Exercise and dietary change after diagnosis and cancer-related symptoms in long-term survivors of breast cancer: CALGB 79804

The Ohio State University Comprehensive Cancer Center and College of Public Health, Columbus, OH 43210, USA.
Psycho-Oncology (Impact Factor: 2.44). 02/2009; 18(2):128-33. DOI: 10.1002/pon.1378
Source: PubMed


Improving diet and exercise can reduce survivors' risk of cancer-related fatigue, poor physical functioning, and potential recurrence. A cancer diagnosis can represent a 'teachable moment', leading survivors to make positive changes in diet and exercise behaviors; however, little is known about how often this occurs or about factors that enhance or limit survivors' ability to make these changes. This cross-sectional descriptive study investigated both the prevalence and clustering of self-reported changes in diet and exercise and how these changes related to ongoing cancer-related symptoms, social support, and stressful life events among long-term breast cancer survivors.
Survivors (n=227, response rate=72%) of a prior Cancer and Leukemia Group B treatment trial, on average 12 years post-diagnosis, completed a mailed survey assessing health behavior changes since diagnosis and current symptoms, social support, and stressful life events.
Over half of survivors reported making positive exercise or diet changes since diagnosis: over 25% reported making exercise and diet changes. Analyses of covariance models showed that survivors who reported increasing their exercise also reported lower fatigue. Trends were also found between increased fruit and vegetable intake and decreased fatigue and between increased exercise and increased social support.
These results underscore the need for health promotion efforts among survivors. Exercise promotion is especially needed since more survivors attempted to change dietary behaviors than exercise on their own. Further, fatigue may limit survivors' ability to change their health behaviors; alternatively, survivors who increase their exercise may experience less fatigue.

