Grasping the 'teachable moment': time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors

Background A cancer diagnosis may provide a ‘teachable moment’ in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable ser...

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Vydáno v:	Psycho-oncology (Chichester, England) Ročník 24; číslo 10; s. 1250 - 1257
Hlavní autoři:	Bluethmann, Shirley M., Basen-Engquist, Karen, Vernon, Sally W., Cox, Matthew, Gabriel, Kelley Pettee, Stansberry, Sandra A., Carmack, Cindy L., Blalock, Janice A., Demark-Wahnefried, Wendy
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England Blackwell Publishing Ltd 01.10.2015 Wiley Subscription Services, Inc
Témata:	Behavior Breast cancer Burden Cancer Consumption Diet Exercise Fruit Grasping Health behavior Health education Health promotion Healthy food Latin American cultural groups lifestyle behaviors Lifestyles Medical diagnosis Medical treatment Moderated oncology Physical activity Physical fitness Prostate Prostate cancer Proximity psychosocial Recovery Regression analysis Respondents Smoking Survivor survivors Symptoms Time Tobacco United States > US symptoms psychosocial lifestyle behaviors survivors oncology
ISSN:	1057-9249, 1099-1611
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Abstract	Background A cancer diagnosis may provide a ‘teachable moment’ in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3–5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors. Methods We analyzed cross‐sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors. Results Respondents were mostly female (55%) and non‐Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = −0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = −0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors. Conclusion We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Copyright © 2015 John Wiley & Sons, Ltd.
AbstractList	BACKGROUNDA cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3-5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors.METHODSWe analyzed cross-sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors.RESULTSRespondents were mostly female (55%) and non-Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = -0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = -0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors.CONCLUSIONWe assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Copyright © 2015 John Wiley & Sons, Ltd. A cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., 150 active min, 3-5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors. We analyzed cross-sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors. Respondents were mostly female (55%) and non-Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = -0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = -0.08, p .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors. We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. 47 references A cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3-5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors. We analyzed cross-sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors. Respondents were mostly female (55%) and non-Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = -0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = -0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors. We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Copyright © 2015 John Wiley & Sons, Ltd. A cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3-5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors. We analyzed cross-sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors. Respondents were mostly female (55%) and non-Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = -0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = -0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors. We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Background