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Cancer Causes & Control

, Volume 30, Issue 12, pp 1327–1339 | Cite as

Correlates of poor adherence to a healthy lifestyle among a diverse group of colorectal cancer survivors

  • Cindy K. BlairEmail author
  • Jean A. McDougall
  • Vi K. Chiu
  • Charles L. Wiggins
  • Ashwani Rajput
  • Elizabeth M. Harding
  • Anita Y. Kinney
Original Paper

Abstract

Purpose

Lifestyle factors may have a synergistic effect on health. We evaluated the correlates of poor adherence to a healthy lifestyle among a diverse sample of colorectal cancer (CRC) survivors to inform future lifestyle promotion programs.

Methods

Lifestyle questions from a cross-sectional survey were completed by 283 CRC survivors (41% Hispanic, 40% rural, 33% low income). Adherence to recommendations (yes/no) for physical activity, fruit and vegetable servings/day, avoiding tobacco, and healthy weight was summed to create an overall lifestyle quality score. Polytomous logistic regression was used to evaluate correlates of good (reference group), moderate, and poor overall lifestyle quality. Potential correlates included sociodemographic characteristics, cancer-related factors, and indicators of health and well-being.

Results

CRC survivors with poor adherence were 2- to 3.4-fold significantly more likely to report multiple comorbidities, poor physical functioning, fatigue, anxiety/depressive symptoms, and poor social participation. In multivariable analyses, poor physical functioning was the only significant correlate of poor adherence to lifestyle recommendations, compared to good adherence [OR (95% CI) 3.4 (1.8–6.4)]. The majority of survivors, 71% and 78%, indicated interest in receiving information on exercise and eating a healthy diet, respectively.

Conclusion

Future lifestyle promotion programs for CRC survivors should carefully consider indicators of physical and psychosocial health and well-being, especially poor physical functioning, in the design, recruitment, and implementation of these health programs.

Keywords

Cancer survivors Colorectal cancer Physical activity Diet Rural Lifestyle behaviors Modifiable risk factors 

