Journal of Cancer Survivorship

, Volume 4, Issue 1, pp 20–32 | Cite as

Health-related behavior change after cancer: results of the American Cancer Society’s studies of cancer survivors (SCS)

  • Nikki A. HawkinsEmail author
  • Tenbroeck Smith
  • Luhua Zhao
  • Juan Rodriguez
  • Zahava Berkowitz
  • Kevin D. Stein



Cancer survivors are known to make positive health-related behavior changes after cancer, but less is known about negative behavior changes and correlates of behavior change. The present study was undertaken to examine positive and negative behavior changes after cancer and to identify medical, demographic, and psychosocial correlates of changes.


We analyzed data from a cross-sectional survey of 7,903 cancer survivors at 3, 6, and 11 years after diagnosis.


Of 15 behaviors assessed, survivors reported 4 positive and 1 or 0 negative behavior changes. Positive change correlated with younger age, greater education, breast cancer, longer time since diagnosis, comorbidities, vitality, fear of recurrence, and spiritual well-being, while negative change correlated with younger age, being non-Hispanic African American, being widowed, divorced or separated, and lower physical and emotional health. Faith mediated the relationship between race/ethnicity and positive change.


Cancer survivors were more likely to make positive than negative behavior changes after cancer. Demographic, medical, and psychosocial variables were associated with both types of changes.

Implications for cancer survivors

Results provide direction for behavior interventions and illustrate the importance of looking beyond medical and demographic variables to understand the motivators and barriers to positive behavior change after cancer.


Cancer survivors Health behavior Behavior change Spiritual well-being 



The American Cancer Society (ACS) Studies of Cancer Survivors (SCS) were funded as an intramural program of research conducted by the ACS Behavioral Research Center. We wish to acknowledge the cooperation and efforts of the cancer registries and public health departments from the states of Arizona, California (Regions 2–6), Colorado, Delaware, Illinois, Iowa, Maine, Massachusetts, Michigan, Nebraska, New Jersey, Pennsylvania, Washington, and Wyoming. We also thank the staff of the hundreds of hospitals that reported cases to the participating cancer registries. Lastly, we are grateful to the thousands of cancer survivors, their physicians, and their loved ones who contributed to the collection of these data. The authors assume full responsibility for analyses and interpretation of these data.