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    • "More anxious patients may also want more information on a ‘prostate-friendly’ diet [30]. Thus there are opportunities for healthcare professionals to assist PC patients both clinically and psychologically by the routine integration of healthy eating advice into survivorship care plans [31,32], particularly for men embarking on AS/AM programmes who may have frequent monitoring appointments over a long period. This may be increasingly important with the increasing use of non-radical approaches in men with low-risk disease worldwide [20] and the lack of other actions that can be taken [33,34]. "
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    ABSTRACT: Background The diagnosis of prostate cancer (PC) can provide a trigger for dietary change, and there is evidence that healthier diets may improve quality of life and clinical outcomes. However, men’s views about dietary change in PC survivorship are largely unknown. This multi-centre qualitative interview study explored men’s views about dietary change in PC survivorship, to better understand motivations for, and barriers to, achieving desired changes. The role of radical and active surveillance treatments on dietary change and the influence of men’s partners were examined. Focus groups also evaluated stakeholder opinion, including healthcare professionals, about the provision of dietary advice to PC patients. Methods A multi-centre interview study explored views about diet and motivations for, and barriers to, dietary change in men at elevated risk or diagnosed with PC following prostate specific antigen (PSA) testing. 58 men and 11 partners were interviewed. Interviews and focus groups were undertaken with 11 healthcare professionals, 5 patients and 4 partners to evaluate stakeholders’ opinions about the feasibility and acceptability of providing dietary advice to PC patients. Data were analysed using methods of constant comparison and thematic analysis. Results Over half of diagnosed men reported making dietary changes, primarily to promote general or prostate health or facilitate coping, despite their uncertainty about diet-PC links. Interest in dietary advice was high. Information needs varied depending on treatment received, with men on active surveillance more frequently modifying their diet and regarding this as an adjunct therapy. Men considered their partners integral to implementing changes. Provision of dietary advice to men diagnosed with PC was considered by healthcare professionals and men to be feasible and appropriate in the context of a holistic ‘care package’. Conclusions Many men make positive dietary changes after PC diagnosis, which are perceived by men and their partners to bring psychological and general health benefits and could help future dietary intervention trials. Men and their partners desire more and better dietary information that may support PC survivorship, particularly among those embarking on active surveillance/monitoring programmes. There are opportunities for healthcare professionals to support PC patients both clinically and psychologically by the routine integration of healthy eating advice into survivorship care plans.
    Full-text · Article · May 2014 · BMC Family Practice
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    • "Finally, many cancer survivors did not return to FSFL to complete the one-month post-baseline survey secondary to illness; conflicting priorities and not being able to identify a caregiver to participate in the current study resulted in a high attrition rate. That is consistent with previous research demonstrating that adult cancer survivors have limited opportunity to participate in PA because of problematic levels of symptoms, stressful life events, and poor social support (Alfano et al., 2009). "
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    ABSTRACT: Purpose/Objectives: To explore the relationships between adult cancer survivor and caregiver social support, self-efficacy for physical activity (SEPA), physical activity (PA) behavior, and quality of life (QOL); and to understand cancer survivors' and their caregivers' perceptions of social support in PA participation. Design: Quasi-experimental. Setting: Five community-based exercise sites located in East Texas. Sample: 101 adult cancer survivors and caregivers. Methods: Participants completed questionnaires, the 8-Foot Up-and-Go test, and open-ended questions. Data analysis included descriptive statistics and frequencies, Spearman's rho, Mann-Whitney U, and Wilcoxon signed-rank test. Qualitative data were analyzed using thematic analysis. Main Research Variables: Social support, SEPA, PA, and QOL. Findings: Physical QOL was significantly higher in caregivers than cancer survivors. Spearman's rho identified a negative relationship between physical QOL and PA in cancer survivors; and a significant relationship between PA and PA participation in caregivers with social support from friend. Three themes emerged from the qualitative data regarding the perception of social support: companionship, motivation, and health promotion. Conclusions: Caregivers have higher QOL despite being the major social support provider to cancer survivors. Social support is essential to PA participation. Implications for Nursing: Interventions to increase PA in adult cancer survivors may consider encouraging their caregivers to actively participate. Knowledge Translation: Caregivers play an important role in the PA of cancer survivors. Perceived social support in the form of companionship and motivation may increase PA in cancer survivors and caregivers. Therefore, nurses may consider educating cancer survivors and caregivers on the importance of adopting and maintaining PA throughout the cancer care continuum.
    Full-text · Article · Sep 2013 · Oncology Nursing Forum
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    • "Social support was identified as an important facilitator of PA behaviour in the current study. This is not unexpected, as previous research has consistently highlighted the benefits of having an exercise partner and/or a strong support network (generally) on exercise behaviour (Alfano et al., 2009; Emery et al., 2009). However, our findings suggest that appraisal support (Heaney and Israel, 2002), such as offering encouragement and helping to monitor PA progress, may be an important aspect of social support to consider when developing PA intervention strategies . "
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    ABSTRACT: Purpose: The majority of post treatment breast cancer survivors do not engage in physical activity (PA) at the recommended level. The promotion of PA among this group has the potential to dramatically improve quality of life and health outcomes. To maximise effectiveness, programs should be theory-based and address key determinants of PA behaviour. Social Cognitive Theory (SCT) has shown particular promise for developing and guiding PA interventions, but future research regarding how each SCT construct relates to PA among this group is needed. This study aims to explore how core SCT constructs impact on PA participation among post treatment breast cancer survivors, and gain greater insights into how to shape PA program strategies that will be appealing and effective for this group. Methods: Post treatment breast cancer survivors were recruited from the Breast Cancer Network Australia's review and survey group. Semi-structured telephone interviews examined PA patterns and SCT constructs and data were analysed thematically. Results: Eight post treatment breast cancer survivors participated in the study. Changes in activity level since diagnosis were common; in most cases this reflected a decline in PA. Key social cognitive and environmental influences on PA were described under the following themes: knowledge, outcome expectations, self-efficacy and personal, behavioural and environment facilitators and inhibitors. Conclusion: The results of this study demonstrate the utility of SCT for guiding PA programs. Insight into how social cognitive factors may influence PA behaviour in this group is offered and direction for how oncology-based health professionals can promote PA among breast cancer survivors is provided.
    Full-text · Article · Nov 2012 · European journal of oncology nursing: the official journal of European Oncology Nursing Society
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