Iris Kanera

5 109 Lifestyle-related effects of the Kanker Nazorg Wijzer BACKGROUND Healthy lifestyle behaviors have been proven to be highly beneficial for cancer survivors in improving recovery and quality of life (QoL) and lowering the risk of cancer recurrence and comorbidities (Baena & Salinas, 2014, 2015; Florou et al., 2014; Husson et al., 2015; Schmid & Leitzmann, 2014; Vijayvergia & Denlinger, 2015). As a result, comprehensive lifestyle recommendations have been developed by the World Cancer Research Fund (2009) and the American Institute for Cancer Research (WCRF/AICR) and the American Cancer Society (Kushi et al., 2012; Rock et al., 2012). The recommendations with regard to physical activity (PA) and dietary behavior are displayed in Box 5.1. In addition, it is advised to refrain from smoking (Boyle et al., 2015; Florou et al., 2014; National Comprehensive Cancer Network, 2015; Vijayvergia & Denlinger, 2015). Nonetheless, and despite the beneficial effects, only about 30 – 47% of cancer survivors follow the PA recommendations, about 15 – 34% follow the vegetable and fruit recommendations, and about 7.8 - 20.8% continue to smoke (Blanchard et al., 2008; Inoue-Choi et al., 2013; Kanera et al., 2016a; LeMasters et al., 2014; Westmaas et al., 2014; Zhang, Liu, John, Must, & Demark-Wahnefried, 2015). In turn, cancer survivors have indicated unmet needs in psychosocial and physical domains, including the need for specific and evidenced based information and support to build up PA, to improve their diet, and to quit smoking. These needs have been stressed by oncology care providers as well (Anderson et al., 2013; Coa et al., 2015; James-Martin et al., 2014; Kwok et al., 2015; Pullar et al., 2012; Willems et al., 2016; Wu & Harden, 2015). Moreover, oncologists have expressed a lack of time and expertise as barriers to giving multiple lifestyle behavior advice (Coa et al., 2015; Demark-Wahnefried et al., 2015; Warren et al., 2013). Consequently, health promotion initiatives should respond to these needs, and to the problems of care professionals who are serving a growing number of cancer survivors with restricted time, knowledge, and counseling skills (Azadmanjir, Safdari, & Ghazisaeidi, 2015; Comprehensive Cancer Centre the Netherlands, 2011b; De Angelis et al., 2014; Hammer et al., 2015). An increasing number of cancer survivors search the Internet for health-related information (Chou et al., 2011; Warren et al., 2014). Web-based interventions have a wide reach and can be used at any time, any place and at an individuals’own pace. They might be also less costly than face-to-face interventions (Kohl et al., 2013). Additionally, web-delivered interventions can effectively provide personalized information by means of computer tailoring, a proven effective method in health behavior change interventions (Broekhuizen et al., 2012; Civljak, Stead, Hartmann-Boyce, Sheikh, & Car, 2013; Neville, O’Hara, & Milat, 2009; Peels, van Stralen, et al., 2014; Schulz et al., 2014; Te Poel et al., 2009; van Stralen et al., 2009).