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A 15-year follow-up study on long-term adherence to health behaviour recommendations in women diagnosed with breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

Whilst a cancer diagnosis may prompt health behaviour change, there is limited evidence regarding whether such changes are maintained in the long-term. We aimed to investigate the impact of cancer diagnosis on health behaviour changes over the long-term survivorship period among breast cancer survivors (BCSs).

Methods

The sample comprised 153 BCSs and 4778 cancer-free women, aged 49–55 years in 2001 (our baseline), from the 1946–1951 birth cohort of the Australian Longitudinal Study on Women's Health. Health behaviours (physical activity, smoking, alcohol, diet and Body Mass Index), recommended by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), were assessed in five survivorship periods: ≤ 3 years, 3 to ≤ 6 years, 6 to ≤ 9 years, 9 to ≤ 12 years, and 12 to 15 years since diagnosis. A validated semi-quantitative Food Frequency Questionnaire was used for dietary assessment. Pre-diagnosis (baseline) health behaviours of BCSs and cancer-free women were compared (using Generalized Linear Models (GLM)). Multilevel (mixed effect) models were used for longitudinal data in BCSs.

Results

There was no significant difference in health behaviours between BCSs (prior to diagnosis) and cancer-free women. Following diagnosis, BCSs were significantly more physically active (≥ 600 MET min/week; 50.8% to 63.3%; p = 0.02) and consumed more fruit (≥ 2 serves/day; 57.4% to 66.4%; p = 0.01) in the recent survivorship period, but were less likely to be classified in the healthy weight range (p < 0.01). The proportion of non-drinkers and non-smokers slightly increased over the survivorship period. Whole-vegetable intake did not significantly change; however, the intake of non-starchy vegetables significantly increased from pre-diagnosis (LS mean = 89.1 g/day) to post-diagnosis, 6 to ≤ 9 years (LS mean = 137.1 g/day), and 9 to ≤ 12 years (LS mean = 120.8 g/day). There were no significant changes in the total intake of fibre, carotenoids, calcium, fat, saturated fat, vitamin C, or vitamin E observed, except for increased total energy intake (p = 0.012).

Conclusion

Before diagnosis, BCSs had similar adherence to health behaviours compared to cancer-free women. Initial positive changes to health behaviours were observed post BC diagnosis, except healthy body weight, but maintenance of such changes over the long-term was poor. BCSs may benefit from additional advice and support to make healthy lifestyle choices throughout survivorship.

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Acknowledgements

DNT was supported by a University of Newcastle PhD scholarship. The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH) by the University of Queensland and the University of Newcastle. We are grateful to the Australian Government Department of Health for funding the ALSWH and to the women who provided the survey data. The authors also thank Professor Graham Giles of the Cancer Epidemiology Centre of Cancer Council Victoria, for permission to use the Dietary Questionnaire for Epidemiological Studies (Version 2), Melbourne: Cancer Council Victoria, 1996.

Funding

This research received no external funding.

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Authors and Affiliations

  1. School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Newcastle, NSW, 2305, Australia

    Daniel N. Tollosa, Elizabeth Holliday, Alexis Hure, Meredith Tavener & Erica L. James

  2. Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia

    Daniel N. Tollosa, Elizabeth Holliday, Alexis Hure, Meredith Tavener & Erica L. James

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  1. Daniel N. Tollosa
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Contributions

DNT, EH, AH, MT, and EJ conceptualized the study; DNT, AH and EH conducted the analysis; DNT prepared the draft manuscript. All authors contributed to and approved the final manuscript.

Corresponding author

Correspondence to Daniel N. Tollosa.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee from University of Newcastle (Approval No. H-076–0795 and H-2012-0256) and the University of Queensland (Approval No. 2004000224 and 2012000950) approved the study.

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

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Tollosa, D.N., Holliday, E., Hure, A. et al. A 15-year follow-up study on long-term adherence to health behaviour recommendations in women diagnosed with breast cancer. Breast Cancer Res Treat 182, 727–738 (2020). https://doi.org/10.1007/s10549-020-05704-4

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