Lifestyle behaviors, obesity, and perceived health among men with and without a diagnosis of prostate cancer: a population-based, cross-sectional study

Association between body mass index and physical activity among prostate cancer survivors

PURPOSE

We assessed the associations between (1) body mass index (BMI) and participating in any physical activities (PAs) in past 30 days and (2) cancer and behavioral-related variables and participating in any PAs in past 30 days among prostate cancer (PCa) survivors.

METHODS

We conducted a cross-sectional analysis of data from the 2018-2022 Behavioral Risk Factor Surveillance System. Multivariable weighted logistic regression was used to examine the associations.

RESULTS

Of the 4944 PCa respondents, 22.9% were classified as obese class I and 10.6% as obese class II or III. Obese class I and obese class II or III respondents were significantly less likely to participate in any PAs in past 30 days (odds ratio (OR) = 0.48; 95% confidence interval (CI): 0.28-0.84 and OR = 0.37; 95% CI: 0.20-0.67, respectively). Men who received a summary of their cancer treatment were significantly more likely to participate in any PAs in past 30 days (OR = 1.53; 95% CI: 1.03-2.28). Men who received instructions from a doctor for routine check-ups after completing treatment for cancer were not significantly more likely to participate in any PAs in past 30 days (OR = 1.36; 95% CI: 0.87-2.12). Current smokers were less likely to participate in any PAs in past 30 days (OR = 0.50; 95% CI: 0.26-0.96).

CONCLUSIONS

Obese men and current smokers were less likely to participate in any PAs in past 30 days. Men who received a summary of their cancer treatment were more likely to participate in any PAs in past 30 days. Health care providers should talk to their patients about the benefits of participating in PA and refer PCa patients to available exercise programs.

IMPLICATIONS FOR CANCER SURVIVORS

PA was lowest among obese class II or III PCa survivors. These men could benefit from a coordinated multidisciplinary health care team effort to improve PCa prognosis and QoL.

Alcohol and Prostate Cancer: Time to Draw Conclusions

It has been a long-standing debate in the research and medical societies whether alcohol consumption is linked to the risk of prostate cancer (PCa). Many comprehensive studies from different geographical areas and nationalities have shown that moderate and heavy drinking is positively correlated with the development of PCa. Nevertheless, some observations could not confirm that such a correlation exists; some even suggest that wine consumption could prevent or slow prostate tumor growth. Here, we have rigorously analyzed the evidence both for and against the role of alcohol in PCa development. We found that many of the epidemiological studies did not consider other, potentially critical, factors, including diet (especially, low intake of fish, vegetables and linoleic acid, and excessive use of red meat), smoking, family history of PCa, low physical activity, history of high sexual activities especially with early age of first intercourse, and sexually transmitted infections. In addition, discrepancies between observations come from selectivity criteria for control groups, questionnaires about the type and dosage of alcohol, and misreported alcohol consumption. The lifetime history of alcohol consumption is critical given that a prostate tumor is typically slow-growing; however, many epidemiological observations that show no association monitored only current or relatively recent drinking status. Nevertheless, the overall conclusion is that high alcohol intake, especially binge drinking, is associated with increased risk for PCa, and this effect is not limited to any type of beverage. Alcohol consumption is also directly linked to PCa lethality as it may accelerate the growth of prostate tumors and significantly shorten the time for the progression to metastatic PCa. Thus, we recommend immediately quitting alcohol for patients diagnosed with PCa. We discuss the features of alcohol metabolism in the prostate tissue and the damaging effect of ethanol metabolites on intracellular organization and trafficking. In addition, we review the impact of alcohol consumption on prostate-specific antigen level and the risk for benign prostatic hyperplasia. Lastly, we highlight the known mechanisms of alcohol interference in prostate carcinogenesis and the possible side effects of alcohol during androgen deprivation therapy.

Racial and Ethnic Disparities in Health Status, Chronic Conditions, and Behavioral Risk Factors Among Prostate Cancer Survivors, United States, 2015

INTRODUCTION

Little is known about perceived health status and behavioral risk factors among prostate cancer survivors. The objective of this study was to describe racial and ethnic differences in self-reported health status, chronic conditions, and selected behavioral risk factors among prostate cancer survivors in the US.

