The number of cancer survivors has risen substantially due to improvements in early diagnosis and treatment. Health behaviours such as physical activity (PA) and diet can reduce recurrence and mortality, and alleviate negative consequences of cancer and treatments. Digital behaviour change interventions (DBCIs) have the potential to reach large numbers of cancer survivors. We conducted a systematic review and meta-analyses of relevant studies identified by a search of Medline, EMBASE, PubMed and CINAHL. Studies which assessed a DBCI with measures of PA, diet and/or sedentary behaviour were included. Fifteen studies were identified. Random effects meta-analyses showed significant improvements in moderate-vigorous PA (seven studies; mean difference (MD) = 41 min per week; 95% CI 12, 71) and body mass index (BMI)/weight (standardised mean difference (SMD) = −0.23; 95% CI −0.41, −0.05). There was a trend towards significance for reduced fatigue and no significant change in cancer-specific measures of quality of life (QoL). Narrative synthesis revealed mixed evidence for effects on diet, generic QoL measures and self-efficacy and no evidence of an effect on mental health. Two studies suggested improved sleep quality. DBCIs may improve PA and BMI among cancer survivors, and there is mixed evidence for diet. The number of included studies is small, and risk of bias and heterogeneity was high. Future research should address these limitations with large, high-quality RCTs, with objective measures of PA and sedentary time. Digital technologies offer a promising approach to encourage health behaviour change among cancer survivors.

/pdf/digital-health-behaviour-change-interventions-targeting-3kotr8y8me.pdf

Digital health behaviour change interventions targeting physical activity and diet in cancer survivors: a systematic review and meta-analysis.

The overall 5‐year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence‐based, cancer‐specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer‐specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta‐analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health‐related behaviors and comorbidities, long‐term sequelae and patient‐reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.3322/caac.21719

American Cancer Society nutrition and physical activity guideline for cancer survivors

Physical activity can improve health and wellbeing after cancer and may reduce cancer recurrence and mortality. To achieve such long-term benefits cancer survivors must be habitually active. This review evaluates the effectiveness of interventions in supporting maintenance of physical activity behaviour change among adults diagnosed with cancer and explores which intervention components and contextual features are associated with effectiveness. Relevant randomised controlled trials (RCTs) were identified by a search of Ovid Medline, Ovid Embase and PsychINFO. Trials including adults diagnosed with cancer, assessed an intervention targeting physical activity and reported physical activity behaviour at baseline and ≥ 3 months post-intervention were included. The behaviour change technique (BCT) taxonomy was used to identify intervention components and the Template for Intervention Description and Replication to capture contextual features. Random effect meta-analysis explored between and within group differences in physical activity behaviour. Standardised mean differences (SMD) describe effect size. Twenty seven RCTs were included, 19 were pooled in meta-analyses. Interventions were effective at changing long-term behaviour; SMD in moderate to vigorous physical activity (MVPA) between groups 0.25; 95% CI = 0.16–0.35. Within-group pre-post intervention analysis yielded a mean increase of 27.48 (95% CI = 11.48-43.49) mins/wk. of MVPA in control groups and 65.30 (95% CI = 45.59–85.01) mins/wk. of MVPA in intervention groups. Ineffective interventions tended to include older populations with existing physical limitations, had fewer contacts with participants, were less likely to include a supervised element or the BCTs of ‘action planning’, ‘graded tasks’ and ‘social support (unspecified)’. Included studies were biased towards inclusion of younger, female, well-educated and white populations who were already engaging in some physical activity. Existing interventions are effective in achieving modest increases in physical activity at least 3 months post-intervention completion. Small improvements were also evident in control groups suggesting low-intensity interventions may be sufficient in promoting small changes in behaviour that last beyond intervention completion. However, study samples are not representative of typical cancer populations. Interventions should consider a stepped-care approach, providing more intensive support for older people with physical limitations and others less likely to engage in these interventions.

