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55 The Kanker Nazorg Wijzer protocol 3 BACKGROUND With advances in cancer detection and treatment and an aging population, the number of cancer survivors is increasing significantly (The Dutch Cancer Society, 2011). It is well- known that survivors face a variety of difficulties and challenges after treatment, such as anxiety, depression, fear of recurrence, fatigue, pain, physical and cognitive limitations, difficulties with employment, and sexual dysfunctions (Duijts et al., 2014; Harrington, Hansen, Moskowitz, Todd, & Feuerstein, 2010; Kattlove &Winn, 2003; Mehnert & Koch, 2008; Prue, Rankin, Allen, Gracey, & Cramp, 2006; Simard et al., 2013; Valdivieso, Kujawa, Jones, & Baker, 2012; Wu & Harden, 2015). These issues can have a negative impact on quality of life (QoL; Harrington et al., 2010; Wu & Harden, 2015) and may continue long after treatment has ended (Foster, Wright, Hill, Hopkinson, & Roffe, 2009). Cancer patients experience a peak level of distress within the first year after treatment, which might be partially explained by loss of security associated with being in treatment and loss of regular contact with health professionals (Hinnen et al., 2008). Moreover, having a healthy lifestyle expedites recovery and, therefore, is of special importance for survivors. However, many survivors do not have a healthier lifestyle than people without a history of cancer (Mayer et al., 2007): more than half are overweight, less than half comply with physical activity (PA) recommendations, only one fifth adheres to fruit and vegetable recommendations, and one in ten smokes (Bellizzi et al., 2005; Inoue-Choi et al., 2013; LeMasters et al., 2014; Williams et al., 2013). More than half of the survivors report having unmet information and support needs on how to deal with issues, such as emotional and social support, fear and stress, and treatment and follow-up care (Hodgkinson, Butow, Fuchs, et al., 2007a; Hodgkinson, Butow, Hunt, Pendlebury, Hobbs, &Wain, 2007c; Smith et al., 2013; Willems et al., 2016). Concerning lifestyle, survivors express a need for information and support regarding increasing exercise, improving diet, and smoking cessation (James-Martin, Koczwara, Smith, & Miller, 2014; Pullar, Chisholm, & Jackson, 2012; Willems et al., 2016). To improve the aftercare for cancer survivors, a national guideline for cancer survivorship care was developed in the Netherlands (Comprehensive Cancer Centre the Netherlands, 2011b). This guideline describes the importance of a broad programmatic approach for oncology aftercare in which self-management should be stimulated. The Internet has become a key source for health-related information for cancer survivors (Chou, Liu, Post & Hesse, 2011; Mayer, Terrin, Kreps, et al., 2007; Warren, Footman, Tinelli, McKee, & Knai, 2014) and has the potential to fill an important gap in cancer care (Leykin et al., 2012). A great advantage of web-based interventions is that they can reach many patients at once and are accessible anytime and anywhere (Lustria, Cortese, Noar, & Glueckauf, 2009). However, due to the broad variety of difficulties experienced and the different characteristics of the survivors, it is challenging to provide individually relevant information and support (Willems et al., 2016). By means of computer tailoring, information