Journal of Cancer Survivorship

, Volume 10, Issue 2, pp 271–279 | Cite as

Are long-term cancer survivors and physicians discussing health promotion and healthy behaviors?

  • Kelly Kenzik
  • Maria Pisu
  • Mona N. Fouad
  • Michelle Y. MartinEmail author



This study aimed to (1) describe the proportion of survivors reporting that a physician discussed strategies to improve health and (2) identify which groups are more likely to report these discussions.


Lung cancer and colorectal cancer (CRC) survivors (>5 years from diagnosis) (n = 874) completed questionnaires, including questions on whether, in the previous year, a physician discussed (1) strategies to improve health, (2) exercise, and (3) diet habits. Chi-square tests and logistic regression models were used to examine whether the likelihood of these discussions varied by demographic and clinical characteristics.


Fifty-nine percent reported that a physician discussed strategies to improve health and exercise, 44 % reported discussions on diet, and 24 % reported no discussions. Compared to their counterparts, survivors with lower education were less likely to report discussing all three areas, but survivors with diabetes were more likely. Survivors ≥65 years old were less likely to report discussing strategies to improve health and diet. Males and CRC survivors reported discussing diet more than their female and lung cancer counterparts, respectively.


The frequency of health promotion discussions varied across survivor characteristics. Discussions were more frequently reported by some groups, e.g., survivors with diabetes, or among individuals less likely to engage in healthy behaviors. In contrast, males and older and less educated survivors were less likely to have these discussions.

Implications for Cancer Survivors

Decreasing physician barriers and encouraging patients to discuss health promotion, especially in the context of clinical care for older survivors and those with low education, is essential for promoting the overall well-being of cancer survivors.


Cancer survivors Health behavior Health promotion Physician advice 



The work was supported by the CanCORS consortium, which was supported by grants from the National Cancer Institute (NCI) to the Statistical Coordinating Center (U01 CA093344) and the NCI-supported Primary Data Collection and Research Centers (Dana-Farber Cancer Institute/Cancer Research Network [U01 CA093332], Harvard Medical School/Northern California Cancer Center [U01 CA093324], RAND/UCLA [U01 CA093348], University of Alabama at Birmingham [U01CA093329], University of Iowa [U01CA093339], University of North Carolina [U01 CA 093326] and by a Department of Veterans Affairs grant to the Durham VA Medical Center [CRS 02–164]), and grant 2 T32 HS013852 from the Agency for Healthcare Research and Quality, Rockville, MD, USA (KK). We thank Dr. Donald Hill from the UAB Division of Preventive Medicine for his editorial review of the manuscript.

