Many cancer survivors follow diet and exercise guidelines, but few comply with all
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Key takeaways:
- ACS guidelines on nutrition and physical activityrarely followed completely by cancer survivors.
- Women, Black individuals followed the guidelines more rigorously than other demographics.
A minimal amount of cancer survivors appear to completely follow American Cancer Society guidelines regarding physical activity, obesity, consumption of produce and alcohol use, according to study results in JAMA Oncology.
However, certain demographics adhered to guidelines more closely, including women and Black individuals.
“We feel that awareness of the low adherence to these guidelines is the first step to rectifying the problem,” Kathryn Norman, MD, resident physician at Beth Israel Deaconess Medical Center, told Healio. “We would advocate that physicians — including oncologists and internists — taking care of people who are completing cancer treatments or have a history of cancer take opportunities to discuss these guidelines with patients and collaborate with them on how they may be able to make meaningful lifestyle changes.”
Background and methodology
More than 18 million cancer survivors currently live in the U.S., and that number will likely grow as screening numbers improve and new treatments gain approval, according to background information provided by researchers.
Modifiable risk factors have been identified in previous studies to decrease the likelihood of recurrence, and the American Cancer Society (ACS) created nutrition and physical activity guidelines to aid survivorship.
“It is essential for physicians to gain an understanding of the extent to which ACS’s nutritional and physical activity guidelines are adopted by people who have completed cancer treatment so that we can best support our patients in living happy and healthy lives after cancer,” Norman said.
Study investigators used the CDC’s Behavioral Risk Factor Surveillance System, a national telephone survey that collects information on health-related behaviors and chronic disease in individuals aged at least 18 years, to construct their study cohort.
Researchers included data from administration years 2017, 2019 and 2021 from respondents who had been diagnosed with cancer and completed treatment.
They examined if participants followed guidelines regarding body weight, exercise, fruit and vegetable consumption, and alcohol use.
The study cohort consisted of 10,020 individuals, a representative sample of 2.7 million people, who completed cancer treatment (mean age, 64.2 years; 57% women; 84% white).
Results and next steps
More survivors followed physical activity criteria than any other guidelines (72% of respondents), followed by body weight (68%), alcohol use (50%), and fruit and vegetable intake (12%).
Only 4% of survivors adhered to guidelines for all four risk factors.
“This was interesting to us because it is lower than estimates by previous work,” Norman said.
Survivors also averaged fewer healthy behaviors than the general population (0.101; 95% CI, 0.14 to 0.6).
“Our work did not investigate why adherence to the guidelines is so low, but we suspect a large part is that lifestyle changes can be difficult to implement, and the lifestyle guidelines included — especially avoiding alcohol — may be quite difficult for people to achieve,” Norman said. “We think there is likely also an extent to which people who have finished cancer treatment may not be aware of the guidelines or the significant evidence behind them, so are not necessarily working actively toward following these recommendations.”
Various demographics had higher rates of healthier habits, including women compared with men (P < .001), older age (P = .001), Black individuals compared with white (P = .02), college compared with high school graduates (P = .001) and those living in the western part of the U.S. compared with the Midwest (P < .001).
Study limitations included the use of self-reported data, lack of analysis of cancer type, and inability to directly match guidelines to the survey. For example, instead of getting information on whether an individual regularly engaged in physical activity, researchers had to use responses on whether the person exercised in the previous 30 days.
Norman said future research is needed to understand why adherence among survivors is low.
“Once these barriers have been identified, we can imagine future projects that would work to develop high-quality interventions to improve adherence,” she said.
For more information:
Kathryn Norman, MD, can be reached at kenorman19@gmail.com.
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Baughman C, et al. JAMA Oncol. 2024;doi:10.1001/jamaoncol.2024.0470.
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