With improvements in cancer survival rates, more patients with cancer are living longer, and hence, cancer is becoming viewed as a chronic illness requiring long-term management. An important aspect of patient care during and after cancer treatment is patient health behaviors. For example, sequelae from various cancer treatments, such as chemotherapy and radiotherapy (RT), can compromise health in a variety ways, including decreased immune functioning, cardiotoxic effects of chemotherapy and/or RT, and weight gain. In addition, the stress caused by a cancer diagnosis and its treatment can disrupt existing health behaviors or exacerbate unhealthy behaviors. Continued smoking or alcohol use can complicate treatment and increase risk for further malignancy. Furthermore, decreased physical activity and poor nutrition can cause weight gain, which may contribute to secondary health problems such as cardiovascular disease and diabetes. The authors reviewed the extant literature on four key health behaviors among patients with cancer and survivors: healthy diet, reduced tobacco use, reduced alcohol use, and increased physical activity. They described the prevalence of these behaviors, reviewed the effects of interventions designed to alter unhealthy behaviors, and discussed the implications and future directions for this emerging area of research.
With primary prevention efforts, improved detection, and treatment, cancer incidence rates have decreased among men (Surveillance, Epidemiology, and End Results program and National Program of Cancer Registries data, 1992-1998) and overall mortality rates have decreased in both men and women.1 According to the Office of Cancer Survivorship, 2 9.6 million individuals in the U.S. have been diagnosed with cancer (a majority with breast, prostate, and colorectal cancers): 39% were diagnosed 0 to Ͻ 5 years ago, 47% were diagnosed 5 to Ͻ 20 years ago, and 14% were diagnosed Ͼ 20 years previously.With improvements in survival and the possibility that cancer may be viewed as a chronic disease, the reduction of risk behaviors such as smoking, sedentary behavior, and unhealthy diets or, conversely, the adoption and maintenance of healthy behaviors, becomes more salient. Cancer treatments are known to disrupt health behaviors. For example, retrospective reports show that patients report reduction in exercise behavior during the phase of active treatment 3 and changes in taste sensitivity associated with chemotherapy alter food preferences and nutritional intake. 4 Furthermore, the stress associated with a cancer diagnosis may disrupt health behaviors and potentially increase unhealthy behaviors. In some instances, continued unhealthy behaviors such as smoking can adversely affect responsiveness to RT (e.g., increased side effects such as oral mucosi-
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