Iris Kanera

12 Chapter 1 Lifestyle behavior among cancer survivors Research has shown that cancer survivors did not follow consistently the lifestyle recommendations. Among Dutch colorectal cancer survivors, only 9% adhered to the fruit- and vegetable recommendations, 74% adhered to the PA recommendation, and 74% adhered to the alcohol recommendations (Winkels et al., 2016). Prior international research reported that more than half of cancer survivors were overweight, less than half followed the PA recommendations, only a minority adhered to the fruit and vegetable recommendations, while the majority did adhere to the alcohol and smoking recommendations (Bellizzi, Rowland, Jeffery, & McNeel, 2005; LeMasters, Madhavan, Sambamoorthi, & Kurian, 2014). Several studies concluded that survivors of various types of cancer were not more likely to adhere to the lifestyle recommendations as compared to the general population (Bellizzi et al., 2005; Blanchard, Courneya, Stein, & American Cancer Society’s SCS-II, 2008; Coups & Ostroff, 2005; DeNysschen et al., 2015; Inoue-Choi et al., 2013; LeMasters et al., 2014; Ramaswamy, Toll, Chagpar, & Judson, 2016; Stevinson, Lydon, & Amir, 2014; Westmaas, Alcaraz, Berg, & Stein, 2014). In contrast, recent evidence did find higher rates of inactive and overweight individuals, and a lower number of heavy drinkers among cancer survivors compared to individuals with no history of cancer (Mowls, Brame, Martinez, & Beebe, 2016). Specific subgroups of cancer survivors might be more at risk to maintain unhealthy lifestyle behaviors. Individuals with a younger age, female gender, lower education, lower income, high-risk alcohol consumption, a body mass index (BMI) > 25, and having household members who smoke are more likely to maintain smoking (Kim, Kim, Park, Shin, & Song, 2015; Westmaas et al., 2014). Moreover, among cervical cancer survivors, individuals who were currently employed and had a higher income were more likely to have lower levels of PA (Park et al., 2016). Additionally, being younger, married/cohabiting, and higher educated was correlated with less alcohol consumption (Park et al., 2016). Among breast cancer survivors, individuals with a higher age and higher education were more likely to be engaged in more PA, and a healthy diet, including less alcohol consumption (George et al., 2011). Interestingly, recent findings demonstrated that cancer patients were more likely to adhere to diet and smoking recommendations just after cancer diagnosis. This suggests that a cancer diagnosis might serve as a teachable moment in which individuals are triggered and motivated to perform healthy behaviors (Bluethmann et al., 2015; LeMasters et al., 2014; Westmaas et al., 2015; Winkels et al., 2016). Nevertheless, a cancer diagnosis as the only trigger seems to be insufficient to change health behaviors in the long term. Researchers suggest that behavioral support is needed to achieve sustainable lifestyle changes (Mowls et al., 2016; Williams, Steptoe, & Wardle, 2013). This is confirmed by Charlier et al. (2012), reporting that more than half of breast cancer survivors surveyed reported a supportive care need for performing PA. Therefore, the greatest benefits of lifestyle interventions may be achieved during the early stages of survivorship when survivors might be most receptive