Photo Credit: EJGrubbs

Improved widespread and systematic counseling on ACS guidelines is needed to increase uptake of healthy behaviors among male and younger cancer survivors.

Positive lifestyle changes after cancer treatment have been shown to reduce the risk for cancer recurrence. Isolating those risk factors most likely to affect cancer survivors, the American Cancer Society (ACS) developed the Guideline for Diet and Physical Activity to direct patients toward risk-reducing lifestyle choices.

Four of the major directives in the guidelines are avoiding obesity, adopting a healthy diet with a substantial intake of fruits and vegetables, participating in regular physical activity, and refraining from alcohol. According to experts, adherence to the ACS guidelines would increase healthy behaviors and post-cancer treatment survival.

Choices After Treatment

It is unknown whether cancer survivors have successfully followed the ACS guidelines. To assess this, Kathryn Norman, MD, and colleagues developed a cross-sectional study that examined ACS guideline adherence in patients following cancer treatment completion. JAMA Oncology published the results of this study.

The study drew its pool of participants from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). This nationwide telephone-based survey gathers self-reported data on behaviors related to health and chronic disease progression in people aged 18 years or older who reside in the United States. Of the 2.7 million people who provided answers to BRFSS over three years, 10,020 patients in the participant group for this study completed cancer treatment.

The participants had a median age of 64.2 years, and females made up 57% of the group. Patients received their initial cancer diagnosis at a mean age of 53.2 years. In terms of racial demographics, 1% identified as American Indian or Native of Alaska, 1% as Asian, 5% as Black, 7% as Hispanic, 84% as White, and 2% as other races. Most participants (91%) completed the questionnaire with all four targeted guideline metrics questions answered.

Guideline Adherence

Regarding meeting physical activity guideline requirements, 72% (95% CI, 71%-74%) of cancer survivors questioned met the outlined criteria. Regarding weight, 68% (95% CI, 66%-69%) of participants avoided obesity. As for keeping a consistent nutritional diet with adequate servings of fruits and vegetables, 12% (95% CI, 11%-13%) of the participants met this criterion. Half (95% CI, 49%-52%) of the participants surveyed refrained from alcohol consumption.

When examined in combination, only 4% (95% confidence interval, 3%- 4%) of the cancer survivors surveyed followed all four of the ACS guidelines’ major directives (Table). Two is the mean number of guidelines met.

When comparing the participant group to the general population (adjusting for age, race and ethnicity, and region), those who completed cancer treatment had –0.101 (95% CI, –0.140 to 0.060) fewer healthy behaviors than members of the general public (P < 0.001).

Dr. Norman and colleagues found that the female patients in the study participated in more healthy behaviors than the male patients (coefficient [SE], 0.14 [0.03]; P<0.001). Furthermore, those of an older age showed results that they had greater adherence to healthy lifestyle choices (coefficient [SE],0.05 [0.01] per increase in decade; P=0.001). In terms of racial disparity, Black patients had more healthy lifestyle behaviors than White participants (coefficient [SE],0.20 [0.08]; P=0.02). The researchers noted that a higher degree of education is associated with greater adherence to the healthy behaviors outlined in the ACS guidelines.

“While we identified some factors associated with adherence that may aid in targeting recommendations, it is essential for oncologists and general internists to improve widespread and systematic counseling on these guidelines to improve uptake of healthy behaviors in this vulnerable patient population,” the researchers wrote.