METHODS

We used data from the 2015 National Health Interview Survey to calculate the prevalence of various levels of health status, chronic conditions, behavioral risk factors, and sociodemographic characteristics among prostate cancer survivors aged 50 years or older. We stratified results by race and ethnicity.

RESULTS

Of the 317 prostate cancer survivors in our sample, 33.1% reported no physical activity, 64.2% reported being current drinkers, 26.1% characterized their drinking as moderate/heavy, 42.3% reported being former smokers, and 8.7% were current smokers. Nearly one-third (29.1%) of survivors were obese (body mass index ≥30), and 15.1% had 3 to 6 chronic conditions. A greater percentage of White (29.7%) than Black (14.2%) or Hispanic (16.3%) survivors were moderate/heavy drinkers. A greater percentage of Black (16.2%) than White (7.5%) or Hispanic (7.3%) survivors were current smokers. A greater percentage of Black (25.1%) or Hispanic (27.7%) than White (11.4%) survivors had 3 to 6 chronic conditions.

CONCLUSION

As the population of older men increases, prostate cancer diagnoses and those surviving the disease will also increase. Significant racial and ethnic group differences in behavioral risk factors and chronic conditions exist among prostate cancer survivors. Public health could prioritize efforts to improve health behaviors among prostate cancer survivors and use targeted interventions to address disparities.

Hereditary Predisposition to Prostate Cancer: From Genetics to Clinical Implications

Prostate cancer (PrCa) ranks among the top five cancers for both incidence and mortality worldwide. A significant proportion of PrCa susceptibility has been attributed to inherited predisposition, with 10-20% of cases expected to occur in a hereditary/familial context. Advances in DNA sequencing technologies have uncovered several moderate- to high-penetrance PrCa susceptibility genes, most of which have previously been related to known hereditary cancer syndromes, namely the hereditary breast and ovarian cancer (BRCA1, BRCA2, ATM, CHEK2, and PALB2) and Lynch syndrome (MLH1, MSH2, MSH6, and PMS2) genes. Additional candidate genes have also been suggested, but further evidence is needed to include them in routine genetic testing. Recommendations based on clinical features, family history, and ethnicity have been established for more cost-efficient genetic testing of patients and families who may be at an increased risk of developing PrCa. The identification of alterations in PrCa predisposing genes may help to inform screening strategies, as well as treatment options, in the metastatic setting. This review provides an overview of the genetic basis underlying hereditary predisposition to PrCa, the current genetic screening recommendations, and the implications for clinical management of the disease.

Modifiable health behaviors among low-income, uninsured men with prostate cancer

BACKGROUND

As life expectancy of men with prostate cancer (CaP)improves, the risks of chronic diseases and comorbid conditions become more relevant. Improving modifiable health behaviors now serves as a focus of guidelines to reduce all-cause morbidity and mortality from chronic disease among CaP survivors. Few studies have reported on these health behaviors in low-income, uninsured men with CaP METHODS: In addition to baseline demographic data, we collected four health behaviors in low-income men with CaP via telephone survey: physical activity, dietary intake of fruits and vegetables, weight management, and alcohol consumption. These behaviors were assessed for adherence to the American Cancer Society Prostate Cancer Survivorship Care Guidelines for health promotion.

RESULTS

Of 236 participants, most self-identified as racial/ethnic minority (61% Hispanic, 16% Black). Most men demonstrated low (21%) or moderate (66%) adherence to guidelines, almost all of whom had poor adherence with recommendations for physical activity and fruit and vegetable intake. Multivariate analysis showed that non-white men were more likely to demonstrate low or moderate adherence.

CONCLUSIONS

Most men in this cohort of low-income, uninsured CaP survivors did not engage the healthy behaviors promulgated by the American Cancer Society. Future interventions in this population should focus on encouraging and facilitating healthier lifestyle choices in physical activity, diet, and weight management.

