR, Rapkin DA: Increasing adherence to a provider-implemented smoking cessation intervention for head and neck cancer patients. In Engstrom PF, Rimer B, Mortenson L (eds),Advances in Cancer Control: Screening and Prevention. New York: Wiley-Liss, 1990, 84–93.
Hall SM, Turnstall CD, Vila KL, Duffy J: Weight gain prevention and smoking cessation: Cautionary findings.American Journal of Public Health. 1992,82: 799–803.
Pirie PL, McBride CM, Hellerstedt W, et al: Smoking cessation in women concerned about weight.American Journal of Public Health. 1992,82: 1238–1243.
Emmons KM, Marcus BH, Linnan L, Rossi JS, Abrams DB: Mechanisms in multiple risk factor interventions: Smoking, physical activity, and dietary fat intake among manufacturing workers.Preventive Medicine. 1994,23: 481–489.
Epstein LH: Integrating theoretical approaches to promote physical activity.American Journal of Preventive Medicine. 1998,15: 257–265.
Rosenstock IM: Historical origins of the health belief model.Health Education Monographs. 1974,2: 328–335.
Ajzen I: The theory of planned behavior.Organizational Behavior and Human Decision Processes. 1991,50: 179–211.
Rogers RW: Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In Cacioppo JR, Petty RE (eds),Social Psychology: A Source Book. New York: Guiford Press, 1983, 153–176.
Rotter JB:Social Learning and Clinical Psychology. New York: Prentice Hall, 1954.
Bandura A:Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall, 1977.
Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: Toward an integrative model of change.Journal of Consulting and Clinical Psychology. 1983,51: 663–674.
Reardon KK, Aydin CE: Changes in lifestyle initiated by breast cancer patients: Who does and who doesn’t?Health Communication. 1993,5: 263–282.
Orleans CT, George LK, Houpt JL, Brodie KH: Health promotion in primary care: A survey of U.S. family practitioners.Preventive Medicine. 1985,14: 636–647.
Frank E, Kunovich-Frieze T: Physicians’ prevention counseling behaviors: Current status and future directions.Preventive Medicine. 1995,24: 543–545.
Fiore M, Bailey W, Cohen SJ, et al:Smoking Cessation: Clinical Practice Guidelines, No. 18, AHCPR Publication No. 96-0692. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1996.
U.S. Preventive Services Task Force:Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore, MD: Williams & Wilkins, 1989.
Calfas KJ, Long BJ, Sallis JF, et al: A controlled trial of physician counseling to promote the adoption of physical activity.Preventive Medicine. 1996,5: 225–233.
Goldstein MG, Pinto BM, Marcus BM, et al: Physician-based physical activity counseling for middle-aged and older adults: A randomized trial.Annals of Behavioral Medicine. 1999,21: 40–47.
Marcus BH, Pinto BM, Clark MM, et al: Physician delivered interventions for dietary and exercise promotion.Medicine, Exercise, Nutrition and Health. 1995,4: 325–334.
Marcus AC, Morra ME, Bettinghaus E, et al: The Cancer Information Service Research Consortium: An emerging laboratory for cancer control research.Preventive Medicine. 1998,27: S3-S15.
De Vries H, Brug J: Computer-tailored interventions motivating people to adopt health promoting behaviours: Introduction to a new approach.Patient Education and Counseling. 1999,36: 99–105.
Brug J, Glanz K, Assema PV, Kok G, van Breukelen GJP: The impact of computer-tailored feedback and iterative feedback on fat, fruit, and vegetable intake.Health Education and Behavior. 1988,25: 517–531.
Campbell MK, DeVellis BM, Strecher VJ, et al: Improving dietary behavior: The effectiveness of tailored messages in primary care settings.American Journal of Public Health. 1994,84: 783–787.
Marcus BH, Banspach SW, Lefebvre RC, et al: Using the stages of change model to increase the adoption of physical activity among community participants.American Journal of Health Promotion. 1992,6: 424–429.
Marcus BH, Bock BC, Pinto BM, et al: Efficacy of an individualized, motivationally-tailored physical activity intervention.Annals of Behavioral Medicine. 1998,20: 174–180.
Prochaska JO, DiClemente CC, Velicer WF, Rossi JS: Standardized, individualized, interactive and personalized self-help programs for smoking cessation.Health Psychology. 1993,12: 399–405.
Glynn TJ: Relative effectiveness of physician-initiated smoking cessation programs.Cancer Bulletin. 1988,40: 359–364.
Ockene J, Kristeller NL, Goldberg R, et al: Smoking cessation and severity of disease: The Coronary Artery Smoking Intervention Study.Health Psychology. 1992,11: 119–126.
Taylor CB, Houston-Miller N, Killen JD, DeBusk RF: Smoking cessation after acute myocardial infarction: Effects of a nurse-managed intervention.Annals of Internal Medicine. 1990,113: 118–123.
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Preparation of this manuscript was supported in part by the National Cancer Institute Grant CA 75452.
We thank Judith DePue, Ed.D., M.P.H. and Christopher Sciamanna, M.D., M.P.H. for their valuable comments on an earlier version of the manuscript. We thank Barbara Doll and Barbara McCray for assistance with manuscript preparation.
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Pinto, B.M., Eakin, E. & Maruyama, N.C. Health behavior changes after a cancer diagnosis: What do we know and where do we go from here?. ann. behav. med. 22, 38–52 (2000). https://doi.org/10.1007/BF02895166
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DOI: https://doi.org/10.1007/BF02895166