Unhealthy behaviors after breast cancer: Capitalizing on a teachable moment to promote lifestyle improvements

Abstract

Background This study assessed the prevalence and risk factors of unhealthy behaviors among survivors of early‐stage breast cancer. Methods Women (n = 9556) from the CANcer TOxicity cohort (NCT01993498) were included. Physical activity (PA), tobacco and alcohol consumption, and body mass index were assessed at diagnosis and at years 1 and 2 after diagnosis. A behavior was defined as unhealthy if patients failed to meet PA recommendations (≥10 metabolic equivalent task hours per week), reduce/quit tobacco, or decrease alcohol consumption to less than daily, or if they gained substantial weight over time. Multivariable‐adjusted generalized estimating equations explored associations with unhealthy behaviors. Results At diagnosis, 41.7% of patients were inactive, 18.2% currently used tobacco, 14.6% consumed alcohol daily, and 48.9% were overweight or obese. At years 1 and 2, unhealthy PA behavior was reported among 37.0% and 35.6% of patients, respectively, unhealthy tobacco use behavior was reported among 11.4% and 9.5%, respectively, and unhealthy alcohol behavior was reported among 13.1% and 12.6%, respectively. In comparison with the previous assessment, 9.4% and 5.9% of underweight and normal‐weight patients had transitioned to the overweight or obese category at years 1 and 2, respectively, and 15.4% and 16.2% of overweight and obese patients had gained ≥5% of their weight at years 1 and 2, respectively. One in 3 current tobacco smokers and 1 in 10 daily alcohol users reported improved behaviors after diagnosis. Older women (5‐year increment) were more likely to be inactive (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 1.01‐1.05) and report unhealthy alcohol behavior (aOR, 1.28; 95% CI, 1.23‐1.33) but were less likely to engage in unhealthy tobacco use (aOR, 0.81; 95% CI, 0.78‐0.85). Being at risk for depression (vs not being at risk for depression) was associated with reduced odds of unhealthy tobacco use (aOR, 0.67; 95% CI, 0.46‐0.97) and with a higher likelihood of unhealthy alcohol behavior (aOR, 1.58; 95% CI, 1.14‐2.19). Women with a college education (vs a primary school education) less frequently reported an unhealthy PA behavior (aOR, 0.61; 95% CI, 0.51‐0.73) and were more likely to report unhealthy alcohol behavior (aOR, 1.85; 95% CI, 1.37‐2.49). Receipt of chemotherapy (vs not receiving chemotherapy) was associated with higher odds of gaining weight (aOR, 1.51; 95% CI, 1.23‐1.87) among those who were overweight or obese at diagnosis. Conclusions The majority of women were adherent to healthy lifestyle behaviors at the time of their breast cancer diagnosis, but a significant subset was nonadherent. Unhealthy behaviors tended to persist after the breast cancer diagnosis, having varying clinical, psychological, sociodemographic, and treatment‐related determinants. This study will inform more targeted interventions to promote optimal health.

Factors Affecting the Occurrence of Mental Health Problems in Female Cancer Survivors: A Nationwide Cohort Study

“…Previous studies revealed that health-related behaviors differ according to these stages of survivorship [ 9 ], and inappropriate health-related behaviors increase as the duration of the disease increases [ 10 , 11 ] Health-related behaviors such as smoking, drinking alcohol, and physical activity are defined by the International Agency for Research on Cancer (IARC) as carcinogenic factors for gynecological cancers such as ovarian and uterine cancers, and breast cancers [ 12 ]. Inappropriate health-related behaviors have been reported to affect the occurrence of mental health problems [ 13 , 14 , 15 ].…”

“…A previous study revealed that smokers who experienced cancer reported severe psychological distress more frequently due to depression and anxiety compared to nonsmokers who experienced cancer [ 16 ], and the higher the depression score, the higher the risk of drinking in breast cancer survivors [ 15 ]. In addition, physical activity promotes the release and synthesis of serotonin as well as improvements of physical symptoms such as fatigue and pain, thereby reducing anxiety and depressive symptoms [ 17 ].…”

“…Consequently, it is necessary to examine the relationship between health-related behaviors such as smoking and physical activity and the mental health status of female cancer survivors. Most previous studies on mental health problems of women who have experienced cancer focused on breast cancer [ 15 , 18 , 19 ], health-related behavior, and quality of life at a certain point in time [ 2 , 9 , 10 , 17 ] and identified the relationship over a short-term survival period of fewer than five years [ 3 , 20 , 21 ]. However, there are insufficient studies on survivors of other female cancers, such as ovarian and endometrial cancers, which have a high incidence rate as well as high survival and recurrence rates.…”

Lifestyle and quality of life in patients with early-stage breast cancer receiving adjuvant endocrine therapy

“…Among those that pursued healthy changes, these mostly seemed to happen in the closer aftermath of diagnosis. In contrast, among those with unhealthy lifestyles (41.7% were physically inactive, 18.2% were current smokers, 14.6% consumed alcohol daily, and 48.9% were overweight or obese), these seemed to persist over time, with distinct determinants and risk factors [60 ▪ ]. Bøhn et al evaluated adherence to general lifestyle recommendations, including physical activity, healthy weight management, daily consumption of fruits and vegetables and smoking habit, among young cancer survivors (below 39 years of age).…”

Coffee and tea consumption, patient‐reported, and clinical outcomes in a longitudinal study of patients with breast cancer

“…Nevertheless, uptake of healthy behaviors is not ubiquitous across survivors 41 . We previously explored this dimension in the CANTO cohort and observed that (1) a nonnegligible proportion of survivors engages or persists in unhealthy behaviors, such as insufficient physical activity, and gain weight, and (2) specific risk factors linked to these unhealthy behaviors can be identified 42 …”