Diet Quality among Cancer Survivors and Participants without Cancer: A Population-Based, Cross-Sectional Study in the Atlantic Partnership for Tomorrow's Health Project

Cancer survivors are encouraged to have a healthy lifestyle to reduce health risks and improve survival. An understanding of health behaviors, such as diet, is also important for informing post-diagnosis support. We investigated the diet quality of cancer survivors relative to participants without cancer, overall and by cancer site and time from diagnosis. A cross-sectional study design within the Atlantic PATH study was used which included 19,973 participants aged 35 to 69 years from Atlantic Canada, of whom 1,930 were cancer survivors. A diet quality score was derived from a food frequency questionnaire. Comparisons of diet quality between cancer survivors and non-cancer controls, cancer site and years since diagnosis were examined in multivariable multi-level models. Cancer survivors had a mean diet quality of 39.1 out of 60 (SD: 8.82) and a higher diet quality than participants without cancer (mean difference: 0.45, 95% CI: 0.07, 0.84) after adjustment for confounders. Odds of high diet quality was greater in breast cancer survivors than participants without cancer (OR = 1.42, 95% CI: 1.06, 1.90), and higher among survivors diagnosed ≤2 years versus >10 years (OR = 1.71, 95% CI: 1.05, 2.80). No other differences by cancer site and years since diagnosis were observed. The difference in diet quality, although statistically significant, is unlikely to be meaningful, suggesting that cancer survivors have similar diet quality as participants without cancer. There was considerable room for dietary improvement regardless of cancer status, highlighting the need for dietary interventions, especially among cancer survivors, who are at higher risk for secondary health problems.

Assessing Physical Activity Behavior of Cancer Survivors by Race and Social Determinants of Health

Introduction:

Black cancer survivors remain at a higher risk for secondary cancers, cancer recurrence, and comorbid conditions than non-Hispanic White survivors. Physical activity may help improve health outcomes and overall quality of life. We assessed cancer survivors’ physical activity by race/ethnicity and the effect of social determinants of health (SDH) constructs (i.e., economic stability, education, and access to health care) on physical activity.

Methods:

This was a cross-sectional analysis of data from the 2016 Behavioral Risk Factor Surveillance System. The outcome variable was physical activity after cancer diagnosis and the predictor variables were SDH and race. Multivariable logistic regressions were used to examine associations between race and physical activity and the effect of SDH on physical activity.

Results:

Among 3,787 cancer survivors, 91.6% self-identified as White and 8.4% as Black. Blacks were more likely than Whites to report low economic stability, low access to health care, and low health literacy (all p s < .01). Blacks were less likely than Whites to engage in physical activity after controlling for demographic and clinical factors (adjusted odds ratio [ORAdj] = 0.71; 95% confidence interval [CI] = 0.56–0.91; p = .01) and after additional adjustment of SDH (ORAdj = 0.77; 95% CI = 0.60–0.99; p = .04).

Conclusions:

The findings suggest that though Black cancer survivors are less than White to engage in physical activity, and SDH partially explained the racial difference in physical activity behaviors. These findings highlight the need to address barriers to health-care access, economic stability, and educational attainment.

Barriers and facilitators to healthy lifestyle and acceptability of a dietary and physical activity intervention among African Caribbean prostate cancer survivors in the UK: a qualitative study

OBJECTIVES

Diet and lifestyle may have a role in delaying prostate cancer progression, but little is known about the health behaviours of Black British prostate cancer survivors despite this group having a higher prostate cancer mortality rate than their White counterparts. We explored the barriers and facilitators to dietary and lifestyle changes and the acceptability of a diet and physical activity intervention in African Caribbean prostate cancer survivors.

DESIGN

We conducted semistructured in-depth interviews and used thematic analysis to code and group the data.

PARTICIPANTS AND SETTING

We recruited 14 African Caribbean prostate cancer survivors via letter or at oncology follow-up appointments using purposive and convenience sampling.

