Healthy lifestyle changes during the period before and after cancer diagnosis among breast cancer survivors

Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors

Background

Fear of cancer recurrence or progression (FCR) is common amongst cancer survivors and an important minority develop clinically significant levels of FCR. However, it is unclear how current clinical services might best support the growing numbers of cancer survivors.

Purpose

The aim of this study is to develop recommendations for future research in the management of FCR and propose a model of care to help manage FCR in the growing population of cancer survivors.

Methods

This is a narrative review and synthesis of empirical research relevant to managing FCR. We reviewed meta-analyses, systematic reviews and individual studies that had investigated interventions for FCR.

Results

A recent, well-conducted meta-analysis confirmed a range of moderately effective treatments for FCR. However, many survivors continued to experience clinical levels of FCR after treatment, indicating a clear need to improve the gold standard treatments. Accessibility of interventions is arguably a greater concern. The majority of FCR treatments require face-to-face therapy, with highly skilled psycho-oncologists to produce moderate changes in FCR. With increasing numbers of cancer survivors, we need to consider how to meet the unmet need of cancer survivors in relation to FCR. Although there have been attempts to develop minimal interventions, these are not yet sufficiently well supported to warrant implementation. Attempts to help clinicians to provide information which might prevent the development of clinically significant FCR have shown some early promise, but research is needed to confirm efficacy.

Conclusion

The next decade of research needs to focus on developing preventative approaches for FCR, and minimal interventions for those with mild-to-moderate symptoms. When evidence-based approaches to prevent FCR or manage moderate levels of FCR are available, stepped care approaches that could meet the needs of survivors could be implemented. However, we also need to improve existing interventions for severe FCR.

Lifestyle modifications after the diagnosis of gynecological cancer

Background

The influence of lifestyle factors on the quality of life, incidence and tumor recurrence has been evaluated in several studies and is gaining increasing importance in cancer research. However, the extent of the influence of such lifestyle factors on the quality of life of cancer patients remains largely unclear, as does the number of patients actually pursuing these lifestyle changes. The purpose of this study was to examine the prevalence and predictors of lifestyle changes in patients with gynecological cancer.

Methods

The survey consisted of a pseudonymous questionnaire that was conducted from January to May 2014 via a telephone interview with 141 patients with a gynaecological malignancy who had undergone surgery at our Department of Gynaecology and Obstetrics. Lifestyle factors (diet, physical activity, stress level, alcohol and nicotine consumption) prior to and after the diagnosis of cancer were evaluated.

Results

89% (n = 125) of the patients reported lifestyle changes after being diagnosed with cancer. There was a significant association between the implementation of lifestyle changes and age as well as the use of complementary medicine. Nutrition: 66% of the patients (n = 93) consumed more fruit and vegetables and 65% ate less meat (n = 92). Physical activity: 37% (n = 52) reported no change in their exercise routine, 36% (n = 51) described a decrease, 27% (n = 38) an increase in their physical activity. Subjective feeling of stress: 77% of the patients (n = 108) described a reduction in their perceived level of stress. Nicotine consumption: 63% (n = 12) of the 19 patients who were smokers at the time of the diagnosis quit or reduced smoking thereafter. Alcohol consumption: 47% (n = 61/129) of the patients reduced their alcohol consumption.

Conclusions

Most of the patients from our study group implemented lifestyle changes after being diagnosed with cancer. Prospective randomized trials are needed in order to determine the benefit of lifestyle changes (physical activity, dietary habits and stress reduction) for cancer survivors. The potential impact of lifestyle on the quality of life and the trajectory of the disease should be discussed with all oncological patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01391-5.

Changes in health behaviours and body mass index after a breast cancer diagnosis: results from a prospective cohort study

The aim of the study was to describe changes in health behaviours and BMI after breast cancer diagnosis, depicting the potential influence of sociodemographic, clinical and psychological characteristics. A total of 428 breast cancer patients were prospectively followed for 3 years, since diagnosis. At the end of follow-up, women were classified regarding their adherence to recommendations for cancer prevention, prediagnosis and after 3 years, including not smoking, alcohol consumption up to one drink per day, intake of at least five portions per day of fruits and/or vegetables, physical activity and body mass index (BMI) less than 25.0 kg/m. To quantify associations between patients' characteristics and changes in adherence to each recommendation, age, education and cancer stage-adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Among women adhering to each recommendation before diagnosis, 54.1% reduced their physical activity, 32.4% became overweight or obese and 6.1% reduced fruits and/or vegetables intake, but there were virtually no changes in alcohol consumption or smoking. Older and more educated participants were more likely to reduce their physical activity (OR=4.71, 95% CI: 1.17-18.99; OR=11.53, 95% CI: 2.20-60.53, respectively). Among participants not following each recommendation before diagnosis, 29.1% stopped smoking, 24.6% reduced alcohol consumption, 9.9% became physically active, 7.8% increased fruits and/or vegetables intake and 3.3% reduced their BMI to less than 25.0 kg/m. Older women were less likely to become physically active (OR=0.32, 95% CI: 0.14-0.75). Breast cancer patients showed some positive changes in their health behaviours after diagnosis. However, there is a large margin for improvement, which highlights the importance of health promotion interventions in this context.

