Change That Behavior!

January 27, 2010

Good news came from the American Cancer Society this week. Research suggesting that positive behavior changes are more likely than negative behavior changes among cancer survivors after a cancer diagnosis was published in the Journal of Cancer Survivorship. The study examined over 7000 cancer survivors at 3, 6, and 11 years post-diagnosis. The researchers defined positive behavior changes as one of the following: getting regular check-ups, taking vitamins, eating healthy foods, using sunscreen, trying to lose weight, avoiding sun exposure, exercising, getting good rest, spending more time with family and friends, spending time on hobbies, going to church, avoiding alcohol, avoiding smoking. While this is good news for sure, there are two key limitations of this study. First, the researchers defined a negative behavior change with respect to the categories listed above. In other words, the researchers gave survivors "plus points" for engaging in the positive behavior and "minus points" for not engaging in the behavior. Obviously, this discounts a host of behavior changes, especially those with largely negative skews in which a survivor could engage. For example, consider adherence to self-administered medication. Clearly, failing to adhere to a regimen is a negative behavior, but proper adherence might not be considered a positive behavior; rather, it is likely considered by most to be neutral – in other words, what you are expected to do. Second, the researchers learned about the behavior changes through a mailed questionnaire, and it could be argued that survivors are more likely to report or view their behaviors as more positive than they have been. In other words, survivors might be less likely to admit to negative behavior. One last note of concern – the list of behavior changes considered in this study is certainly far from exhaustive. What should cancer survivors take away from this study? 1) A cancer diagnosis is a poignant event in one’s life, and it can be good time to re-evaluate behaviors and make modifications. 2) The reason the study was conducted is that health behaviors during survivorship can have broad impacts on a survivor’s overall health. It would be good to take this list, consult with your physician, and come up with a list of behaviors that would most benefit you and your survivorship.

Click here for a PubMed listing of the study.

Keeping on the theme of behavior changes and effects on a survivor's life, a study published in the journal, Psycho-Oncology, this month highlights the specificity of different cancer diagnoses with respect to the lifestyle changes that ultimately improve physical well-being. I know that was a complicated sentence. Let’s start with what the study examined – the researchers looked at European-descendant and Latina breast and cervical cancer survivors. They examined health behaviors such as eating a healthy diet or improving exercise habits or stress management. The researchers found, through a complicated analysis, that the magnitude of the effects of specific behaviors differs significantly depending on the cancer-type, the race of the survivor, other lifestyle changes. These findings confirm what we know to be true – cancer is a complicated disease, and understanding survivorship is more complicated than most imagine. For survivors, this is simply more evidence supporting individualized survivorship plans. This means that a survivor must take the time to investigate what pathways are best for him/her because survivorship is one place where one size certainly does not fit all.

Click here for a PubMed listing of the study.

In previous blogs for the CT Challenge, I have written about systematic reviews of the research literature. I wrote:

"If you are not directly involved with it, the world of medical research can easily seem overly complicated and unnecessarily complex. The truth is this: research does get complicated at times; often many research projects address similar (if not exactly the same) questions. But researchers do recognize this, and ever-so-often, researchers will take a time-out to look at all the research on a specific topic. Sometimes researchers will do this in a more formal way, and they will publish their work as a systematic review and/or meta-analysis. Systematic reviews and meta-analyses are research projects in which the researchers examine all the research on a given topic, and then they summarize what was found.”

Another apropos systematic review was published recently. Researchers examined the big-picture effects of physical activity level, diet quality, and adiposity (fatness) on breast cancer recurrence and mortality among breast cancer survivors. The results speak for themselves; the authors of the review suggest that being overweight is associated with 30% increase risk for mortality among breast cancer survivors. The researchers also suggest that research shows high proportions of breast cancer survivors are overweight or obese and/or sedentary. It seems logical that for breast cancer survivors increasing physical activity and decreasing adiposity (fatness) might lead to better prognoses with respect to recurrence and mortality.

Click here for a PubMed listing of the study.

Much has been written and discussed regarding lymphedema, so I won’t belabor the point. In short, lymphedema is the retention of fluid in the lymph node (most commonly experienced in the arm by breast cancer survivors who underwent surgery). As anyone who has investigated lymphedema knows, there is no cure for the condition, and the medical community is confused about how to treat it. A recent study from Sweden focused on the importance of identifying lymphedema early in its development because it seems that if it is identified when the volume of fluid being retained is relatively small, treatments can keep the volume low for at least 10 years (the length of the study from Sweden). In fact, it seems from this research that the most important factor in controlling lymphedema is identifying it before the volume of fluid retained by the lymph nodes gets to be too much. If you are experiencing any of the following symptoms of lymphedema, be sure to contact your doctor promptly.

Lymphedema Symptoms

-Swelling of part of your arm or leg or your entire arm or leg, including your fingers or toes

-A feeling of heaviness or tightness in your arm or leg

-Restricted range of motion in your arm or leg

-Aching or discomfort in your arm or leg

-Recurring infections in your affected limb

-Hardening and thickening of the skin on your arm or leg

Click here for a PubMed listing of the study.