RESULTS

A prostate cancer diagnosis did not trigger dietary and lifestyle changes in most men. This lack of change was underpinned by five themes: precancer diet and lifestyle, evidence, coping with prostate cancer, ageing, and autonomy. Men perceived their diet and lifestyle to be healthy and were uncertain about the therapeutic benefits of these factors on prostate cancer recurrence. They considered a lifestyle intervention as unnecessary because their prostate-specific antigen (PSA) level was kept under control by the treatments they had received. They believed dietary and lifestyle changes should be self-initiated and motivated, but were willing to make additional changes if they were perceived to be beneficial to health. Nonetheless, some men cited advice from health professionals and social support in coping with prostate cancer as facilitators to positive dietary and lifestyle changes. A prostate cancer diagnosis and ageing also heightened men's awareness of their health, particularly in regards to their body weight.

CONCLUSIONS

A dietary and physical activity intervention framed as helping men to regain fitness and aid post-treatment recovery aimed at men with elevated PSA may be appealing and acceptable to African Caribbean prostate cancer survivors.

Associations of objectively measured moderate-to-vigorous physical activity and sedentary behavior with quality of life and psychological well-being in prostate cancer survivors

Purpose

Although evidence is building on the positive effects of physical activity for prostate cancer survivors, less is known about the possible independent effects of sedentary behavior on quality of life and psychological well-being in this population. We determined the extent to which objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary behavior were independently associated with quality of life, anxiety, and depressive symptoms in prostate cancer survivors.

Methods

An exploratory cross-sectional analysis was undertaken on baseline data from a multicenter, cluster randomized controlled trial on the efficacy of a clinician referral and 12-week exercise program for men who had completed active treatment for prostate cancer. Multiple regression analyses were performed using data from 98 prostate cancer survivors who wore hip-mounted accelerometers (time spent sedentary defined as <100 counts per minute [CPM]; MVPA defined as >1,951 CPM) and completed self-report instruments on their quality of life, anxiety, and depressive symptoms. Results were compared with minimal clinically important differences for the quality of life scales.

Results

Independent of sedentary behavior, increases in MVPA of between 15 and 33 min/day were associated with clinically important (but not statistically significant) improvements in three quality of life scales (insomnia, diarrhea, and financial difficulties). Independent of MVPA, decreases in sedentary behavior of 119 and 107 min/day were associated with clinically important (but not statistically significant) improvements in physical functioning and role functioning, respectively.

Conclusion

Within our exploratory study, modest increases in MVPA and more substantive decreases in sedentary behavior were independently associated with clinically important improvements in several quality of life scales. Further research, including prospective studies, is required to understand sedentary behavior across larger and more representative samples (in terms of their physical, psychological, and social functioning and their engagement in physical activity) of prostate cancer survivors.

Trial registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000609055

Racial and Ethnic Differences in Health Behaviors and Preventive Health Services Among Prostate Cancer Survivors in the United States

Introduction

Little is known about how health behaviors and receipt of preventive health care differ by race and ethnicity among prostate cancer survivors. The purpose of this study was to identify differences in the prevalence of 7 modifiable factors related to prostate cancer: smoking, alcohol consumption, physical inactivity, weight, colorectal cancer screening, influenza vaccination, and pneumococcal vaccination.

Methods

We used data from the 2010 Behavioral Risk Factor Surveillance System to calculate the racial/ethnic prevalence of sociodemographic and health-related characteristics, health behaviors, and preventive health care among prostate cancer survivors. Adjusted prevalence estimates were calculated by using multivariable logistic regression.

Results

We identified 8,016 men with a history of prostate cancer. Multivariable analyses indicated that more black men reported being obese (29.9%; 95% confidence interval [CI], 24.5%–35.9%) than white men (22.8%; 95% CI, 21.1%–24.6%). More white men (3.6%; 95% CI, 2.9%–4.5%) reported consuming more than 2 alcoholic drinks per day than black men (0.9%; 95% CI, 0.4%–2.0%). More white men aged 65 or older reported receiving pneumococcal vaccine (74.2%; 95% CI, 72.2%–76.1%) than black men of the same age (63.2%; 95% CI, 54.8%–70.8%).We did not observe any differences in the prevalence of health behaviors and preventive health care between white men and men in Hispanic or other race categories.