Association of striking life events with primary breast cancer in 265 Chinese women: a case-control study

The current case-control study investigated the relationship between striking life events and breast cancer in Chinese women. A total of 265 primary breast cancer patients and 265 controls were enrolled with matching for age and completed questionnaires. Logistic regression analysis was used. Thirty-nine breast cancer patients reported striking life events and twenty-four of the controls reported striking life events. The number of striking life events was significantly greater in patients (p = 0.04). It indicated a striking life event led to a 1.726-fold increased HR (95% CI 1.005-2.965, p < 0.05) for breast cancer with adjustment for age, and a 1.811-fold increased HR (95% CI 1.021 - 3.212, P < 0.05) with adjustment for age, BMI, and late age at menopause. High BMI (OR: 1.680, 95% CI: 1.258-2.196, p < 0.05) and a family history of breast cancer (OR: 2.244, 95% CI: 1.065-4.729, p < 0.05, respectively) increased the risk of breast cancer, and late age at menopause decreased the risk for breast cancer (OR: 0.513, 95% CI: 0.303-0.868, p < 0.05). Our findings indicate a significant association between striking life events and breast cancer in Chinese women, especially in the subpopulation with high BMI or family history of breast cancer.

"What about diet?" A qualitative study of cancer survivors' views on diet and cancer and their sources of information

Given the abundance of misreporting about diet and cancer in the media and online, cancer survivors are at risk of misinformation. The aim of this study was to explore cancer survivors' beliefs about diet quality and cancer, the impact on their behaviour and sources of information. Semi-structured interviews were conducted with adult cancer survivors in the United Kingdom who had been diagnosed with any cancer in adulthood and were not currently receiving treatment (n = 19). Interviews were analysed using Thematic Analysis. Emergent themes highlighted that participants were aware of diet affecting risk for the development of cancer, but were less clear about its role in recurrence. Nonetheless, their cancer diagnosis appeared to be a prompt for dietary change; predominantly to promote general health. Changes were generally consistent with healthy eating recommendations, although dietary supplements and other non-evidence-based actions were mentioned. Participants reported that they had not generally received professional advice about diet and were keen to know more, but were often unsure about information from other sources. The views of our participants suggest cancer survivors would welcome guidance from health professionals. Advice that provides clear recommendations, and which emphasises the benefits of healthy eating for overall well-being, may be particularly well-received.

Do long term cancer survivors have better health-promoting behavior than non-cancer populations?: case-control study in Korea

BACKGROUND

We compared the health-promoting behavior of long-term cancer survivors with those of the general population to identify necessary behavioral interventions to reduce the health risk among cancer patients.

MATERIALS AND METHODS

We used data from the 2007 and 2012 Korea National Health and Nutrition Examination Surveys (KNHANES IV [2007~2009] and KNHANES V [2010~2012]) on smoking status, alcohol use, physical exercise, and disease screening. We compared long-term cancer survivors with members of the general population; the controls were matched by propensity score matching. A multiple logistic regression model was used to investigate the association between cancer status and health-promoting behavior.

RESULTS

Long-term cancer survivors had a lower risk of smoking than the general population controls (OR: 0.42, 95%CI: 0.25-0.71). In addition, the long-term cancer survivors had a lower risk of alcohol use than the general population controls (OR: 0.70, 95%CI: 0.50-0.98). However, in terms of physical exercise and disease screening, no statistically significant differences were detected (physical exercise OR: 1.01, 95%CI: 0.75-1.35; disease screening OR: 1.27, 95%CI: 0.93-1.74). All covariates were adjusted.

CONCLUSIONS

The long-term cancer survivors had a much lower risk of smoking and alcohol use than the general population controls. However, almost no differences in physical exercise and screening for cancer recurrence or secondary disease were detected between the long-term cancer survivors and general population controls. To reduce the health risks and challenges facing long-term cancer survivors, interventions to encourage physical exercise and screening for cancer recurrence and secondary disease should be implemented.

From self-care for healthy people to self-management for cancer patients with cancer portals

Self-care to prevent cancer and self-management to cope with the disease are two discrete effective mechanisms for improving of control and management of neoplasia. Both them have certain strategies and practices. Often the two are used interchangeably despite their different approaches. Strategies of self-care usually refer to prevention at different levels include primary, secondary and tertiary. In contrast, strategies of self-management are related to management and alleviation of unpleasant cancer-related symptoms and treatment-related side effects for improving the quality of life of cancer survivors. Successful promoting of self-care and self-management strategies need people and survivor empowerment. Within this context, innovative approaches open a new window. In this paper after a brief review of related strategies and practices, we provide an explanation of how cancer portals may play an important role in the empowerment process and what are key potentials for implementing of self- care and self-management strategies for cancer.