A cancer diagnosis may provide a ‘teachable moment’ in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3–5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors. Methods We analyzed cross‐sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors. Results Respondents were mostly female (55%) and non‐Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = −0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = −0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors. Conclusion We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Copyright © 2015 John Wiley & Sons, Ltd.
Author	Bluethmann, Shirley M. Demark-Wahnefried, Wendy Vernon, Sally W. Blalock, Janice A. Cox, Matthew Gabriel, Kelley Pettee Stansberry, Sandra A. Carmack, Cindy L. Basen-Engquist, Karen
AuthorAffiliation	1 University of Texas School of Public Health, Houston, TX 2 University of Texas MD Anderson Cancer Center, Houston, TX 3 University of Alabama-Birmingham Comprehensive Cancer Center, Birmingham, AL
AuthorAffiliation_xml	– name: 3 University of Alabama-Birmingham Comprehensive Cancer Center, Birmingham, AL – name: 2 University of Texas MD Anderson Cancer Center, Houston, TX – name: 1 University of Texas School of Public Health, Houston, TX
Author_xml	– sequence: 1 givenname: Shirley M. surname: Bluethmann fullname: Bluethmann, Shirley M. email: shelley.bluethmann@nih.gov organization: University of Texas School of Public Health, Houston, TX, USA – sequence: 2 givenname: Karen surname: Basen-Engquist fullname: Basen-Engquist, Karen organization: University of Texas MD Anderson Cancer Center, TX, Houston, USA – sequence: 3 givenname: Sally W. surname: Vernon fullname: Vernon, Sally W. organization: University of Texas School of Public Health, TX, Houston, USA – sequence: 4 givenname: Matthew surname: Cox fullname: Cox, Matthew organization: University of Texas MD Anderson Cancer Center, TX, Houston, USA – sequence: 5 givenname: Kelley Pettee surname: Gabriel fullname: Gabriel, Kelley Pettee organization: University of Texas School of Public Health, TX, Houston, USA – sequence: 6 givenname: Sandra A. surname: Stansberry fullname: Stansberry, Sandra A. organization: University of Texas MD Anderson Cancer Center, TX, Houston, USA – sequence: 7 givenname: Cindy L. surname: Carmack fullname: Carmack, Cindy L. organization: University of Texas MD Anderson Cancer Center, TX, Houston, USA – sequence: 8 givenname: Janice A. surname: Blalock fullname: Blalock, Janice A. organization: University of Texas MD Anderson Cancer Center, TX, Houston, USA – sequence: 9 givenname: Wendy surname: Demark-Wahnefried fullname: Demark-Wahnefried, Wendy organization: University of Alabama-Birmingham Comprehensive Cancer Center, AL, Birmingham, USA
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Notes	ark:/67375/WNG-HRRMGP58-C National Cancer Institute - No. R25CA57712 Susan G. Komen Foundation - No. KG111378 ArticleID:PON3857 istex:5D20670D501F956BD9B59D0B9CD8111DC1CF7285 Patient-reported Outcomes, Survey & Population Research Shared Resource - No. CA016672 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Dr. Bluethmann is now a Cancer Prevention Fellow at the National Cancer Institute
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PublicationTitleAlternate	Psycho-Oncology
PublicationYear	2015
Publisher	Blackwell Publishing Ltd Wiley Subscription Services, Inc
Publisher_xml	– name: Blackwell Publishing Ltd – name: Wiley Subscription Services, Inc
