Study Identifies Cancer Survivors at Risk for Unhealthy Behaviors

By Teresa Hagan Thomas, PhD, RN - Last Updated: September 9, 2022

As patients with cancer live longer, oncology nurses are integrating survivorship care models into their practice. Behaviors like smoking, alcohol use, e-cigarette use, and physical activity continue to put cancer survivors at risk for cancer recurrence, development of new cancers, and overall mortality. Recognizing which patients are most at-risk for such unhealthy behaviors can help oncology nurses and other clinicians proactively support patients who could benefit from health promotion interventions.

Jiyeong Kim, a PhD student at the University of California – Davis Department of Public Health Sciences, recently published results of a national study describing unhealthy behaviors among US cancer survivors in the Journal of Cancer Survivorship. The research team analyzed the Health Information National Trends Survey (HINTS) 2017 – 2020 dataset including data from 2579 cancer survivors. The National Cancer Institute administers this survey using mailed and web surveys to all non-institutionalized US adults with response rates between 30% and 37%, helping ensure a representative study sample.

Half of participants were diagnosed with cancer over 11 years ago, and 14% were within a year of the cancer diagnosis. The most reported cancer types were skin (25%) and breast (13%); 17% of participants reported more than one type of cancer.

Alcohol Use. 75% of survivors were light drinkers (0 to 3 drinks per week) while 16% were heavy drinkers (≥ 7 drinks per week). Moderate to heavy drinking was more common in men, non-Hispanic whites, college graduates, those making > $50,000 a year, and in some cancer subgroups, including those with a history of breast, prostate, skin cancer, or melanoma.

Cigarette Use. 12% of survivors reported smoking cigarettes, and 3% reported using e-cigarettes. Cigarette use was more common in survivors who were 35-64 years old, female, white, had a high school education, not married, and had a history of lung disease, depression, or psychological distress. E-cigarette use was higher among survivors who were 35-49 years old, female, white, less educated, not married, with comorbidities, psychological distress, and certain types of cancer including breast, cervical, colon, and melanoma.

Physical Inactivity. 68% of survivors reported 0-150 minutes per week of moderate activity like brisk walking, cycling at a regular pace, or swimming at a regular pace. This category is considered “physically inactive” based on the US Physical Activity Guidelines that suggest > 150 minutes of moderate activity per week. The median time spent moderately exercising each week was 90 minutes. Physical activity was more common in survivors who were Black/African Americans, had a high school education or less, had VA medical insurance, had psychological distress, and those living in rural areas.

The researchers note that from prior evaluations of data collected between 2013 to 2017, moderate and heavy drinking rates have increased, and physical activity levels have increased. They also note how unhealthy behaviors cluster among certain groups of cancer survivors. For example, cigarette and e-cigarette use is highest in survivors who are non-Hispanic white, less educated, not married, living in metropolitan areas, and with a history of lung disease and depression. Also, cigarette use and heavy drinking were correlated, suggesting that interventions could target multiple healthy behaviors.

Also, the researchers highlight that cancer survivors with psychological distress and depression were more likely to be physically inactive and use e-cigarettes. Unmarried men also had higher rates of unhealthy drinking and smoking. Targeting interventions to these groups can help provide tailored support.

Oncology nurses should identify strategies to promote healthy behaviors among all individuals with a history of cancer, especially survivors at risk for unhealthy behaviors. Smoking cessation programs including the National Cancer Institute’s free quit line (1-877-44U-QUIT or 1-877-448-7848) and other resources are available online. Additionally, increasing physical activity can be encouraged at all stages of the cancer experience (see examples of how to safely promote physical activity here). Programs through LIVESTRONG and the YMCA and local hospitals promote physical activity among cancer survivors. Linking cancer survivors to these resources can reduce barriers to healthy behaviors, as can personalizing these approaches to the specific at-risk subgroups of survivors.



Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA-a cross-sectional study