/pdf/systematic-review-and-meta-analysis-of-maintenance-of-15y56z4vor.pdf

Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors

Purpose Quitting smoking provides important health benefits to patients with cancer. A cancer diagnosis may motivate quitting—potentially providing a teachable moment in which oncologists can encourage and assist patients to quit—but little is known about whether a recent cancer diagnosis (including diagnosis of a cancer that is less strongly linked to smoking) is associated with increased quitting. Methods Cancer Prevention Study-II Nutrition Cohort participants reported smoking status at enrollment in 1992 to 1993 and approximately biennially through 2009. Quit rates of smokers diagnosed with cancer during 2- and 4-year intervals were compared with those of smokers not diagnosed with cancer (12,182 and 12,538 smokers in 2- and 4-year analyses, respectively). Cancers likely to cause physical limitations or symptoms that could influence smoking (cancers of the lung, head and neck, esophagus, or any metastatic cancer) were excluded. Logistic regressions calculated quit rates controlling for age, sex, surve...

https://ascopubs.org/doi/pdf/10.1200/JCO.2014.58.3088

Does a Recent Cancer Diagnosis Predict Smoking Cessation? An Analysis From a Large Prospective US Cohort

Objectives The present study tested the hypothesis that recall of receiving physical activity (PA) advice would be associated with higher levels of PA in patients with a diagnosis of colorectal cancer (CRC). Setting Colorectal cancer patients who were diagnosed in 2010 or 2011, and had been treated in the English National Health Service (NHS). Participants 17 753 respondents completed at least one section of the survey relevant to the current study and after exclusion of 171 with dementia (since results relied on recall), 15 254 had complete data for the current study. 60% were male, 67% were >65 years and 96% were from a white ethnic group. Primary and secondary outcome measures Patients completed the ‘Living with and Beyond Colorectal Cancer’ Patient-Reported Outcome Measures (PROMS) survey in 2013. The survey included questions on receiving exercise advice/information (‘PA advice’), and the frequency of currently doing at least 30 min of brisk PA per day (‘PA level’: 0, 1–4 or 5–7 days, within the past week; with the top category meeting UK guidelines). Results A third of respondents (31%) recalled receiving PA advice. Independent of demographics and treatment, patients who recalled having PA advice were more likely to be currently doing some brisk PA (51% in the advice group vs 42% in the no advice group; OR 1.74, 95% CI 1.60 to 1.90; p Conclusions Recalling being given PA advice after a diagnosis of CRC was associated with higher levels of PA. However, less than a third of patients recalled receiving advice. Future research should examine the context in which advice is given and randomised trials are required. However, encouraging clinicians working with patients with CRC to give brief PA advice is warranted and may help improve outcomes for CRC survivors.

https://bmjopen.bmj.com/content/bmjopen/5/4/e006853.full.pdf

Recall of physical activity advice was associated with higher levels of physical activity in colorectal cancer patients.

A healthy lifestyle following a cancer diagnosis may improve long-term outcomes. No studies have examined health behaviour change among UK cancer survivors, or tracked behaviours over time in survivors and controls. We assessed smoking, alcohol and physical activity at three times (0–2 years before a cancer diagnosis, 0–2 years post-diagnosis and 2–4 years post-diagnosis) and at matched times in a comparison group. Data were from waves 1–5 of the English Longitudinal Study of Ageing; a cohort of older adults in England. Behavioural measures were taken at each wave. Generalised estimating equations were used to examine differences by group and time, and group-by-time interactions. Of the 5146 adults included in the analyses, 433 (8.4%) were diagnosed with cancer. Those with a cancer diagnosis were less likely to be physically active (P<0.01) and more likely to be sedentary (P<0.001). There were no group differences in alcohol or smoking. Smoking, alcohol and activity reduced over time in the whole group. Group-by-time interactions were not significant for smoking (P=0.17), alcohol (P=0.20), activity (P=0.17) or sedentary behaviour (P=0.86), although there were trends towards a transient improvement from pre-diagnosis to immediately post-diagnosis. We found little evidence that a cancer diagnosis motivates health-protective changes. Given the importance of healthy lifestyles, strategies for effective support for behaviour change in cancer survivors need to be identified.

Kenneth T. Williams

Papers

Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study.