References	Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. National Academies Press: Washington, DC, 2005. Rosenstock IM. The health belief model and preventive health behavior. Health Educ Behav 1974;2:354-386. Carmack CL, Basen-Engquist K, Gritz ER. Survivors at higher risk for adverse late outcomes due to psychosocial and behavioral risk factors. Cancer Epidemiol Biomarkers Prev 2011;20:2068-2077. Thompson FE, Midthune D, Subar AF, Kahle LL, Schatzkin A, Kipnis V. Performance of a short tool to assess dietary intakes of fruits and vegetables, percentage energy from fat and fibre. Public Health Nutr-Cab International 2004;7:1097-1106. Demark-Wahnefried W, Morey MC, Sloane R, et al. Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol 2012;30:2354-2361. Ganz PA. Late effects of cancer and its treatment. Semin Oncol Nurs 2001;17:241-248. Maunsell E, Drolet M, Brisson J, Robert J, Deschenes L. Dietary change after breast cancer: extent, predictors, and relation with psychological distress. J Clin Oncol 2002;20:1017-1025. Ballard-Barbash R, Siddiqi SM, Berrigan DA, Ross SA, Nebeling LC, Dowling EC. Trends in research on energy balance supported by the National Cancer Institute. Am J Prev Med 2013;44:416-423. Slymen DJ, Ayala GX, Arredondo EM, Elder JP. A demonstration of modeling count data with an application to physical activity. Epidemiol Perspect Innov 2006;3:3. Ottenbacher A, Sloane R, Snyder DC, Kraus W, Sprod L, Demark-Wahnefried W. Cancer-specific concerns and physical activity among recently diagnosed breast and prostate cancer survivors. Integr Cancer Ther 2013;12:206-212. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2010;123:627-635. Husebø A, Lunde M, Dyrstad SM, Søreide JA, Bru E. Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors. J Clin Nurs 2013;22:4-21. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol 2005;23:8884-8893. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005;23:5814-5830. Sabiston CM, Brunet J. Reviewing the benefits of physical activity during cancer survivorship. Am J Lifestyle Med 2012;6:167-177. Bluethmann SM, Vernon SW, Gabriel KP, Murphy CC, Bartholomew LK. Taking the next step: a systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors. Breast Cancer Res Treat 2015;1-12. Ligibel J. Lifestyle factors in cancer survivorship. J Clin Oncol 2012;30(30):3697-3704. Bellury L, Pett MA, Ellington L, Beck SL, Clark JC, Stein KD. The effect of aging and cancer on the symptom experience and physical function of elderly breast cancer survivors. Cancer 2012;118:6171-6178. Jones LW, Alfano CM. Exercise-oncology research: past, present, and future. Acta Oncol 2013;52:195-215. Williams K, Steptoe A, Wardle J. Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study. Br J Cancer 2013;108(11):2407-2412. Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med 2005;40:702-711. Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer 2011;105:S52-S73. Mcbride CM, Clipp E, Peterson BL, Lipkus IM, Demark-Wahnefried W. Psychological impact of diagnosis and risk reduction among cancer survivors. Psycho-Oncology 2000;9:418-427. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods 2002;7:83. Campo RA, Rowland JH, Irwin ML, Nathan PC, Gritz ER, Kinney AY. Cancer prevention after cancer: changing the paradigm - a report from the American society of preventive oncology. Cancer Epidemiol Biomarkers Prev 2011;20:2317-2324. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 1985;10:141. Fritz MS, Mackinnon DP. Required sample size to detect the mediated effect. Psychol Sci 2007;18:233-239. Rabin C. Promoting lifestyle change among cancer survivors: when is the teachable moment? American Journal of Lifestyle Medicine September/October 2009;3:369-378. Chambers SK, Lynch BM, Aitken J, Baade P. Relationship over time between psychological distress and physical activity in colorectal cancer survivors. J Clin Oncol 2009;27:1600-1606. Basen-Engquist K, Hughes D, Perkins H, Shinn E, Taylor CC. Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors. J Cancer Surviv 2008;2:253-261. Dunn J, Ng SK, Holland J, et al. Trajectories of psychological distress after colorectal cancer. Psycho-Oncology 2013;22:1759-1765. Spark LC, Reeves MM, Fjeldsoe BS, Eakin EG. Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes. J Cancer Surviv 2013;7:74-82. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin 2013;63:11-30. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer 2000;89:1634-1646. Jemal A, Thun MJ, Ries LAG, et al. Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 2008;100:1672-1694. Hawkins NA, Smith T, Zhao L, Rodriguez J, Berkowitz Z, Stein KD. Health-related behavior change after cancer: results of the American Cancer Society's studies of cancer survivors (SCS). J Cancer Survivorship 2010;4:20-32. Atkins DC, Gallop RJ. Rethinking how family researchers model infrequent outcomes: a tutorial on count regression and zero-inflated models. J Fam Psychol 2007;21:726. Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP. Successes and failures of the teachable moment. Cancer 2006;106:17-27. Alfano CM, Day JM, Katz ML, et al. Exercise and dietary change after diagnosis and cancer-related symptoms in long-term survivors of breast cancer: CALGB 79804. Psycho-Oncology 2009;18:128-133. Courneya KS, Vallance JKH, McNeely ML, Karvinen KH, Peddle CJ, Mackey JR. Exercise issues in older cancer survivors. Crit Rev Oncol 2004;51:249-261. Little RJ. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc 1988;83:1198-1202. Trudel-Fitzgerald C, Savard J, Ivers H. Evolution of cancer-related symptoms over an 18-month period. J Pain Symptom Manage 2013;45:1007-1018. 2007; 18 2013; 44 2012 2013; 22 2013; 108 2000; 89 2013; 45 2000; 9 2004; 7 2002; 7 2010; 123 2013; 63 2005; 40 2007 2005 2006; 3 2013; 7 2008; 100 2008; 2 2009; 27 2005; 23 1974; 2 2012; 30 2011; 105 2004; 51 2002; 20 2013; 12 2013; 52 2011; 20 1988; 83 2015 2001; 17 2012; 6 2009; 3 2007; 21 2010; 4 1985; 10 2006; 106 2012; 118 2009; 18 e_1_2_7_6_1 e_1_2_7_5_1 e_1_2_7_4_1 e_1_2_7_3_1 Bluethmann SM (e_1_2_7_47_1) 2015 e_1_2_7_9_1 e_1_2_7_8_1 Godin G (e_1_2_7_22_1) 1985; 10 e_1_2_7_19_1 e_1_2_7_18_1 e_1_2_7_17_1 e_1_2_7_16_1 e_1_2_7_40_1 e_1_2_7_2_1 e_1_2_7_15_1 e_1_2_7_41_1 e_1_2_7_14_1 e_1_2_7_42_1 e_1_2_7_13_1 e_1_2_7_43_1 e_1_2_7_12_1 e_1_2_7_44_1 e_1_2_7_11_1 e_1_2_7_45_1 e_1_2_7_10_1 e_1_2_7_46_1 e_1_2_7_26_1 e_1_2_7_48_1 e_1_2_7_27_1 e_1_2_7_28_1 e_1_2_7_29_1 e_1_2_7_30_1 e_1_2_7_25_1 e_1_2_7_31_1 e_1_2_7_24_1 e_1_2_7_32_1 e_1_2_7_23_1 e_1_2_7_33_1 e_1_2_7_34_1 e_1_2_7_21_1 e_1_2_7_35_1 e_1_2_7_20_1 e_1_2_7_36_1 e_1_2_7_37_1 e_1_2_7_38_1 Hewitt M (e_1_2_7_7_1) 2005 e_1_2_7_39_1 15331082 - Crit Rev Oncol Hematol. 2004 Sep;51(3):249-61 20571870 - Breast Cancer Res Treat. 2010 Oct;123(3):627-35 19255326 - J Clin Oncol. 2009 Apr 1;27(10):1600-6 23163239 - J Clin Nurs. 2013 Jan;22(1-2):4-21 23179496 - J Cancer Surviv. 2013 Mar;7(1):74-82 18179344 - J Fam Psychol. 2007 Dec;21(4):726-35 11928892 - Psychol Methods. 2002 Mar;7(1):83-104 23017613 - J Pain Symptom Manage. 2013 Jun;45(6):1007-18 4053261 - Can J Appl Sport Sci. 1985 Sep;10(3):141-6 22258477 - MMWR Surveill Summ. 2012 Jan 20;61(1):1-23 21980014 - Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2068-77 19902360 - J Cancer Surviv. 2010 Mar;4(1):20-32 22539238 - CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74 11013380 - Cancer. 2000 Oct 1;89(7):1634-46 23498109 - Am J Prev Med. 2013 Apr;44(4):416-23 11844825 - J Clin Oncol. 2002 Feb 15;20(4):1017-25 22895961 - Cochrane Database Syst Rev. 2012 Aug 15;(8):CD007566 16311986 - Cancer. 2006 Jan 1;106(1):17-27 17951226 - J Natl Cancer Inst Monogr. 2007;(37):16-21 18923906 - J Cancer Surviv. 2008 Dec;2(4):253-61 23335087 - CA Cancer J Clin. 2013 Jan;63(1):11-30 25555831 - Breast Cancer Res Treat. 2015 Jan;149(2):331-42 22048034 - Br J Cancer. 2011 Nov 8;105 Suppl 1:S52-73 16314649 - J Clin Oncol. 2005 Dec 1;23(34):8884-93 15850868 - Prev Med. 2005 Jun;40(6):702-11 23008316 - J Clin Oncol. 2012 Oct 20;30(30):3697-704 22590805 - Health Rep. 2012 Mar;23(1):47-53 22674036 - Cancer. 2012 Dec 15;118(24):6171-8 23695026 - Br J Cancer. 2013 Jun 11;108(11):2407-12 11038480 - Psychooncology. 2000 Sep-Oct;9(5):418-27 22879576 - Integr Cancer Ther. 2013 May;12(3):206-12 16551368 - Epidemiol Perspect Innov. 