Conclusion

Differences in alcohol consumption, obesity, and receipt of pneumococcal vaccination existed only between black and white prostate cancer survivors. These differences underscore the need to develop culturally appropriate, evidence-based interventions to reduce excessive alcohol consumption, maintain a healthy weight, and promote pneumococcal vaccination among prostate cancer survivors.

Health Behaviors of Cancer Survivors in Nationwide Cross-Sectional Survey in Korea: Higher Alcohol Drinking, Lower Smoking, and Physical Inactivity Pattern in Survivors with Higher Household Income

This study investigated the prevalence of smoking, alcohol consumption, and physical activity in cancer survivors and examined the sociodemographic factors affecting these health-related behaviors.We used data from the 4th and 5th Korean National Health and Nutrition Examination Survey conducted between 2007 and 2012, which identified 1153 cancer cases and 36,451 people without a history of cancer ≥20 years of age. We used a structured questionnaire to obtain information concerning cancer diagnosis, health-related behaviors, and sociodemographic characteristics.The proportion of cancer survivors who were current drinkers, heavy drinkers, current smokers, or engaged in physical activity were 49.1, 9.0, 9.2, or 50.7%, respectively. Compared with people with no history of cancer, cancer survivors were less likely to be current drinkers (odds ratio [OR] = 0.45; 95% confidence interval [CI] 0.36-0.56), heavy drinkers (OR = 0.53; 95% CI 0.36-0.78), current smokers (OR = 0.37; 95% CI 0.24-0.55), or physically inactive (OR = 0.77; 95% CI 0.63-0.95). Cancer survivors with higher household incomes had higher odds of current drinking and heavy drinking (P trend = 0.039 and 0.033, respectively) and were less likely to be current smokers or physically inactive (P trend = 0.016 and 0.046, respectively). Age, sex, sites of cancer, and the time since diagnosis affected the health behaviors in cancer survivors. Furthermore, we confirmed that these unhealthy behaviors are interrelated.We found that household income had a bidirectional effect on health behaviors and confirmed an aggregation of unhealthy lifestyles. Identification of survivors vulnerable to unhealthy lifestyles, focusing on household income level would allow intervention programs to be more effective.

Racial and ethnic differences in health behaviors among cancer survivors

INTRODUCTION

Previous studies of health behaviors of adult cancer survivors have not adequately examined racial and ethnic differences because of small sample sizes. A national data set was used to examine differences in health behaviors between cancer survivors and controls and between racial and ethnic groups among survivors.

METHODS

The study analyzed 2009 Behavioral Risk Factor Surveillance System survey data in 2012-2014. Descriptive statistics were used to examine differences in health behaviors between cancer survivors and controls aged 20-64 years. Multivariable analysis was conducted to examine associations between race/ethnicity (white, African American, Hispanic, Asian, or Native American) and health behaviors (BMI, fruit and vegetable consumption, physical activity, and smoking status) while adjusting for demographic and medical characteristics. Significance was set at p<0.01.

RESULTS

Compared with controls (n=245,283), cancer survivors (n=17,158) had higher prevalence rates for overweight/obese status (67% vs 65%); not meeting physical activity recommendations (53% vs 49%); and current smoking status (22% vs 20%). In the multivariable model, diet and smoking behavior differed across cancer status. African American (AOR=1.95) and Hispanic (AOR=2.06) survivors were more likely to have higher BMI than white survivors. African American survivors (AOR=1.6) were less likely to meet physical activity guidelines. Native American (AOR=3.08) and multiracial (AOR=1.74) survivors were more likely to be current smokers than non-Hispanic white survivors.

CONCLUSIONS

This study suggests that racial and ethnic differences exist in the adoption of recommended health behaviors; future research should identify factors to reduce these differences.

Effects of a clinician referral and exercise program for men who have completed active treatment for prostate cancer: A multicenter cluster randomized controlled trial (ENGAGE)

BACKGROUND

The purpose of this study was to determine the efficacy of a clinician referral and exercise program in improving exercise levels and quality of life for men with prostate cancer.

METHODS

This was a multicenter cluster randomized controlled trial in Melbourne, Australia comprising 15 clinicians: 8 clinicians were randomized to refer eligible participants (n = 54) to a 12-week exercise program comprising 2 supervised gym sessions and 1 home-based session per week, and 7 clinicians were randomized to follow usual care (n = 93). The primary outcome was self-reported physical activity; the secondary outcomes were quality of life, anxiety, and symptoms of depression.

RESULTS

A significant intervention effect was observed for vigorous-intensity exercise (effect size: Cohen's d, 0.46; 95% confidence interval [CI], 0.09-0.82; P = .010) but not for combined moderate and vigorous exercise levels (effect size: d, 0.08; 95% CI, −0.28 to 0.45; P = .48). Significant intervention effects were also observed for meeting exercise guidelines (≥150 min/wk; odds ratio, 3.9; 95% CI, 1.9-7.8; P = .002); positive intervention effects were observed in the intervention group for cognitive functioning (effect size: d, 0.34; 95% CI, −0.02 to 0.70; P = .06) and depression symptoms (effect size: d, −0.35; 95% CI, −0.71 to 0.02; P = .06). Eighty percent of participants reported that the clinician's referral influenced their decision to participate in the exercise program.

CONCLUSIONS

The clinician referral and 12-week exercise program significantly improved vigorous exercise levels and had a positive impact on mental health outcomes for men living with prostate cancer. Further research is needed to determine the sustainability of the exercise program and its generalizability to other cancer populations. Cancer 2015;121:2646–2654. © 2015 American Cancer Society.

Diet, exercise, obesity, smoking and alcohol consumption in cancer survivors and the general population: a comparative study of 16 282 individuals

Background:

Cancer survivors may be particularly motivated to improve their health behaviours.

Methods:

We compared health behaviours and obesity in cancer survivors with the general population, using household survey and cancer registry data.

Results:

Cancer survivors were more likely than those with no history of cancer to eat fruit and vegetables (OR_adj 1.41, 95% CI 1.19–1.66), less likely to engage in physical activity (OR_adj 0.79, 95% CI 0.67–0.93) and more likely to have stopped smoking (OR_adj 1.25, 95% CI 1.09–1.44).

Conclusions:

Most health-related behaviours were better in cancer survivors than the general population, but low physical activity levels may be amenable to health promotion interventions.

Obesity and Weight Loss Attempts among Subjects with a Personal History of Cancer

OBJECTIVES

Obesity is a risk factor for many cancers and obese cancer patients have a poorer prognosis. This study aimed to evaluate the prevalence of obesity and attempts to lose weight among cancer survivors. The effects of cancer treatment and time since cancer treatment were also evaluated.

METHODS

The 2007 Health Information National Trends Survey data were analysed between 2011 and 2013; respondents with (n = 966) and without (n = 6,093) a personal history of cancer were identified. Each respondent's body mass index (BMI) was calculated using self-reported height and weight measurements and categorised as normal (<25 kg/m(2)), overweight (25-29.9 kg/m(2)) or obese (≥30 kg/m(2)).

RESULTS

Cancer survivors were older (mean age = 63.4 versus 44.7 years for those with no history of cancer). Overall, there were similar percentages of overweight (37.6% versus 34.1%; relative risk ratio [RRR] = 0.99; 95% confidence interval [CI]: 0.75-1.31) and obese (31.4% versus 27.5%; RRR = 1.04; 95% CI: 0.79 1.39) respondents among both cancer survivors and those without a history of cancer. Among overweight and obese participants, cancer survivors did not demonstrate increased weight loss attempts compared to those without a history of cancer (61.6% versus 66.3%; odds ratio = 0.94; 95% CI: 0.73 1.20).

CONCLUSION

A high prevalence of overweight and obese cancer survivors were identified without any association with cancer treatment. However, cancer survivors did not demonstrate increased attempts to lose weight in comparison to those without a history of cancer despite awareness of their degree of body fatness. Increased efforts to promote the maintenance of a healthy weight among cancer survivors are needed.

