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Provider Counseling About Health Behaviors Among Cancer Survivors in the United States

Susan A. Sabatino, Ralph J. Coates, Robert J. Uhler, Lori A. Pollack, Linda G. Alley, Laura J. Zauderer

From the Division of Cancer Prevention and Control, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
Deceased

Address reprint requests to Susan A. Sabatino, MD, Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Highway (K-52), Atlanta, GA 30341; e-mail: ssabatino{at}cdc.gov

Purpose To examine provider discussion or counseling of US cancer survivors about diet, exercise, and tobacco use.

Methods We used 2000 National Health Interview Survey data to examine whether US cancer survivors reported that, within 1 year, a provider (1) discussed diet, (2) recommended they begin or continue exercise, or (3) asked about smoking. We included survivors more than 1 year beyond diagnosis (n = 1,600) and adults without cancer (AWCs; n = 24,636) who saw/talked to a provider within 1 year. We used generalized linear contrasts in bivariable analyses and logistic regression to calculate predicted marginals adjusted for age, sex, comorbidity, usual source of care, and number of provider visits in the prior year.

Results Few survivors reported discussions or recommendations for all three health behaviors (10% of survivors v 9% of AWCs; P = .57). Although report was more likely than among AWCs, few survivors reported diet discussions (30% of survivors v 23% of AWCs; P < .0001) or exercise recommendations (26% of survivors v 23% of AWCs; P < .005), and a minority were asked about smoking (42% of survivors v 41% of AWCs; P = .41). After adjustment, survivors were less likely to report exercise recommendations than were AWCs (22% v 24%, respectively; P = .02). Colorectal cancer survivors were less likely than were AWCs of similar age range to report exercise recommendations (16% v 27%, respectively; P < .003) or smoking discussions (31% v 41%, respectively; P < .05). Cervical cancer survivors were more likely than AWCs of similar age range to discuss smoking (58% v 43%, respectively; P < .001).

Conclusion Findings from this nationally representative sample suggest that many providers may miss opportunities to counsel survivors about healthy behaviors, perhaps particularly colorectal cancer survivors.

Supported by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention (CDC) administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and CDC (S.S.).

Presented in part at the 2006 International Union Against Cancer (UICC) World Cancer Congress, July 11, 2006, Washington, DC.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency.

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

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