  1. 1.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23:5814–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Humpel N, Magee C, Jones SC. The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends. Support Cancer Care. 2007;15:621–30.CrossRefGoogle Scholar
  3. 3.
    Ganz PA. Late effects of cancer and its treatment. Semin Oncol Nurs. 2001;17:241–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Pinto BM, Eakin E, Maruyama NC. Health behavior changes after a cancer diagnosis: what do we know and where do we go from here? Ann Behav Med. 2000;22:38–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Blanchard CM, Denniston MM, Baker F, Ainsworth SR, Courneya KS, Hann DM, et al. Do adults change their behaviors after a cancer diagnosis? Am J Health Behav. 2003;27:246–56.PubMedGoogle Scholar
  6. 6.
    Patterson RE, Neuhouser ML, Hedderson MM, Schwartz SM, Standish LJ, Bowen DJ. Changes in diet, physical activity, and supplement use among adults diagnosed with cancer. J Am Diet Assoc. 2003;103:323–8.PubMedGoogle Scholar
  7. 7.
    Satia JA, Campbell MK, Galanko JA, James A, Carr C, Sandler RS. Longitudinal changes in health behaviors and health status in colon cancer survivors. Cancer Epidemiol Biomarkers Prev. 2004;13:1022–31.PubMedGoogle Scholar
  8. 8.
    Maskarinec G, Murphy S, Shumay DM, Kakai H. Dietary changes among cancer survivors. Eur J Cancer Care. 2001;10:12–20.CrossRefGoogle Scholar
  9. 9.
    Maunsell E, Drolet M, Brisson J, Robert J, Descenes L. Dietary change after breast cancer: extent, predictors, and relation with psychological distress. J Clin Oncol. 2002;20:1017–25.CrossRefPubMedGoogle Scholar
  10. 10.
    Greenlee H, et al. Supplement use among cancer survivors in the Vitamin and Behavior (VITAL) study cohort. J Altern Complement Med. 2004;10:660–6.PubMedGoogle Scholar
  11. 11.
    Hounshell J, Tomori C, Newlin R, Knox K, Rundhaugen L, Tallman M, et al. Changes in finances, insurance, employment, and behavior among persons diagnosed with hairy cell leukemia. Oncologist. 2001;6:435–40.CrossRefPubMedGoogle Scholar
  12. 12.
    Humpel N, Jones SC. Gaining insight into the what, why, and where of complementary and alternative medicine use by cancer patients and survivors. Eur J Cancer Care. 2006;15:362–8.CrossRefGoogle Scholar
  13. 13.
    Lawsin C, DuHamel K, Itzkowitz S, Brown K, Lim H, Thelemaque L, et al. Demographic, medical, and psychosocial correlates to CAM use among survivors of colorectal cancer. Support Cancer Care. 2007;15:557–64.CrossRefGoogle Scholar
  14. 14.
    Ostroff J, Garland J, Moadel A, Fleshner N, Hay J, Cramer L, et al. Cigarette smoking patters in patients after treatment of bladder cancer. J Cancer Educ. 2000;15:86–90.PubMedGoogle Scholar
  15. 15.
    Pinto BM, Trunzo JJ. Health behaviors during and after a cancer diagnosis. Cancer. 2005;104:2614–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Vander Ark W, DiNardo LJ, Oliver DS. Factors affecting smoking cessation in patients with head and neck cancer. Laryngoscope. 1997;107:888–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Allison PJ. Factors associated with smoking and alcohol consumption following treatment for head and neck cancer. Oral Oncol. 2001;37:513–20.CrossRefPubMedGoogle Scholar
  18. 18.
    Duffy SA, Terrell JE, Valenstein M, Ronis DL, Copeland LA, Connors M. Effects of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. Gen Hosp Psychiatry. 2002;24:140–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Bellizzi KM, Miller MF, Arora NK, Rowland JH. Positive and negative life changes experienced by survivors of non-Hodgkin’s Lymphoma. Ann Behav Med. 2007;34:188–99.CrossRefPubMedGoogle Scholar
  20. 20.
    Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Berlin TR. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94:39–49.PubMedGoogle Scholar
  21. 21.
    Glanz K, Lerman C. Psychosocial impact of breast cancer: a critical review. Ann Behav Med. 1992;14:204–12.Google Scholar
  22. 22.
    Park CL, Edmondson D, Fenster JR, Blank TO. Positive and negative health behavior changes in cancer survivors. J Health Psychol. 2008;13:1198–206.CrossRefPubMedGoogle Scholar
  23. 23.
    Blanchard CM, Stein KD, Baker F, Dent MF, Denniston MM, Courneya KS, et al. Association between current behaviors and health related quality of life in breast, colorectal, and prostate cancer survivors. Psychol Health. 2004;19:1–13.CrossRefGoogle Scholar
  24. 24.
    Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000;88:674–84.CrossRefPubMedGoogle Scholar
