Introduction

1. LIFESTYLE BEHAVIOURS OF PEOPLE WITH COLORECTAL CANCER LIVING ON VANCOUVER ISLAND: ADHERENCE TO HEALTHY HABITS AND PERCEIVED BARRIERS Helena Daudt, PhD; Nancy Payeur, RSW, MSW; Cheri Cosby, RD, MSc; Darcy Dennis, BSc; Heather Watson, RN, BScN BC Cancer Agency, Vancouver Island Centre, Victoria, BC, Canada Preliminary Results A high percentage of surveys were returned by the initial group of 649 CRC patients (49%) with frequent comments and requests for more information. A preliminary analysis of the random sample revealed: • Introduction • Colorectal cancer (CRC) is the third most commonly occurring cancer and yet it has a relatively high survival rate. Cancer survivors have been shown at increased risk for secondary tumours, cardiovascular disease and diabetes. Healthy lifestyle behaviours may decrease the risk of developing co-morbidities and may be beneficial in reducing cancer recurrence. There has been limited research regarding the lifestyle behaviours of people with CRC. Some studies indicate that CRC survivors change their health-related behaviours after diagnosis. However, results are mixed pertaining to maintaining of lifestyles changes over the long term in this patient group. • Objectives • 1. To identify the self-reported lifestyle behaviours of CRC patients over the continuum, including diagnosis, treatment, short and long term post treatment phases. • 2. To examine the perceived barriers to changing lifestyle behaviors from the patient’s perspective, their readiness to participate in healthy lifestyle behaviours interventions and the type of support patients identify as useful. • Material and Methods • A modified version of the validated FANTASTIC – lifestyle assessment tool was used to assess the lifestyle behaviors of patients by scoring the questions. Patients also completed a series of open-ended questions. The survey was mailed to patients identified using the PREDICT database. Additional subjects are still being recruited. • A preliminary analysis was conducted on a random sample of 120 of the surveys returned to date. These were divided into 4 groups of 30 based on treatment status at the time of survey completion: • Pre treatment (no treatments OR they had completed surgery only and were planning to start chemo and RT) • Ongoing (receiving one or more treatments) • Completed ≤6 months (completed all planned treatments 6 months ago or less) • Completed >6 months (completed all planned treatments more than 6 months ago). • Statistical analysis of preliminary data was run with SPSS 14.0 using mostly descriptive statistics. Differences between groups were examined using one-way ANOVA with Tukey’s HSD test for continuous variables and McNemar’s chi-squared analysis with Bonferroni correction for categorical data. Statistical significance was reported at P<0.05 level (two-tailed). Qualitative data will be analyzed using thematic analysis once recruitment is completed. b b a,b a Figure 7. Significantly fewer pretreatment subjects report having made lifestyle changes than those who had completed treatment (≤6 months, P=0.012; >6 months, P=0.000). Figure 1. Most people are moderately active frequently, but vigorously active less than one time per week. “Have spoken to both doctors and nurses to reassure myself that my recovery is progressing as it should. I was concerned that it was not going as well as it should have.” “Using local recreation centre, gym, and pool. Joined a walking group.” “I usually get out for an hour or so everyday and walk, Tai Chi, Swim, or lift weights. Most important put any worry I cannot solve off in a corner or forget it. Everything is ok with a little prayer.” “I need to remember that everything I put into my mouth needs to nourish my body; not just give me calories.” “Since having an ileostomy I have found eating a healthy diet extremely difficult. There are so many fruits and vegetables, nuts, etc. that I cannot tolerate…It is very discouraging.” “I am fortunate to have strong support from family & friends. I eat more fruit & vegetables and less and less meat.” “Re-evaluate activities in terms of doing more “fun” things instead of all the have too’s” “These lifestyle changes are by no means a “fait accompli” but rather a process or learning experience. Things like a lifetime of bad dietary habits and a lack of adequate stress management can’t be changed quickly or easily. Fortunately it seems that every positive change makes the next step easier.” Figure 2. Respondents tended to take either the recommended level of Vitamin D or none. Figure 8. Approximately 45% of survey respondents provided written comments along with their lifestyle checklists. • Final Comments • Mail-out surveys are a feasible way to acquire patient feedback from this population. • Healthy lifestyle behaviors were reported by the majority of CRC patients who completed the surveys. However behaviours that may require further attention include: • physical activity • Maintenance of ideal body weight • Vitamin D intake. • For the preliminary sample, pretreatment subjects had significantly higher lifestyle scores than subjects who had begun or completed treatment. However, subjects who had completed treatment reported having made more lifestyle changes than pretreatment subjects. It is possible that people who have completed treatment simply had more time to make lifestyle changes than pretreatment subjects, but this may also indicate the considerable impact of treatment on the lives of people with CRC. • The preliminary results of this project may serve as a foundation for an expanded investigation and may influence future care practice and population-based programs. Figure 3. While many people were at their ideal weight, a portion were considerably outside of this range. Table 1. Population demographics for the preliminary sample population Figure 4. Of the 50% of people who made lifestyle changes since diagnosis, many had already made healthier dietary choices. Figure 5. Of the 52% of people who wanted to make future lifestyle changes, most wanted to increase physical activity * • References • Blanshard,CM et al. 2008. Cancer survivor’s adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Onc, 28:2198-2204. • Canadian Cancer Society, National Cancer Institute of Canada. Canadian cancer statistics, 2008.104. • Patterson,RE et al.2003. Changes in diet, physical activity, and supplement use among adults diagnosed with cancer. J Am Diet Assoc 103:323-28. • Wilson, D & Ciliska D. 1984a. Lifestyle Assessment: Development and use of the FANTASTIC checklist. Can Fam Phys, 30:1527-1532. *This research has been funded by BC Cancer Foundation/Vancouver Island Research and Development - Catalyst Program. Figure 6.The mean lifestyle score for the pretreatment group was significantly higher than that of the other 3 groups combined (P= 0.001).