Notes

Acknowledgments

This work was supported by the University of New Mexico Comprehensive Cancer Center (P30CA118100) and by Contract HHSN261201800014I, Task Order HHSN26100001 from the National Cancer Institute. CKB is supported by an NIH K07 Grant CA215937.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH et al (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66(4):271–289.  https://doi.org/10.3322/caac.21349 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Overholser LS, Callaway C (2018) Preventive health in cancer survivors: what should we be recommending? J Natl Compr Canc Netw 16(10):1251–1258.  https://doi.org/10.6004/jnccn.2018.7083 CrossRefPubMedGoogle Scholar
  3. 3.
    Primrose JN, Perera R, Gray A, Rose P, Fuller A, Corkhill A et al (2014) Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA 311(3):263–270.  https://doi.org/10.1001/jama.2013.285718 CrossRefPubMedGoogle Scholar
  4. 4.
    Tjandra JJ, Chan MK (2007) Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum 50(11):1783–1799.  https://doi.org/10.1007/s10350-007-9030-5 CrossRefPubMedGoogle Scholar
  5. 5.
    Mariotto AB, Rowland JH, Ries LA, Scoppa S, Feuer EJ (2007) Multiple cancer prevalence: a growing challenge in long-term survivorship. Cancer Epidemiol Biomark Prev 16(3):566–571.  https://doi.org/10.1158/1055-9965.EPI-06-0782 CrossRefGoogle Scholar
  6. 6.
    Deimling GT, Arendt JA, Kypriotakis G, Bowman KF (2009) Functioning of older, long-term cancer survivors: the role of cancer and comorbidities. J Am Geriatr Soc 57(Suppl 2):S289–S292.  https://doi.org/10.1111/j.1532-5415.2009.02515.x CrossRefPubMedGoogle Scholar
  7. 7.
    Stava CJ, Jimenez C, Hu MI, Vassilopoulou-Sellin R (2009) Skeletal sequelae of cancer and cancer treatment. J Cancer Surv 3(2):75–88.  https://doi.org/10.1007/s11764-009-0083-4 CrossRefGoogle Scholar
  8. 8.
    Hewitt M, Rowland JH, Yancik R (2003) Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci 58(1):82–91CrossRefGoogle Scholar
  9. 9.
    Singh S, Earle CC, Bae SJ, Fischer HD, Yun L, Austin PC et al (2016) Incidence of diabetes in colorectal cancer survivors. J Natl Cancer Inst 108(6):402.  https://doi.org/10.1093/jnci/djv402 CrossRefGoogle Scholar
  10. 10.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830.  https://doi.org/10.1200/JCO.2005.01.230 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Weaver KE, Foraker RE, Alfano CM, Rowland JH, Arora NK, Bellizzi KM et al (2013) Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv 7(2):253–261.  https://doi.org/10.1007/s11764-013-0267-9 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Blanchard CM, Courneya KS, Stein K (2008) Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol 26(13):2198–2204.  https://doi.org/10.1200/JCO.2007.14.6217 CrossRefPubMedGoogle Scholar
  13. 13.
    LeMasters TJ, Madhavan SS, Sambamoorthi U, Kurian S (2014) Health behaviors among breast, prostate, and colorectal cancer survivors: a US population-based case-control study, with comparisons by cancer type and gender. J Cancer Surv 8(3):336–348.  https://doi.org/10.1007/s11764-014-0347-5 CrossRefGoogle Scholar
  14. 14.
    WCRF/AICR (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. World Cancer Research Fund/American Institute for Cancer Research, Washington, DC.Google Scholar
  15. 15.
    Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV et al (2012) American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62(1):30–67.  https://doi.org/10.3322/caac.20140 CrossRefPubMedGoogle Scholar
  16. 16.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin.  https://doi.org/10.3322/caac.21142 CrossRefPubMedGoogle Scholar
  17. 17.
    Denlinger CS, Ligibel JA, Are M, Baker KS, Demark-Wahnefried W, Dizon D et al (2014) Survivorship: healthy lifestyles, version 2.2014. J Natl Compr Canc Netw 12(9):1222–1227CrossRefGoogle Scholar
  18. 18.
    El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML et al (2015) American Cancer Society colorectal cancer survivorship care guidelines. CA Cancer J Clin 65(6):428–455.  https://doi.org/10.3322/caac.21286 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Van Blarigan EL, Fuchs CS, Niedzwiecki D, Zhang S, Saltz LB, Mayer RJ et al (2018) Association of survival with adherence to the American Cancer Society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis: the CALGB 89803/alliance trial. JAMA Oncol 4(6):783–790.  https://doi.org/10.1001/jamaoncol.2018.0126 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    McCullough ML, Patel AV, Kushi LH, Patel R, Willett WC, Doyle C et al (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomark Prev 20(6):1089–1097.  https://doi.org/10.1158/1055-9965.EPI-10-1173 CrossRefGoogle Scholar
  21. 21.
    Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH et al (2018) Impact of healthy lifestyle factors on life expectancies in the US population. Circulation.  https://doi.org/10.1161/CIRCULATIONAHA.117.032047 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Jacob ME, Yee LM, Diehr PH, Arnold AM, Thielke SM, Chaves PH et al (2016) Can a healthy lifestyle compress the disabled period in older adults? J Am Geriatr Soc 64(10):1952–1961.  https://doi.org/10.1111/jgs.14314 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Rohan EA, Townsend JS, Fairley TL, Stewart SL (2015) Health behaviors and quality of life among colorectal cancer survivors. J Natl Compr Canc Netw 13(3):297–302CrossRefGoogle Scholar
  24. 24.
    Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ et al (2018) Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin 68(1):31–54.  https://doi.org/10.3322/caac.21440 CrossRefPubMedGoogle Scholar