  25. 25.
    Gritz ER, Nisenbaum R, Elashoff RE, Holmes EC. Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. Cancer Causes Controls. 1991;2:105–12.CrossRefGoogle Scholar
  26. 26.
    McBride CM, Clipp E, Peterson BL, Lipkus IM, Demark-Wahnefried W. Psychological impact of diagnosis and risk reduction among cancer survivors. Psychooncology. 2000;9:418–27.CrossRefPubMedGoogle Scholar
  27. 27.
    Park CL, Gaffey AE. Relationships between psychosocial factors and health behavior change in cancer survivors: an integrative review. Ann Behav Med. 2007;34:115–34.CrossRefPubMedGoogle Scholar
  28. 28.
    Hamilton JB, Powe BD, Pollard AB, Lee KJ, Felton AM. Spirituality among African American cancer survivors: having a personal relationship with God. Cancer Nurs. 2007;304:309–16.CrossRefGoogle Scholar
  29. 29.
    Krupski TL, Kwan L, Fink A, Sonn GA, Maliski S, Litwin MS. Spirituality influences health related quality of life in men with prostate cancer. Psychooncology. 2006;15:121–31.CrossRefPubMedGoogle Scholar
  30. 30.
    Levine EG, Targ E. Spiritual correlates of functional well-being in women with breast cancer. Integr Cancer Ther. 2002;1:166–74.CrossRefPubMedGoogle Scholar
  31. 31.
    Perkins EA, Small BJ, Balducci L, Exterman M, Robb C, Haley WE. Individual differences in well-being in older breast cancer survivors. Crit Rev Oncol Hematol. 2007;62:74–83.CrossRefPubMedGoogle Scholar
  32. 32.
    Jim SH, Richardson SA, Golden-Kreutz DM, Andersen BL. Strategies used in coping with a cancer diagnosis predicts meaning in life for survivors. Health Psychol. 2006;25:621–30.CrossRefGoogle Scholar
  33. 33.
    Levine EG, Yoo G, Aviv C, Ewing C, Au A. Ethnicity and spirituality in breast cancer survivors. J Cancer Surviv. 2007;1:212–25.CrossRefPubMedGoogle Scholar
  34. 34.
    Smith AK, McCarthy EP, Paulk E, Balboni TA, Maciejewski PK, Block SD, et al. Racial and ethnic differences in advance care planning among patients with cancer: impact of terminal illness acknowledgement, religiousness, and treatment preferences. J Clin Oncol. 2008;26:4131–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Kurtz ME, Wyatt G, Kurtz JC. Psychological and sexual well-being, philosophical/spiritual views, and health habits of long-term cancer survivors. Health Care Women Int. 1995;16:253–62.CrossRefPubMedGoogle Scholar
  36. 36.
    Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11:1–47.PubMedGoogle Scholar
  37. 37.
    Ajzen I. The theory of planned behavior. Organ Behav Hum Dec. 1991;50:179–211.CrossRefGoogle Scholar
  38. 38.
    Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psychooncology. 2006;15:306–20.CrossRefPubMedGoogle Scholar
  39. 39.
    Stein KD, Smith T, Kim Y, Mehta CC, Stafford J, Spillers RL, et al. The American Cancer Society’s studies of cancer survivors: the largest, most diverse investigation of long-term cancer survivors so far. Am J Nurs. 2006;106:83–5.PubMedGoogle Scholar
  40. 40.
    Smith T, Stein KD, Mehta CC, Kaw C, Kepner JL, Buskirk T, et al. The rationale, design, and implementation of the American Cancer Society’s studies of cancer survivors. Cancer. 2007;109:1–12.CrossRefPubMedGoogle Scholar
  41. 41.
    Mullens AB, McCaul KD, Erickson SC, Sandgren AK. Coping after cancer: risk perceptions, worry and health behaviors among colorectal cancer survivors. Psychooncology. 2004;13:367–76.CrossRefPubMedGoogle Scholar
  42. 42.
    Wayne SJ, Lopez ST, Butler LM, Baumgartner KB, Baumgartner RN, Ballard-Barbash R. Changes in dietary intake after diagnosis of breast cancer. J Am Diet Assoc. 2004;104:1561–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Ware JE, Sherbourne CD. The MOS 36 item short form health survey (SF-36): conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefPubMedGoogle Scholar
  44. 44.
    Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res. 1998;152:396–411.PubMedGoogle Scholar
  45. 45.
    Penson DF, Stoddard ML, Pasta DJ, Lubeck DP, Flanders SC, Litwin MS. The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer. J Clin Epidemiol. 2001;54:350–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Stein KD, Denniston M, Baker F, Dent M, Hann DM, Bushhouse S, et al. Validation of a modified Rotterdam symptom checklist for use with cancer patients in the United States. J Pain Symptom Manage. 2003;26:975–89.CrossRefPubMedGoogle Scholar
  47. 47.
    Baker F, Zabora J, Polland A, Wingard J. Reintegration after bone marrow transplantation. Cancer Pract. 1999;7:190–7.CrossRefPubMedGoogle Scholar