2006 Mar 21;3:3 19033571 - J Natl Cancer Inst. 2008 Dec 3;100(23):1672-94 15548349 - Public Health Nutr. 2004 Dec;7(8):1097-105 23244677 - Acta Oncol. 2013 Feb;52(2):195-215 11764707 - Semin Oncol Nurs. 2001 Nov;17(4):241-8 23125004 - Psychooncology. 2013 Aug;22(8):1759-65 18536022 - Psychooncology. 2009 Feb;18(2):128-33 17444920 - Psychol Sci. 2007 Mar;18(3):233-9 21908726 - Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2317-24 22614994 - J Clin Oncol. 2012 Jul 1;30(19):2354-61 16043830 - J Clin Oncol. 2005 Aug 20;23(24):5814-30
References_xml	– reference: Ballard-Barbash R, Siddiqi SM, Berrigan DA, Ross SA, Nebeling LC, Dowling EC. Trends in research on energy balance supported by the National Cancer Institute. Am J Prev Med 2013;44:416-423. – reference: Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med 2005;40:702-711. – reference: Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2010;123:627-635. – reference: Alfano CM, Day JM, Katz ML, et al. Exercise and dietary change after diagnosis and cancer-related symptoms in long-term survivors of breast cancer: CALGB 79804. Psycho-Oncology 2009;18:128-133. – reference: Dunn J, Ng SK, Holland J, et al. Trajectories of psychological distress after colorectal cancer. Psycho-Oncology 2013;22:1759-1765. – reference: Mcbride CM, Clipp E, Peterson BL, Lipkus IM, Demark-Wahnefried W. Psychological impact of diagnosis and risk reduction among cancer survivors. Psycho-Oncology 2000;9:418-427. – reference: Rabin C. Promoting lifestyle change among cancer survivors: when is the teachable moment? American Journal of Lifestyle Medicine September/October 2009;3:369-378. – reference: Ganz PA. Late effects of cancer and its treatment. Semin Oncol Nurs 2001;17:241-248. – reference: Little RJ. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc 1988;83:1198-1202. – reference: Carmack CL, Basen-Engquist K, Gritz ER. Survivors at higher risk for adverse late outcomes due to psychosocial and behavioral risk factors. Cancer Epidemiol Biomarkers Prev 2011;20:2068-2077. – reference: Bluethmann SM, Vernon SW, Gabriel KP, Murphy CC, Bartholomew LK. Taking the next step: a systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors. Breast Cancer Res Treat 2015;1-12. – reference: Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer 2000;89:1634-1646. – reference: Basen-Engquist K, Hughes D, Perkins H, Shinn E, Taylor CC. Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors. J Cancer Surviv 2008;2:253-261. – reference: Maunsell E, Drolet M, Brisson J, Robert J, Deschenes L. Dietary change after breast cancer: extent, predictors, and relation with psychological distress. J Clin Oncol 2002;20:1017-1025. – reference: Trudel-Fitzgerald C, Savard J, Ivers H. Evolution of cancer-related symptoms over an 18-month period. J Pain Symptom Manage 2013;45:1007-1018. – reference: Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin 2013;63:11-30. – reference: Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 1985;10:141. – reference: Jemal A, Thun MJ, Ries LAG, et al. Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 2008;100:1672-1694. – reference: Slymen DJ, Ayala GX, Arredondo EM, Elder JP. A demonstration of modeling count data with an application to physical activity. Epidemiol Perspect Innov 2006;3:3. – reference: Atkins DC, Gallop RJ. Rethinking how family researchers model infrequent outcomes: a tutorial on count regression and zero-inflated models. J Fam Psychol 2007;21:726. – reference: Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP. Successes and failures of the teachable moment. Cancer 2006;106:17-27. – reference: Courneya KS, Vallance JKH, McNeely ML, Karvinen KH, Peddle CJ, Mackey JR. Exercise issues in older cancer survivors. Crit Rev Oncol 2004;51:249-261. – reference: MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods 2002;7:83. – reference: Jones LW, Alfano CM. Exercise-oncology research: past, present, and future. Acta Oncol 2013;52:195-215. – reference: Demark-Wahnefried W, Morey MC, Sloane R, et al. Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol 2012;30:2354-2361. – reference: Thompson FE, Midthune D, Subar AF, Kahle LL, Schatzkin A, Kipnis V. Performance of a short tool to assess dietary intakes of fruits and vegetables, percentage energy from fat and fibre. Public Health Nutr-Cab International 2004;7:1097-1106. – reference: Husebø A, Lunde M, Dyrstad SM, Søreide JA, Bru E. Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors. J Clin Nurs 2013;22:4-21. – reference: Ligibel J. Lifestyle factors in cancer survivorship. J Clin Oncol 2012;30(30):3697-3704. – reference: Campo RA, Rowland JH, Irwin ML, Nathan PC, Gritz ER, Kinney AY. Cancer prevention after cancer: changing the paradigm - a report from the American society of preventive oncology. Cancer Epidemiol Biomarkers Prev 2011;20:2317-2324. – reference: Spark LC, Reeves MM, Fjeldsoe BS, Eakin EG. Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes. J Cancer Surviv 2013;7:74-82. – reference: Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol 2005;23:8884-8893. – reference: Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. National Academies Press: Washington, DC, 2005. – reference: Chambers SK, Lynch BM, Aitken J, Baade P. Relationship over time between psychological distress and physical activity in colorectal cancer survivors. J Clin Oncol 2009;27:1600-1606. – reference: Hawkins NA, Smith T, Zhao L, Rodriguez J, Berkowitz Z, Stein KD. Health-related behavior change after cancer: results of the American Cancer Society's studies of cancer survivors (SCS). J Cancer Survivorship 2010;4:20-32. – reference: Williams K, Steptoe A, Wardle J. Is a cancer diagnosis a trigger for health behaviour change? Findings from a prospective, population-based study. Br J Cancer 2013;108(11):2407-2412. – reference: Sabiston CM, Brunet J. Reviewing the benefits of physical activity during cancer survivorship. Am J Lifestyle Med 2012;6:167-177. – reference: Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer 2011;105:S52-S73. – reference: Rosenstock IM. The health belief model and preventive health behavior. Health Educ Behav 1974;2:354-386. – reference: Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005;23:5814-5830. – reference: Bellury L, Pett MA, Ellington L, Beck SL, Clark JC, Stein KD. The effect of aging and cancer on the symptom experience and physical function of elderly breast cancer survivors. Cancer 2012;118:6171-6178. – reference: Fritz MS, Mackinnon DP. Required sample size to detect the mediated effect. Psychol Sci 2007;18:233-239. – reference: Ottenbacher A, Sloane R, Snyder DC, Kraus W, Sprod L, Demark-Wahnefried W. Cancer-specific concerns and physical activity among recently diagnosed breast and prostate cancer survivors. 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Snippet	Background A cancer diagnosis may provide a ‘teachable moment’ in cancer recovery. To better understand factors influencing lifestyle choices following... A cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we... BACKGROUNDA cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following...
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SubjectTerms	Behavior Breast cancer Burden Cancer Consumption Diet Exercise Fruit Grasping Health behavior Health education Health promotion Healthy food Latin American cultural groups lifestyle behaviors Lifestyles Medical diagnosis Medical treatment Moderated oncology Physical activity Physical fitness Prostate Prostate cancer Proximity psychosocial Recovery Regression analysis Respondents Smoking Survivor survivors Symptoms Time Tobacco
Title	Grasping the 'teachable moment': time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors
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