Living experiences of Indian adult cancer survivors--a brief report

BACKGROUND

This pilot study looked into the physical, social, psychological and economic issues of Indian adult cancer survivors.

MATERIALS AND METHODS

Assumed cancer free patients, after cancer directed therapy (CDT), were assessed on the basis of a questionnaire developed by the investigators. The mental status of the survivors was elicited by modified MINI international neuro-psychiatric interview. This cross sectional assessment was conducted as a direct interaction with each patient for 30 to 45 minutes at a cancer hospital in 2012.

RESULTS

Thirty one adult cancer survivors participated in this study. Median age was 53 years with a median follow up duration of 21.8 months (Range 2.3-194.1 months). The majority (68%) did not receive financial support for treatment. Median interval after CDT to start of activity of daily living was 1.5 months (range: 0-24 months). Fatigue and loss of appetite were reported by 52% and 29% respectively. The cancer diagnosis and its treatment adversely impacted the financial condition in 42% of patients. Nineteen percent each showed social anxiety and post-traumatic stress disorder and another 13% patients reported depression.

CONCLUSIONS

This prospective assessment highlights survivorship issues and the need to address those issues particularly in the context of developing countries where resources and manpower are limited.

Adherence to health-related lifestyle behavior recommendations and association with quality of life among cancer survivors and age-matched controls in Korea

BACKGROUND

This study was conducted to determine the relationship between lifestyle behavior and quality of life (QoL) among cancer survivors in Korea.

MATERIALS AND METHODS

Data for a total of 471 (173 men, 298 women) cancer survivors (CS) over 40 years old were obtained from the database of the 4th Korean National Health and Nutrition Examination Survey (KNHANES IV). An identical number of subjects of the same age, sex, and education who had no restrictions in physical activity were randomly selected from the database and represented the control group (CG). Drinking, smoking, and exercise behavior were assessed.

RESULTS

The number of heavy drinkers was lower in CS (9.4%) than in CG (15.8%) (p<0.01); similarly, there were fewer smokers in CS (9.1%) than in CG (14.0%) (p<0.05). The percentage of individuals engaging in vigorous, moderate, and low-intensity exercise did not differ between CS (13.6%, 14.7%, and 50.0%) and CG (14.3%, 13.4%, and 49.7%, respectively). No differences in Euro QoL Questionnaire 5-Dimensional Classification (EQ-5D) scores on both drinking and smoking behaviors were noted. Compared to the non-exercisers, the low-intensity exercisers in CG (0.91±0.10 vs. 0.94±0.09), vigorous-intensity exercisers in CS (0.84±0.62 vs. 0.91±0.11), and low-intensity exercisers in CS (0.82±0.22 vs. 0.88±0.13) scored higher on the EQ-5D.

CONCLUSIONS

Although cancer survivors practiced more conscious health behavior in drinking and smoking, their engagement in exercise did not differ from that of non-cancer survivors. Since exercise engagement increases QoL in general, implementation of an educational program that promotes exercise engagement in cancer survivors may be required.

Striking life events associated with primary breast cancer susceptibility in women: a meta-analysis study

Purpose

The association between striking life events, an important stress and acute anxiety disorder, and the occurrence of primary breast cancer is unclear. The current meta-analysis was designed to assess the relationship between striking life events and primary breast cancer incidence in women.

Methods

Systematic computerized searching of the PubMed, ScienceDirect, Embase, and BMJ databases with the combinations of controlled descriptors from Mesh, including breast cancer, breast tumor, cancer of breast, mammary carcinoma, life events, life change events, case–control studies, case-base studies, cohort study, and cohort analysis and identified a total of 307 papers published from January 1995 to April 2012. Following evaluation of methodological quality with the Downs & Black criteria, seven case–control or cohort studies were selected and the association between striking life events and primary breast cancer incidence in women was measured using random effect or fixed-effect odds ratios combined with 95% confidence interval.

Results

The seven studies included in the final meta-analysis included 99,807 women. A meta-analysis showed that the pooled OR for striking life events and breast cancer was 1.51 (95% CI 1.15 - 1.97, P = 0.003), indicating that women with striking life events were at 1.5-fold greater risk of developing breast cancer. The pooled OR for severe striking life events and breast cancer was 2.07 (95% CI 1.06 - 4.03), indicating that women with severe striking life events were at 2-fold greater risk of developing breast cancer.

Conclusions

The current meta-analysis showed significant evidence for a positive association between striking life events and primary breast cancer incidence in women.