  48. 48.
    Zhao L, Smith T, Portier K, Stein KD. Latent factor determination for the cancer problems in living scale (CPILS). Ann Behav Med. 2007;33:S153.Google Scholar
  49. 49.
    Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology. 1999;8:417–28.CrossRefPubMedGoogle Scholar
  50. 50.
    Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the functional assessment of cancer therapy—spiritual well-being scale (FACIT-Sp). Ann Behav Med. 2002;24:49–58.CrossRefPubMedGoogle Scholar
  51. 51.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.CrossRefPubMedGoogle Scholar
  52. 52.
    Bellizzi KM, Rowland JH, Jeffery DD, McNell T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23:8884–93.CrossRefPubMedGoogle Scholar
  53. 53.
    Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML. Life after cancer epidemiology (LACE) study: a cohort of early stage breast cancer survivors. Cancer Causes Controls. 2005;16:545–56.CrossRefGoogle Scholar
  54. 54.
    Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and non-cancer controls. Prev Med. 2005;40:702–11.CrossRefPubMedGoogle Scholar
  55. 55.
    Blanchard CM, Courneya KS, Stein K. 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. 2008;26:2198–204.CrossRefPubMedGoogle Scholar
  56. 56.
    Demark-Wahnefried W, Pinto BM, Gritz ER. Promoting health and physical function among cancer survivors: potential for prevention and questions that remain. J Clin Oncol. 2006;24:5125–31.CrossRefPubMedGoogle Scholar
  57. 57.
    Brown JK, Byers T, Doyle C, Courneya KS, Demark-Wahnefried W, Kushi LH, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2003;53:268–91.CrossRefPubMedGoogle Scholar
  58. 58.
    Courneya KS. Exercise in cancer survivors: an overview of research. Med Sci Sports Exerc. 2003;35:1846–52.CrossRefPubMedGoogle Scholar
  59. 59.
    Centers for Disease Control and Prevention. A national action plan for cancer survivorship: advancing public health strategies. Available at: Accessibility verified June 10, 2008.
  60. 60.
    Humphris GM, Rogers S, McNally D, Lee-Jones C, Brown J, Vaughan D. Fear of recurrence and possible cases of anxiety and depression in orofacial cancer patients. Int J Oral Maxillofac Sur. 2003;32:486–91.Google Scholar
  61. 61.
    Lee-Jones C, Humphris G, Dixon R, Hatcher MB. Fear of cancer recurrence—a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology. 1997;6:95–105.CrossRefPubMedGoogle Scholar
  62. 62.
    Humphris G, Ozakinci G. The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer. Br J Health Psychol. 2008;13:223–30.CrossRefPubMedGoogle Scholar
  63. 63.
    Holt CL, Haire-Joshu DL, Lukwago SN, Lewellyn LA, Kreuter MW. The role of religiosity in dietary beliefs and behaviors among urban African American women. Cancer Control. 2005;12(Suppl 2):84–90.PubMedGoogle Scholar
  64. 64.
    Levin JS, Chatters LM, Taylor RJ. Religious effects on health status and life satisfaction among black Americans. J Gerontol B Psychol Sci Soc Sci. 1995;50:s154–63.PubMedGoogle Scholar
  65. 65.
    Levin JS, Chatters LM, Taylor RJ. Religion, health and medicine in African Americans: implications for physicians. J Natl Med Assoc. 2005;97:237–49.PubMedGoogle Scholar
  66. 66.
    Ross L, Hall I, Fairley T, Taylor Y, Howard D. Prayer and self-reported health among cancer survivors in the United States, National Health Interview Survey, 2002. J Altern Complement Med. 2008;14:931–8.CrossRefPubMedGoogle Scholar
  67. 67.
    Campbell MK, Hudson MA, Resnicow K, Blakeny N, Paxton A, Baskin M. Church-based health promotion interventions: evidence and lessons learned. Annu Rev Public Health. 2007;16:213–34.CrossRefGoogle Scholar
  68. 68.
    Young DR, Stewart KJ. A church-based physical activity intervention for African American women. Fam Community Health. 2006;29:103–17.PubMedGoogle Scholar
  69. 69.
    Reigle BS. The prevention of disablement: a framework for the breast cancer trajectory. Rehabil Nurs. 2006;31:174–9.PubMedGoogle Scholar

Copyright information

© US Government 2009

Authors and Affiliations

  • Nikki A. Hawkins
    • 1
    Email author
  • Tenbroeck Smith
    • 2
  • Luhua Zhao
    • 2
  • Juan Rodriguez
    • 1
  • Zahava Berkowitz
    • 1
  • Kevin D. Stein
    • 2
  1. 1.Centers for Disease Control and Prevention (CDC)Division of Cancer Prevention and ControlAtlantaUSA
  2. 2.American Cancer SocietyBehavioral Research CenterAtlantaUSA

Personalised recommendations