Widening the path to prevention: Health promotion, behavior change and intervention opportunities in cancer survivorship

Shirley M Bluethmann, The University of Texas School of Public Health


Health behaviors in cancer survivorship afford survivors a range of benefits to achieve a better quality of life, reduce symptoms related to cancer/cancer treatment and may potentially prevent recurrence in survivors. This dissertation explored three inquiries to help understand opportunities for behavioral interventions, focused on physical activity as well as dietary habits and tobacco control. A systematic review and meta-analysis describing components of 14 behavior interventions for breast cancer survivors is presented first, followed by detailed analysis of behavior theory use in designing these interventions. The dissertation also presents findings from a cross-sectional survey with 1,053 breast, colorectal and prostate cancer survivors, characterizing their health behaviors and potential opportunities for interventions based on their time since diagnosis and reported symptom burden. Overall, it can be said that physical activity interventions for breast cancer survivors show promise in intervention design and were generally successful in producing short-term behavior changes. In particular, interventions that incorporated home-based components and flexibility in activity types tended to produce larger effects in behavior change. Highly structured, in-person supervision of exercise sessions did not demonstrate substantial benefits to survivors over other types of encouragement, such as phone counseling. However, judicious use of behavior theory did reveal a potential benefit for design of physical activity interventions. An exploratory subgroup analysis suggested that a more focused, consistent application of theory during intervention development, implementation and evaluation may enhance its effectiveness in producing physical activity behavior change. Finally, in the exploration of health behaviors for breast, colorectal and prostate cancers, it was shown that time since diagnosis and the symptom burden experience may be worthy of consideration in targeting health behaviors. It was found that survivors that are closer to diagnosis were significantly more likely to consume more fruits and vegetables and smoke fewer cigarettes than others. Additionally, we found a significant negative correlation between symptom burden and physical activity performance. Carefully crafted behavior interventions may be successful in producing behavior changes in post-treatment survivors. However, more research is needed to identify strategies for sustainable changes, adaptations for different cancer groups and opportunities to contextualize interventions based on the lived experiences of survivors.

Subject Area

Public health

Recommended Citation

Bluethmann, Shirley M, "Widening the path to prevention: Health promotion, behavior change and intervention opportunities in cancer survivorship" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3643575.