Abstract
Purpose
As survival rates for patients treated with colorectal cancer (CRC) increase, it is important to consider the short- and long-term self-management needs. The current work aimed to explore perceived patient needs for advice on diet, activity and beliefs about the role of lifestyle for reducing disease recurrence.
Methods
Forty colorectal cancer survivors, aged between 27 and 84, participated in six focus groups in community locations in the UK.
Results
The findings suggest that CRC survivors would welcome guidance on diet in the immediate posttreatment period to alleviate symptoms and fears about food choices. Many participants actively sought lifestyle advice but experienced confusion, mixed messages, culturally inappropriate guidance and uncertainty about evidence of benefit. There was scepticism over the role of diet and physical activity as causes of cancer, in part because people believed their lifestyles had been healthy and could not see how reinstating healthy behaviours would reduce future disease risk. The sense of changing lifestyle to ‘stack the odds in their favour’ (against recurrence) appeared a more meaningful concept than prevention per se. Those people who had made or maintained dietary changes highlighted the importance of these to contributing to wellbeing and a sense of control in their life.
Conclusions
A dogmatic approach to lifestyle change may lead to perceptions of victim blaming and stigmatisation. Personalised, evidence informed, guidance on lifestyle choices does appear to be a much needed part of care planning and should be built in to survivorship programmes.
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References
Kornblith AB (1998) Psychological adaptation of cancer survivors. In: Holland JC (ed) Psychooncology. Oxford University Press, New York
Institute of Medicine (2005) From cancer patient to cancer survivor: lost in transition. The National Academies Press, Washington DC
McBride et al (2000) Psychological impact of diagnosis and risk reduction among cancer survivors. Psycho-Oncology 9(5):418–427
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:625–638
Davey Smith G, Shipley MJ, Batty GD, Morris JN (2000) Marmot MPhysical activity and cause-specific mortality in the Whitehall study. Public Health 114(5):308–315
Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC (1995) Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 122(5):327–334
Meyerhardt JA, Niedzwiecki D, Hollis D et al (2007) Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA 298(7):754–764
Meyerhardt JA, Catalano PJ, Haller DG et al (2003) Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 98(3):484–495
Meyerhardt JA, Hesletine D, Niedzwiecki et al (2005) The impact of physical activity on patients with stage III colon cancer: findings from Intergroup trial CALGB 89803. J Clin Oncol 23(16S):3534
Meyerhardt JA, Giovannucci EL, Ogino S et al (2009) Physical activity and male colorectal cancer survival. Arch Int Med 169(22):2102–2108
Anderson AS, Caswell S, Wells M, Steele RJ, Macaskill S (2010) "It makes you feel so full of life" LiveWell, a feasibility study of a personalised lifestyle programme for colorectal cancer survivors. Support Care Cancer 18(4):409–415
Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, Hartman TJ, Miller P, Mitchell DC, Demark-Wahnefried W (2009) Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA 13(301(18)):1883–1891
Hawkes AL, Gollschewski S, Lynch BM, Chambers S (2009) A telephone delivered lifestyle intervention for colorectal cancer survivors ‘CanChange’ a pilot study. Psychooncology 18(4):449–455
Stead M, Caswell S, Craigie AM, Eadie D and Anderson A (2011) Understanding the potential and challenges of adenoma treatment as a prevention opportunity: insights from the BeWEL formative study, Preventive Medicine
Skeie G, Hjartaker A, Braaten T, Lund E (2009) Dietary change among breast and colorectal cancer survivors and cancer free women in the Norwegian Women and Cancer cohort study. Cancer Causes Control 20(10):1955–1966
Doyle C et al (2006) Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices American Cancer Society. CA Cancer J Clin 56:323
World Cancer Research Fund / AICR (2007) Food, nutrition, physical activity and the prevention of cancer:a global perspective. WCRF and AICR, Washington, DC
Anderson AS, Steele RJC, Caswell S, Wells EM (2010) Guidance for obesity management in colorectal cancer survivors—clinicians' views NCRI conference proceedings http://www.ncri.org.uk/ncriconference/2010abstracts/abstracts/A73.htm
Patton M (2001) Qualitative research and evaluation methods. Sage, Thousand Oaks
Srivastava A, Thomas SB (2009) Framework analysis: a methodology for applied policy research. JOAAG 4(2):72–79
Craig K (2007) Enjoy project. Evaluation of a lifestyle intervention programme for colorectal cancer patients in Tayside. MPH thesis, University of Dundee
Ko et al (2010) Mediators of fruit and vegetable consumption in colorectal cancer survivors. J Can Survivors
Miles A, Simon A, Wardle J (2010) Answering patient questions about the role of lifestyle factors play in cancer onset, and recurrences. J Health Psychol 15(92):291–298
Faul LA, Shibata D, Townsend I, Jacobsen PB (2010) Improving survivorship care for patients with colorectal cancer. Cancer Control 17(1):35–43
Acknowledgments
The study was funded by Bowel Cancer UK. Mrs Jackie Rodgers (Clinical Nurse Specialist), NHS Tayside and Dr Stephen Caswell (University of Dundee) have also provided helpful comments and guidance on the study design.
Conflict of interest
We (the authors) have had full control of all the primary data and are happy for the journal to review this data as required.
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Anderson, A.S., Steele, R. & Coyle, J. Lifestyle issues for colorectal cancer survivors—perceived needs, beliefs and opportunities. Support Care Cancer 21, 35–42 (2013). https://doi.org/10.1007/s00520-012-1487-7
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DOI: https://doi.org/10.1007/s00520-012-1487-7