Health Behaviors Worse Among Cancer Survivors Than Patients With No History of Cancer

Alarge, population-based study found that a significant proportion of female cancer survivors had poor health behaviors compared with women who have not had cancer (Rausch SM, et al. Am J Clin Oncol. 2012;35:22-31).

Several differences in engaging in health behaviors emerged among primary cancer types, with more cervical cancer survivors reporting being current smokers and regular alcohol users compared with other cancer types. Ovarian and uterine cancer survivors reported being obese more often than other cancer types, and the largest weight gain was observed among cervical cancer survivors. By contrast, leukemia survivors reported engaging in regular mammography more often, had a higher percentage of “never” smokers, and a higher percentage of normal-weight individuals compared with individuals with other primary cancers.

Even though more than half of all cancer deaths in the United States can be attributed to health behaviors such as smoking (30%), poor dietary choices and obesity (25%-30%), and physical inactivity, very little is known about these behaviors in cancer survivors, wrote the authors of this study. “There is considerable need for additional studies to document the prevalence of cancer-related risk factors in a diverse sample of cancer survivors,” they added.

The study included almost 20,000 women aged 35 years and older with no prior breast cancer who presented for screening mammography. Participants were given a self-assessment questionnaire about their health behaviors and previous cancer history.

The questionnaire was completed by 18,510 women—15,797 with no cancer history and 2713 cancer survivors. Health behaviors assessed included smoking, alcohol consumption, physical activity, weight, use of complementary and alternative medicine (CAM), mammography screening, and overall selfrating of health during the past year.

Mean age was 58 years, mean body mass index (BMI) was 26 kg/m², and 74% had education beyond high school. Compared with women who did not have cancer, cancer survivors were about 5 years older on average, had a similar BMI, and 4% more had education beyond high school.

Cancer survivors were less likely than women with no cancer history to report that they had “excellent” health: 13.6% versus 21.5%, respectively; that they engaged in moderate or strenuous exercise: 56.5% versus 63.3%, respectively; and that they used CAM: 57.4% versus 60.2%, respectively. Cancer survivors were more likely to be current smokers (6.3% vs 5.5%) and to rate their overall health as “poor” (15.9% vs 9.1%, respectively), and to gain more weight over time.

Cancer survivors reported more regular participation in mammography screening than women with no cancer: 91.1% versus 86.3%, respectively; the difference was more marked in patients younger than age 40: 80.2% versus 74.3%, respectively.

Cancer survivors were more likely to have had a smoking history; 59% versus 63.7%, respectively, reported being “never” smokers; 34.6% versus 30%, respectively, reported being “former” smokers; and 6.3% versus 5.9% said they were current smokers. The smoking rates were similar between cancer survivors and those without cancer for women older than age 65, whereas cancer survivors aged 30 to 49 years were more likely to be current smokers than women of the same age group who were not cancer survivors: 13% versus 8.5%, respectively.

The authors state that presenting for screening mammography is “a teachable moment” when healthcare providers can educate cancer survivors and discuss risky behaviors. Studies such as this one suggest that there is much room for improvement in areas such as smoking, alcohol consumption, exercise, and weight gain.