Capitalizing on the ‘teachable moment' to promote healthy behavior changes among cancer survivors

As of June 2012, there were approximately 13.7 million U.S. cancer survivors, of which 64% have survived five or more years post-diagnosis. Cancer survivors are at increased risk of cancer recurrence, a second incidence of cancer, development of other chronic diseases. Survivors also report poorer health than adults who have not had cancer. Interventions seeking to promote behavior change have been proposed as one strategy for improving the health outcomes and quality of life of long-term cancer survivors. However, there is limited research exploring the feasibility of implementing behavior change interventions within clinical settings.

We conducted in-depth, semi-structured interviews with 32 clinicians (10 oncologists, 5 surgeons, 6 primary care providers, 7 nurses, and dieticians, social workers and patient navigators) who care for prostate, breast, and/or non-Hodgkin's lymphoma cancer survivors. Interviews were structured around caring for long-term survivors, and clinical perceptions of the importance of promoting behavior change, with a particular emphasis on dietary change.

Clinicians reported that many cancer survivors ask questions about dietary changes. Survivors often ask whether specific foods are good or bad for the cancer, and about supplements. Most clinicians recommended a well-balanced healthy diet rather than cancer-specific ‘super foods.' However, they noted lack of time and expertise as barriers to providing detailed dietary messages or interventions. While dieticians were mentioned as possible interventionists, they are infrequently accessible to cancer survivors.

Given that survivors inquire about diet, there is an opportunity to promote behavior change; however approaches must work within the constraints of the existing clinical structure.