  25. 25.
    Spring B, King AC, Pagoto SL, Van Horn L, Fisher JD (2015) Fostering multiple healthy lifestyle behaviors for primary prevention of cancer. Am Psychol 70(2):75–90.  https://doi.org/10.1037/a0038806 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Liao J, Muniz-Terrera G, Scholes S, Hao Y, Chen YM (2018) Lifestyle index for mortality prediction using multiple ageing cohorts in the USA, UK and Europe. Sci Rep 8(1):6644.  https://doi.org/10.1038/s41598-018-24778-1 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Breedveld-Peters JJL, Koole JL, Muller-Schulte E, van der Linden BWA, Windhausen C, Bours MJL et al (2018) Colorectal cancers survivors' adherence to lifestyle recommendations and cross-sectional associations with health-related quality of life. Br J Nutr 120(2):188–197.  https://doi.org/10.1017/S0007114518000661 CrossRefPubMedGoogle Scholar
  28. 28.
    Grimmett C, Bridgewater J, Steptoe A, Wardle J (2011) Lifestyle and quality of life in colorectal cancer survivors. Qual Life Res 20(8):1237–1245.  https://doi.org/10.1007/s11136-011-9855-1 CrossRefPubMedGoogle Scholar
  29. 29.
    Schlesinger S, Walter J, Hampe J, von Schonfels W, Hinz S, Kuchler T et al (2014) Lifestyle factors and health-related quality of life in colorectal cancer survivors. Cancer Causes Control 25(1):99–110.  https://doi.org/10.1007/s10552-013-0313-y CrossRefPubMedGoogle Scholar
  30. 30.
    Thomson CA, McCullough ML, Wertheim BC, Chlebowski RT, Martinez ME, Stefanick ML et al (2014) Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women's health initiative. Cancer Prev Res 7(1):42–53.  https://doi.org/10.1158/1940-6207.CAPR-13-0258 CrossRefGoogle Scholar
  31. 31.
    National Cancer Institute. Cancer health disparities definitions. https://www.cancer.gov/about-nci/organization/crchd/about-health-disparities/definitions. Accessed 31 Dec 2018.
  32. 32.
    McDougall JA, Banegas MP, Wiggins CL, Chiu VK, Rajput A, Kinney AY (2018) Rural disparities in treatment-related financial hardship and adherence to surveillance colonoscopy in diverse colorectal cancer survivors. Cancer Epidemiol Biomark Prev 27(11):1275–1282.  https://doi.org/10.1158/1055-9965.EPI-17-1083 CrossRefGoogle Scholar
  33. 33.
    van Zutphen M, Kampman E, Giovannucci EL, van Duijnhoven FJB (2017) Lifestyle after colorectal cancer diagnosis in relation to survival and recurrence: a review of the literature. Curr Colorectal Cancer Rep 13(5):370–401.  https://doi.org/10.1007/s11888-017-0386-1 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    World Health Organization. Obesity and overweight fact sheet no. 311. https://www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed May 2012.
  35. 35.
    Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395.  https://doi.org/10.1249/01.MSS.0000078924.61453.FB CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) (2005) https://sites.google.com/site/theipaq/scoring-protocol. Accessed 1 Jan 2019
  37. 37.
    USDA Economic Research Service. Rural-urban commuting area (RUCA) codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/. Accessed 1 Jan 2019
  38. 38.
    USDA Economic Research Service. Rural-urban commuting area (RUCA) codes—documentation. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation/. Accessed 1 Jan 2019
  39. 39.
    U.S. Department of Health & Human Services. Office of the assistant secretary for planning and evaluation: 2015 poverty guidelines (updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2)). https://aspe.hhs.gov/2015-poverty-guidelines. Accessed 1 Jan 2019.
  40. 40.
    Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D (1999) Reliability and validity of the functional assessment of cancer therapy-colorectal (FACT-C) quality of life instrument. Qual Life Res 8(3):181–195CrossRefGoogle Scholar
  41. 41.
    McCaul KD, Goetz PW. NIH Division of Cancer Control & Population Sciences, Behavioral Research Program. Constructs and measures of health behavior: worry. https://cancercontrol.cancer.gov/brp/research/constructs/worry.html
  42. 42.
    Mullens AB, McCaul KD, Erickson SC, Sandgren AK (2004) Coping after cancer: risk perceptions, worry, and health behaviors among colorectal cancer survivors. Psychooncology 13(6):367–376.  https://doi.org/10.1002/pon.751 CrossRefPubMedGoogle Scholar
  43. 43.
    Glanz K, Grove J, Le Marchand L, Gotay C (1999) Underreporting of family history of colon cancer: correlates and implications. Cancer Epidemiol Biomark Prev 8(7):635–639Google Scholar
  44. 44.
    Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582–592.  https://doi.org/10.1097/01.MLR.0000062554.74615.4C CrossRefPubMedGoogle Scholar
  45. 45.
    Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate—a practical and powerful approach to multiple testing. J R Stat Soc B 57(1):289–300Google Scholar
  46. 46.
    Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M et al (2011) Gait speed and survival in older adults. JAMA 305(1):50–58.  https://doi.org/10.1001/jama.2010.1923 CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Onder G, Penninx BW, Ferrucci L, Fried LP, Guralnik JM, Pahor M (2005) Measures of physical performance and risk for progressive and catastrophic disability: results from the Women's Health and Aging Study. J Gerontol Ser A Biol Sci Med Sci 60(1):74–79CrossRefGoogle Scholar
  48. 48.
    Blair CK, Morey MC, Desmond RA, Cohen HJ, Sloane R, Snyder DC et al (2014) Light-intensity activity attenuates functional decline in older cancer survivors. Med Sci Sports Exerc 46(7):1375–1383.  https://doi.org/10.1249/MSS.0000000000000241 CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Morey MC, Blair CK, Sloane R, Cohen HJ, Snyder DC, Demark-Wahnefried W (2015) Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions. Cancer 121(24):4433–4440.  https://doi.org/10.1002/cncr.29684 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Prochaska JJ, Spring B, Nigg CR (2008) Multiple health behavior change research: an introduction and overview. Prev Med 46(3):181–188.  https://doi.org/10.1016/j.ypmed.2008.02.001 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Amireault S, Fong AJ, Sabiston CM (2018) Promoting healthy eating and physical activity behaviors: a systematic review of multiple health behavior change interventions among cancer survivors. Am J Lifestyle Med 12(3):184–199.  https://doi.org/10.1177/1559827616661490 CrossRefPubMedGoogle Scholar
  52. 52.
    Geller K, Lippke S, Nigg CR (2017) Future directions of multiple behavior change research. J Behav Med. 40(1):194–202.  https://doi.org/10.1007/s10865-016-9809-8 CrossRefPubMedGoogle Scholar
  53. 53.
    King TK, Marcus BH, Pinto BM, Emmons KM, Abrams DB (1996) Cognitive-behavioral mediators of changing multiple behaviors: smoking and a sedentary lifestyle. Prev Med 25(6):684–691.  https://doi.org/10.1006/pmed.1996.0107 CrossRefPubMedGoogle Scholar
  54. 54.
    Spring B, Pellegrini C, McFadden HG, Pfammatter AF, Stump TK, Siddique J et al (2018) Multicomponent mHealth intervention for large, sustained change in multiple diet and activity risk behaviors: the make better choices 2 randomized controlled trial. J Med Internet Res 20(6):e10528.  https://doi.org/10.2196/10528 CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Lei H, Nahum-Shani I, Lynch K, Oslin D, Murphy SA (2012) A "SMART" design for building individualized treatment sequences. Annu Rev Clin Psychol 8:21–48.  https://doi.org/10.1146/annurev-clinpsy-032511-143152 CrossRefPubMedGoogle Scholar
  56. 56.
    Almirall D, Nahum-Shani I, Sherwood NE, Murphy SA (2014) Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research. Transl Behav Med 4(3):260–274.  https://doi.org/10.1007/s13142-014-0265-0 CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Naar S, Czajkowski SM, Spring B (2018) Innovative study designs and methods for optimizing and implementing behavioral interventions to improve health. Health Psychol 37(12):1081–1091.  https://doi.org/10.1037/hea0000657 CrossRefPubMedGoogle Scholar
  58. 58.
    Buscemi J, Janke EA, Kugler KC, Duffecy J, Mielenz TJ, St George SM et al (2017) Increasing the public health impact of evidence-based interventions in behavioral medicine: new approaches and future directions. J Behav Med 40(1):203–213.  https://doi.org/10.1007/s10865-016-9773-3 CrossRefPubMedGoogle Scholar
  59. 59.
    Bail JR, Fruge AD, Cases MG, De Los Santos JF, Locher JL, Smith KP et al (2018) A home-based mentored vegetable gardening intervention demonstrates feasibility and improvements in physical activity and performance among breast cancer survivors. Cancer 124(16):3427–3435.  https://doi.org/10.1002/cncr.31559 CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Demark-Wahnefried W, Cases MG, Cantor AB, Fruge AD, Smith KP, Locher J et al (2018) Pilot randomized controlled trial of a home vegetable gardening intervention among older cancer survivors shows feasibility, satisfaction, and promise in improving vegetable and fruit consumption, reassurance of worth, and the trajectory of central adiposity. J Acad Nutr Diet 118(4):689–704.  https://doi.org/10.1016/j.jand.2017.11.001 CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Campo RA, Agarwal N, LaStayo PC, O'Connor K, Pappas L, Boucher KM et al (2014) Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of Qigong. J Cancer Surviv 8(1):60–69.  https://doi.org/10.1007/s11764-013-0315-5 CrossRefPubMedGoogle Scholar
  62. 62.
    Chan JS, Ho RT, Chung KF, Wang CW, Yao TJ, Ng SM et al (2014) Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness. Evid Based Complement Alternat Med 2014:106048.  https://doi.org/10.1155/2014/106048 CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Larkey LK, Roe DJ, Weihs KL, Jahnke R, Lopez AM, Rogers CE et al (2015) Randomized controlled trial of Qigong/Tai Chi easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med 49(2):165–176.  https://doi.org/10.1007/s12160-014-9645-4 CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Oh B, Butow P, Mullan B, Clarke S, Beale P, Pavlakis N et al (2010) Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol 21(3):608–614.  https://doi.org/10.1093/annonc/mdp479 CrossRefPubMedGoogle Scholar
  65. 65.
    Lan C, Chou SW, Chen SY, Lai JS, Wong MK (2004) The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners. Am J Chin Med 32(1):141–150.  https://doi.org/10.1142/S0192415X04001734 CrossRefPubMedGoogle Scholar
  66. 66.
    Larkey L, Jahnke R, Etnier J, Gonzalez J (2009) Meditative movement as a category of exercise: implications for research. J Phys Act Health 6(2):230–238CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of New MexicoAlbuquerqueUSA
  2. 2.University of New Mexico Comprehensive Cancer CenterAlbuquerqueUSA
  3. 3.Department of SurgeryUniversity of New MexicoAlbuquerqueUSA
  4. 4.Department of Health, Exercise, and Sports SciencesUniversity of New MexicoAlbuquerqueUSA
  5. 5.Department of Epidemiology, School of Public HealthRutgers UniversityNew BrunswickUSA
  6. 6.Rutgers Cancer Institute of New JerseyNew BrunswickUSA

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