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    American Cancer Society. Cancer facts and figures 2014. Atlanta: American Cancer Society; 2014.Google Scholar
  2. 2.
    Holmes HM, Nguyen HT, Nayak P, Oh JH, Escalante CP, Elting LS. Chronic conditions and health status in older cancer survivors. Eur J Intern Med. 2014;25:374–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, et al. Cancer, comorbidities, and health-related quality of life of older adults. Health Care Financ Rev. 2008;29:41–56.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Ligibel J. Lifestyle factors in cancer survivorship. J Clin Oncol. 2012;30:3697–704.CrossRefPubMedGoogle Scholar
  5. 5.
    Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23:8884–93.CrossRefPubMedGoogle Scholar
  6. 6.
    Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med. 2005;40:702–11.CrossRefPubMedGoogle Scholar
  7. 7.
    Rebholz CE, Rueegg CS, Michel G, Ammann RA, von der Weid NX, Kuehni CE, et al. Clustering of health behaviours in adult survivors of childhood cancer and the general population. Br J Cancer. 2012;107:234–42.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Pinto BM, Papandonatos GD, Goldstein MG. A randomized trial to promote physical activity among breast cancer patients. Health Psychol. 2013;32:616–26.CrossRefPubMedGoogle Scholar
  9. 9.
    Moldovan-Johnson M, Martinez L, Lewis N, Freres D, Hornik RC. The role of patient-clinician information engagement and information seeking from nonmedical channels in fruit and vegetable intake among cancer patients. J Health Commun. 2014;19:1359–76.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:242–74.CrossRefGoogle Scholar
  11. 11.
    Weaver K, Foraker R, Alfano C, Rowland J, Arora N, Bellizzi K, et al. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv. 2013;7:253–61.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    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
  13. 13.
    Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ. Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol. 2007;25:2100–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Lopez L, Cook EF, Horng MS, Hicks LS. Lifestyle modification counseling for hypertensive patients: results from the National Health and Nutrition Examination Survey 1999–2004. Am J Hypertens. 2009;22:325–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Martin MY. Missed opportunities? Improving the care of patients with high blood pressure. Am J Hypertens. 2009;22:242.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Institute of Medicine [IOM]. From cancer patient to cancer survivor: lost in transition. Washington, D.C.: National Academies Press; 2006.Google Scholar
  17. 17.
    Jones L, Demark-Wahnefried W. Recommendations for health behavior and wellness following primary treatment for cancer. Washington, DC: National Academies Press; 2007.Google Scholar
  18. 18.
    Winger J, Mosher C, Rand K, Morey M, Snyder D, Demark-Wahnefried W. Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors. Ann Behav Med. 2014;1–11.Google Scholar
  19. 19.
    Demark-Wahnefried W, Jones LW. Promoting a healthy lifestyle among cancer survivors. Hematol Oncol Clin North Am. 2008;22:319–42.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor’s perspective. J Clin Oncol. 2011;29:1280–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, Gansler T, et al. 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. 2006;56:254–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Ayanian JZ, Chrischilles EA, Fletcher RH, Fouad MN, Harrington DP, Kahn KL, et al. Understanding cancer treatment and outcomes: the Cancer Care Outcomes Research and Surveillance Consortium. J Clin Oncol. 2004;22:2992–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Malin JL, Ko C, Ayanian JZ, Harrington D, Nerenz DR, Kahn KL, et al. Understanding cancer patients’ experience and outcomes: development and pilot study of the Cancer Care Outcomes Research and Surveillance patient survey. Support Care Cancer. 2006;14:837–48.CrossRefPubMedGoogle Scholar
  24. 24.
    Hosmer DW, Lemeshow S. Applied logistic regression. Hoboken: Wiley; 2000.CrossRefGoogle Scholar
  25. 25.
    SAS Institute. SAS 9.3. 2012; 9.3.Google Scholar
  26. 26.
    Macmillan Cancer Support/ICM. Move more: physical activity: the underrated wonder drug. 2011.Google Scholar
  27. 27.
    Miles A, Simon A, Wardle J. Answering patient questions about the role lifestyle factors play in cancer onset and recurrence: what do health care professionals say? J Health Psychol. 2010;15:291–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Rodman S, Murphy JL. Nutrition knowledge and attitudes of pre-registered and registered nurses in relation to cancer survivorship. Proc Nutr Soc. 2011;70:E307.CrossRefGoogle Scholar
  29. 29.
    Williams K, Beeken RJ, Wardle J. Health behaviour advice to cancer patients: the perspective of social network members. Br J Cancer. 2013;108:831–5.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Aarts MJ, Kamphuis CB, Louwman MJ, Coebergh JW, Mackenbach JP, van Lenthe FJ. Educational inequalities in cancer survival: a role for comorbidities and health behaviours? J Epidemiol Community Health. 2013;67:365–73.CrossRefPubMedGoogle Scholar
  32. 32.
    Blanchard CM, Courneya KS, Stein K, American Cancer Society’s SCS-II. 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
  33. 33.
    Hong S, Bardwell W, Natarajan L, Flatt S, Rock C, Newman V, et al. Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) Study. Breast Cancer Res Treat. 2007;101:225–32.CrossRefPubMedGoogle Scholar
  34. 34.
    Blanchard CM, Stein KD, Baker F, et al. Association between current lifestyle behaviors and health-related quality of life in breast, colorectal and prostate cancer survivors. Psychol Health. 2004;19:1–13.CrossRefGoogle Scholar
  35. 35.
    Vrieling A, Kampman E. The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature. Am J Clin Nutr. 2010;92:471–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Stava CJ, Beck ML, Feng L, Lopez A, Busaidy N, Vassilopoulou-Sellin R. Diabetes mellitus among cancer survivors. J Cancer Surviv. 2007;1:108–15.CrossRefPubMedGoogle Scholar
  37. 37.
    Coa K, Smith K, Klassen A, Caulfield L, Helzlsouer K, Peairs K, et al. Capitalizing on the “teachable moment” to promote healthy dietary changes among cancer survivors: the perspectives of health care providers. Support Care Cancer. 2015;23:679–86.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Volker DL, Becker H, Kang SJ, Kullberg V. A double whammy: health promotion among cancer survivors with preexisting functional limitations. Oncol Nurs Forum. 2013;40:64–71.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Fowler MJ. Diabetes treatment, part 1: diet and exercise. Clin Diabetes. 2007;25:105–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kelly Kenzik
    • 1
  • Maria Pisu
    • 1
  • Mona N. Fouad
    • 1
  • Michelle Y. Martin
    • 1
    • 2
    Email author
  1. 1.School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Preventive Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA

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