High incidence of prostate cancer metastasis in Afro-Brazilian men with low educational levels: a retrospective observational study

BACKGROUND

This study investigated factors related to ethnicity and educational level, their correlation with tumor stage at the time of diagnosis, and their influence on treatment outcomes in patients with prostate cancer.

METHODS

In this retrospective observational study, we analyzed the medical records of 1,349 male patients treated for prostatic adenocarcinoma. We collected information about sociodemographic variables, including educational level and self-reported skin color. We also classified the disease according whether it was to more likely to present with metastasis and measured the tumor response to treatment.

RESULTS

Less-educated (<8 years of education) individuals were 4.8 times more likely to develop metastasis than those with more education (>11 years of education; p < 0.001). Similarly, patients with a self-reported black skin color had a 300% increased risk of metastasis at diagnosis (p = 0.001). Distant metastasis was independently correlated with worse outcomes, such that individuals with distant metastasis were 10 times more likely to die than were those without distant metastasis.

CONCLUSIONS

Patients with self-reported black skin color and <8 years of education were more likely to display advanced disease at the time of diagnosis compared with their counterparts. Only the presence of metastasis was independently associated with mortality or progressive disease.

Psychometric and factor analytic evaluation of the 15D health-related quality of life instrument: the case of Greece

PURPOSE

To investigate the dimensionality, construct validity in the form of factorial, convergent, discriminant, and known-groups validity, as well as scale reliability of the fifteen dimensional (15D) instrument.

METHODS

15D data were collected from a large Greek general population sample (N = 3,268) which was randomly split into two halves. Data from the first sample were used to examine the distributional properties of the 15 items, as well as the factor structure adopting an exploratory approach. Data from the second sample were used to perform a confirmatory factor analysis of the 15 items, examine the goodness of fit of several measurement models, and evaluate reliability and known-groups validity of the resulting subscales, along with convergent and discriminant validity of the constructs.

RESULTS

Exploratory factor analysis, using a distribution-free method, revealed a three-factor solution of the 15D (functional ability, physiological needs satisfaction, emotional well-being). Confirmatory factor analysis provided support for the three-factor solution but suggested that certain modifications should be made to this solution, involving freeing certain elements of the matrix of factor loadings and of the covariance matrix of measurement errors in the observed variables. Evidence of convergent validity was provided for all three factors, but discriminant validity was supported only for the emotional well-being construct. Scale reliability and known-groups validity of the resulting three subscales were satisfactory.

CONCLUSIONS

Our results confirm the multidimensional structure of the 15D and the existence of three latent factors that cover important aspects of the health-related quality of life domain (physical and emotional functioning). The implications of our results for the validity of the 15D and suggestions for future research are outlined.

Physical and mental health status and health behaviors of survivors of multiple cancers: a national, population-based study

BACKGROUND

Little is known about the unique experience of adults with a history of multiple cancer diagnoses (i.e., survivors of multiple cancers).

PURPOSE

This research assessed the health status and health behaviors of survivors of multiple cancers.

METHODS

The health status and health behaviors of 8,734 survivors of multiple cancers, 47,562 survivors of a single cancer, and 348,229 non-cancer controls were compared using weighted data from the 2009 Behavioral Risk Factor Surveillance System.

RESULTS

Survivors of multiple cancers reported poorer physical and mental health status outcomes (e.g., more mental distress and greater activity limitations) than survivors of a single cancer (all p's < 0.001) who reported poorer outcomes than controls (all p's < 0.001). Survivors of multiple cancers reported unhealthier behaviors than survivors of a single cancer and healthier behaviors than controls on most health behavior outcomes (e.g., alcohol use, tobacco use, and diet) (all p's < 0.001).

CONCLUSIONS

Data suggest the need for clinical interventions to enhance physical and mental health status and to increase adoption of healthier behaviors in survivors of multiple cancers.

Comparison of modifiable health behaviours between persons with and without cancer: the Multiethnic Cohort

OBJECTIVE

To compare the prevalence of modifiable risk factors for cancer and other chronic diseases between adult cancer survivors and persons with no history of cancer.

