Provider Counseling About Health Behaviors Among Cancer Survivors in the United States

Division of Cancer Prevention and Control, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA30341, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 06/2007; 25(15):2100-6. DOI: 10.1200/JCO.2006.06.6340
Source: PubMed


To examine provider discussion or counseling of US cancer survivors about diet, exercise, and tobacco use.
We used 2000 National Health Interview Survey data to examine whether US cancer survivors reported that, within 1 year, a provider (1) discussed diet, (2) recommended they begin or continue exercise, or (3) asked about smoking. We included survivors more than 1 year beyond diagnosis (n = 1,600) and adults without cancer (AWCs; n = 24,636) who saw/talked to a provider within 1 year. We used generalized linear contrasts in bivariable analyses and logistic regression to calculate predicted marginals adjusted for age, sex, comorbidity, usual source of care, and number of provider visits in the prior year.
Few survivors reported discussions or recommendations for all three health behaviors (10% of survivors v 9% of AWCs; P = .57). Although report was more likely than among AWCs, few survivors reported diet discussions (30% of survivors v 23% of AWCs; P < .0001) or exercise recommendations (26% of survivors v 23% of AWCs; P < .005), and a minority were asked about smoking (42% of survivors v 41% of AWCs; P = .41). After adjustment, survivors were less likely to report exercise recommendations than were AWCs (22% v 24%, respectively; P = .02). Colorectal cancer survivors were less likely than were AWCs of similar age range to report exercise recommendations (16% v 27%, respectively; P < .003) or smoking discussions (31% v 41%, respectively; P < .05). Cervical cancer survivors were more likely than AWCs of similar age range to discuss smoking (58% v 43%, respectively; P < .001).
Findings from this nationally representative sample suggest that many providers may miss opportunities to counsel survivors about healthy behaviors, perhaps particularly colorectal cancer survivors.

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    • "In this study, knowledge about how to reduce cancer risk was significantly associated with five out of six positive health behaviors. Recent surveys have found that 65% of survivors endorse unmet information needs related to health promotion (Kent et al., 2012) and rarely report receiving recommendations about health behaviors from their clinical providers (Sabatino et al., 2007), suggesting room for improvement in survivor education about how to reduce cancer risk. Increased delivery of comprehensive survivorship care plans, which are recommended to include guidelines for healthy lifestyle and for cancer screenings (Hewitt et al., 2005; Rechis, Beckjord, Arvey, Reynolds, & Goldrick, 2012), are intended to address some of these gaps in survivor knowledge and increase patient selfefficacy to make the positive health changes most essential to their long term well-being. "
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    • "It has been reported that cancer survivors receive less counseling by their primary care physicians on three important health behaviors: diet, exercise and smoking 74. Utilizing the 2000 National Health Interview Survey, 1,600 cancer survivors and 24,636 adults without cancer or non-melanomatous skin cancer history (controls) were studied. "
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