Background: Healthy lifestyle behaviors are associated with positive health outcomes and quality of life in cancer survivors. However, adherence to lifestyle recommendations is low. To improve health-enhancing behaviors, insight is needed into the factors that relate to engagement in lifestyle behaviors. This study explored the contribution of distal (socio-demographic, cancer-related, psychological), and proximal factors (attitude, social support, self-efficacy). Abovementioned factors and intention were assessed in relation to five lifestyle behaviors (smoking, physical activity, and alcohol, fruit, and vegetable consumption). Methods: We conducted a cross-sectional survey among early cancer survivors with various types of cancer. Participants (N = 255; 70.7% females; mean age 60.6 years) were recruited from 8 Dutch hospitals. Socio-demographic, cancer-related, psychological, and social cognitive factors, intention, and lifestyle behaviors were assessed with self-report questionnaires (e.g. EORTC QLQ-C30, HADS, IPAQ). Cross-sectional analyses (correlations and regression analyses) were conducted. Results: The majority (>80%) of the cancer survivors complied with two to four health recommendations. A small group (11%) adhered to all five recommendations, while fewer than 7% adhered to one or no recommendations. Highest adherence to the recommendations was found for engaging in physical activity (87.4%), refraining from smoking (82%), and limiting alcohol consumption (75.4%). Poor adherence was found for the recommendations relating to fruit (54.8%) and vegetable (27.4%) intake. The associations between the different behaviors were weak; however, people who drank more alcohol and smoked more were less likely to adhere to the fruit recommendation. Each separate lifestyle behavior was influenced by different factors. Self-efficacy, attitude, and intention were the strongest correlates in all behaviors examined – although with varying strength – while socio-demographic, cancer-related, and psychological factors made much smaller contributions to the explained variance of behaviors. Moreover, adherence to a higher number of recommendations was exclusively significantly correlated to attitude, social support, self-efficacy, and intention. Conclusions: Adherence to fruit consumption was poor and adherence to vegetable consumption even worse; however, there is room for improvement in all five lifestyle behaviors. Our findings emphasize that all relevant lifestyle behaviors need to be encouraged in cancer survivors, taking into account that each behavior is influenced by a specific set of mainly social cognitive or intention-related factors. These outcomes contributed to the development of a Cancer aftercare intervention, tailored to individual’s situations, in particular to social cognitive factors and intentions, and targeting multiple lifestyle behaviors.
- Cancer survivors