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Few oncologists advise cancer survivors on lifestyle changes
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Physicians, particularly oncologists and specialists, frequently lack the time and resources to discuss healthy-lifestyle modifications with cancer survivors, according to study findings published in Cancer.
“Even though oncologists clearly believe that cancer survivors should adopt a healthy lifestyle, they don’t have the time to address more than cancer care,” Tammy K. Stump, PhD, researcher in the department of preventive medicine at Northwestern University’s Feinberg School of Medicine, said in a press release. “That’s their expertise.”
In the mixed-method study, Stump and colleagues surveyed 91 physicians about their attitudes and practices regarding health promotion counseling for patients. The physicians included 30 primary care physicians, 30 oncologists and 31 specialists, including urologists, dermatologists and gynecologists. Additionally, 12 oncologists participated in, structured, in-person interviews.
The researchers found that among the primary care physicians, 90% recommended healthy lifestyle changes such as weight loss, smoking cessation to at least a portion of cancer survivors they treated. Conversely, only 26.7% of oncologists and 9.7% of specialists reported ever addressing these issues with survivors (P < .001).
When presented with a hypothetical situation in which a physician had 2 minutes left during a regular follow-up visit with a cancer survivor, 8.8% of physicians said they would use the time to address health promotion topics. Primary care physicians were significantly more likely to allocate this time to health promotion (OR = 7.37; 95% CI, 1.39-39.14) than oncologists and specialists (OR = 1.03; 95% CI, 0.06-17.33).
Likewise, in a scenario in which a patient with overweight inquired about weight loss, 93.3% of primary care physicians reported that they would recommend behavioral changes with the aid of a weight-loss app or refer the patient to a dietician. Oncologists and specialists were significantly less likely to make these suggestions (P < .001), with less than 50% choosing the health-promoting options.
When asked whether they would refer cancer survivors to a health-promotion counseling service, 96.7% of primary care physicians answered that they would, compared with only about half of oncologists and specialists (P < .01).
Most of the physicians indicated that they believed at least half of cancer survivors would comply with medication regimens to prevent disease recurrence, but they also believed that only 10.7% of survivors would remain adherent if they were trying to lose weight. The oncologists interviewed also feared that patients would be overwhelmed or distressed by the addition of weight loss or lifestyle regimens to their cancer-preventive medication regimens and would cease to be adherent to the medications.
Thematic analysis identified other physician barriers to providing health-promotion counseling, including oncologists’ primary focus on the cancer itself, time constraints, inadequate training in behavioral change and challenges in care coordination. Perception of a patient benefit and integration of health-promotion resources into cancer care emerged as health-promotion facilitators.
The study was limited to one urban/suburban health care system; therefore, generalizability to other health care settings is not known. Other limitations cited by researchers included the study’s reliance on self-reported survey data.
Clinicians can and should collaborate on healthy lifestyle counseling and support for cancer survivors, according to Bonnie Spring, PhD, director of the Institute for Public Health and Medicine (IPHAM) — Center for Behavior and Health and chief of behavioral medicine in the department of preventive medicine at Weinberg College of Arts and Science.
“Ultimately, we believe that healthy lifestyle support can be provided to cancer survivors most effectively as part of integrated survivorship care delivered by health promotionists trained in nutrition physical activity, and behavioral coaching in a program designed with the input of oncologists to meet the specific needs of cancer survivors,” Spring said in the press release. – by Jennifer Byrne
Disclosures: The researchers report no relevant disclosures.
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