DESIGN

Cross-sectional.

SETTING

Population-based sample residing in California and Hawaii.

SUBJECTS

A total of 177 003 men and women aged 45-75 years who participated in the Multiethnic Cohort Study (MEC). Logistic regression was used to examine adherence to recommendations regarding modifiable risk factors among cancer survivors (n 16 346) when compared with cohort members with no history of cancer (n 160 657).

RESULTS

Cancer survivors were less likely than cohort members with no history of cancer to meet recommendations specified in the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 2007 report (OR = 0·97; 95 % CI 0·96, 0·99). No difference between groups was seen for adherence to dietary recommendations alone (OR = 0·99; 95 % CI 0·98, 1·01). Site-specific analyses showed that results for colorectal cancer were similar to those for all cancers combined, but survivors of breast (OR = 1·04; 95 % CI 1·02, 1·07) and prostate (OR = 1·04; 95 % CI 1·01, 1·07) cancer were more likely to meet dietary recommendations. Latino survivors were less likely to adhere to WCRF/AICR recommendations than Latino controls; however, differences across ethnic groups were not significant (Pinteraction = 0·64).

CONCLUSIONS

The modest differences found between adult cancer survivors and persons with no history of cancer suggest that a diagnosis of cancer in itself may not be associated with improvements in health behaviours related to cancer and other chronic diseases.

A descriptive study of functions, symptoms, and perceived health state after radiotherapy for prostate cancer

PURPOSE

To explore the impact of prostate cancer treatment on: (a) the experience of symptoms (i.e. sexual, urinary, and bowel), and (b) perceived health state of men with prostate cancer one month following their radiation treatment.

METHODS

A prospective pre-test-post-test descriptive survey was conducted on a convenience sample of 73 men with prostate cancer who were recruited from a Regional Cancer Centre in Southwestern Ontario, Canada. Participants receiving radiation treatment (brachy therapy, high dose radiation [HDR] and external beam radiation [EBR], or EBR alone) completed a questionnaire that elicited information pertaining to quality of life (QOL), symptom experiences, and perceived health state prior to, and one month after completion of their radiation treatment.

RESULTS

Post-treatment scores showed increased problems with urinary bother (p<0.001) and function (p<0.001), bowel bother (p=0.002) and function (p=0.001), and sexual function (p<0.001). The results also suggested that urinary bother, sexual bother, and pain were independent predictors of the perceived health state of participants after radiation treatment.

DISCUSSION

Our findings suggest that prostate cancer treatment presents a challenge with regard to symptom experiences and perceived health state in men with prostate cancer. Therefore, strategies for patient education to assist men to cope with their symptoms and to provide them with support in the initial weeks following treatment are discussed.

The effect of race on the discriminatory accuracy of models to predict biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases

To evaluate whether race modifies the accuracy of nomograms to predict biochemical recurrence (BCR) after radical prostatectomy among subjects from the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases. Retrospective analysis of 1721 and 4511 subjects from the SEARCH and DPC cohorts, respectively. The discrimination accuracy for BCR of seven previously published predictive models was assessed using concordance index and compared between African-American men (AAM) and Caucasian men (CM). AAM represented 44% of SEARCH and 14% of DPC. In both cohorts, AAM were more likely to experience BCR than CM (P<0.01). In SEARCH, the mean concordance index across all seven models was lower in AAM (0.678) than CM (0.715), though the mean difference between CM and AAM was modest (0.037; range 0.015-0.062). In DPC the overall mean concordance index for BCR across all seven nomograms was 0.686. In contrast to SEARCH, the mean concordance index in DPC was higher in AAM (0.717) than CM (0.681), though the mean differences between CM and AAM was modest (-0.036; range -0.078 to -0.004). Across all seven models for predicting BCR, the discriminatory accuracy was better among CM in SEARCH and better among AAM in DPC. The mean difference in discriminatory accuracy of all seven nomograms between AAM and CM was approximately 3-4%. This indicates that currently used predictive models have similar performances among CM and AAM. Therefore, nomograms represent a valid and accurate method to predict BCR regardless of race.