Background: With the increasing cancer survivor population comes the need to develop recommendations about how to optimally care for these survivors. In addition to risk for recurrence, cancer survivors are at greater risk for developing second malignancies, cardiovascular disease, diabetes, osteoporosis, and functional decline as a result of cancer treatment, genetic predisposition, and/or common lifestyle factors.
Studies of cancer survivors evaluating the engagement and promotion of healthy eating, weight control, physical activity, and smoking cessation have been published suggesting that lifestyle behaviors may be important to counter some of the adverse effects of cancer treatments and disease recurrence while improving overall quality of life and health outcomes. Realizing that survivors are highly motivated to improve their overall health after a diagnosis of cancer, healthy lifestyle recommendations from oncology providers, including nurse/patient navigators, can serve as a strong tool to motivate survivors to adopt health behavior changes.
Objective: To promote the motivation and adoption of healthy lifestyle behavior changes by cancer survivors through patient-centered education, tools, and resources during survivorship and follow-up care.
Methods: To enhance the promotion and adoption of healthy lifestyle changes (healthy eating/weight control, physical activity, smoking cessation, and cancer screenings) of cancer survivors, a newly developed patient-centered assessment and education protocol utilizing survivorship guidelines from the American Cancer Society (ACS)1 and the National Comprehensive Cancer Network (NCCN)2 was implemented by the oncology nurse navigator. Prior to the process change, upon completion of treatment, cancer survivors met with the nurse navigator to discuss their treatment summary and survivorship care plan, including individualized education on healthy lifestyle behaviors and recommended cancer screenings (mammography, colonoscopy, skin cancer screening) as well as motivational tools/resources for behavior changes, but were not monitored. For the process change, during their survivorship care/follow-up care for 1 year, the navigator monitored the healthy behaviors of cancer survivors regarding weight/diet, physical activity, and smoking cessation and completion of recommended cancer screenings. According to their responses to the quality measures, the cancer survivors were provided with tailored education on behavior changes based on the ACS and NCCN guidelines. Survivors were also provided with tools and referrals to local resources (nutritional consult, Motion to Wellness weekly exercise program, smoking cessation program, and facilities for cancer screening services).
Results: Seventy-seven cancer survivors completing cancer treatment met with the nurse navigator to discuss their treatment summary and survivorship care plan, including healthy lifestyle behaviors, and were monitored for 1 year. The lifestyle of a small group (15%) of the cancer survivors was coherent with all 4 health recommendations, the majority (80%) adhered to 2 or 3 of the 4 recommendations, and only a few (5%) adhered to 1 or none of the recommendations. The highest prevalence in followed recommendations has been detected in cancer screenings (87.4%), refrain from smoking (82%), and physical activity (75.4%). There was low adherence to weight/diet recommendation (54.8%). Survivors who received a recommendation for health promotion and were monitored were more likely to make lifestyle modifications and undergo self-care screenings.
Conclusion: The diagnosis of cancer is recognized as a teachable moment. Navigators have the opportunity to improve the quality of life and overall health of survivors by guiding them into a healthful lifestyle in survivorship. Healthy lifestyle recommendations form an important part of survivorship care and should be included in the survivorship care planning and delivery and throughout follow-up care. As long-term survivorship care progresses, navigators must continue to monitor the health behaviors of survivors and look for opportunities to encourage appropriate follow-up and prevention practices. The receptivity of healthy lifestyle behaviors is improved in survivors if oncology providers, including nurse navigators, educate survivors and endorse evidence-based recommendations.
- American Cancer Society. American Cancer Society Survivorship Care Guidelines. www.cancer.org/health-care-professionals/american-cancer-society-survivorship-guidelines.html.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Survivorship. www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf.