Originally published as JCO Early Release 10.1200/JCO.2005.01.230 on July 25 2005

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Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer

From the Program of Cancer Prevention, Detection and Control Research, Duke Comprehensive Cancer Center, Durham, NC; Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD; and The Miriam Hospital, Lifespan Academic Medical Center, Centers for Behavioral and Preventive Medicine, Brown University, Providence, RI

Address reprint requests to Wendy Demark-Wahnefried, PhD, RD, LDN, Box 3707, Duke University Medical Center, Durham, NC 27710; e-mail: demar001{at}mc.duke.edu

PURPOSE: Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population.

METHODS: Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches.

RESULTS: Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance.

CONCLUSION: With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.

Supported by National Institutes of Health grant Nos. CA81191 (W.D.-W.), CA92468 (W.D.-W.), CA106919 (W.D.-W.), and The Susan G. Komen Foundation (W.D.-W. and N.M.A.), American Cancer Society (B.M.P.), and The Lance Armstrong Foundation (B.M.P.).

Parts of this article have been used to develop a chapter (coauthors: W.D.-W. and N.M.A.) within a planned volume entitled "Handbook of Behavioral Science and Cancer" to be published by the American Psychological Association later this year.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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