Cancer survivors need assistance from their healthcare providers in quitting smoking, and improving their physical activity and dietary behaviors within the context of their post-treatment cancer care. Physician advice has been shown to motivate behavior change, yet clinicians report multiple barriers in assisting patients to implement such changes. This pilot project will examine the feasibility and potential impact of an intervention for promoting healthy lifestyle behaviors as cancer patient's transition to survivorship. We will use a systematic methodology to adapt existing print and telephone-based interventions to an interactive e-health format for self- directed home use. The program, based on DVD format, will be able to be readily integrated into the clinical encounter as an enhancement to clinician advice by providing education and behavior change strategies. In collaboration with four follow-up care clinics, we will recruit a sample of participants with a history of the most prevalent cancers. Using a within-clinic, pre-post design, all patients will be screened for smoking, dietary, and physical activity behaviors. We will recruit cancer survivors at the time of their follow-up clinic appointments and provide the health communication program with instruction to use it at home. Changes in health behaviors and theory-driven variables related to health behavior change will be accessed via phone three months following participants'appointments. This project represents an important effort to disseminate best-practices for a high-risk population of cancer survivors using an inexpensive, yet underutilized communication medium.
There are an estimated 10.8 million persons in the United States who have a history of cancer, a number that has been steadily increasing due to progress in detection and treatment and the overall aging of the population. The 5-year expected survival rate now averages 66% for all cancers and is as high as 98% for early stage breast and prostate cancers. The lives of cancer survivors, however, are often marked by health problems including comorbidities such as cardiovascular disease, diabetes and osteoporosis, as well as treatment sequelae and functional deficits. Cancer survivors are more likely to be older, to die from non-cancer causes, and to suffer functional impairments of daily living than those who have not had a cancer diagnosis. Despite their increased vulnerability, significant percentages of cancer survivors remain nonadherent to lifestyle behavior recommendations, suggesting the need for follow-up care that more fully addresses preventive healthcare and management of comorbid conditions. Although numerous surveys indicate that most survivors are interested in improving their health, several studies have found that a diagnosis of cancer does not necessarily result in increased adherence to healthy lifestyles. A range of interventions is clearly needed to meet the needs of cancer survivors in adopting healthy lifestyle changes. Since most cancer survivors prefer to receive health-related information from their oncologists and/or primary care providers, they need to have the capacity to deliver the assistance that survivors expect. Physician advice has been shown to motivate behavior change, yet clinicians report multiple barriers (e.g., time and training) in assisting patients to implement such changes. This proposed study will address this need by developing and pilot testing an interactive e-health behavior change tool that clinicians can give to patients recently completing cancer treatment that will provide a). Information about the benefits of healthy lifestyle behaviors in survivorship and b). Evidence-based strategies for making desired behavior changes. We will use a carefully planned qualitative and quantitative methodology for adapting evidence-based interventions to the e-health format, thereby supporting a much-needed effort to create a viable survivor-targeted intervention that meets both providers'and survivors'needs. Ultimately, if this theory-based, targeted enhancement is disseminated, it promises to achieve significant impact in reducing behavioral risk factors by reaching a large number of survivors.