Comorbidity burden and adherence to preventive health behavior among cancer survivors
Abstract
Advances in cancer treatments and early diagnosis have led to remarkable improvements in survival from major cancer types. Hence, the number of women living with a cancer diagnosis in the United States continues to increase. These women face many health challenges that negatively impact their quality of life, including an increased burden of comorbidity and ongoing symptoms from their cancer treatment. Adherence to health behavior guidelines may ameliorate some of the treatment-related side effects. This dissertation has three study aims: 1) to estimate the comorbidity burden and poor health status and associated productivity loss among breast cancer survivors (BCS) and women without cancer of middle age; 2) to examine the prevalence of functional impairment and adherence to physical activity recommendations among a population-based sample of gynecologic cancer survivors (GCS); and 3) to conduct a systematic review of the adherence to surveillance mammography among women diagnosed with primary breast cancer. For study aims 1 and 2, we used the Behavioral Risk Factor Surveillance System survey, a publicly available population-based dataset. In study aim 1, we used multivariable logistic regression to compare comorbidity burden and poor health status among middle-aged BCS and women without a history of cancer. For study aim 2, we used multinomial logistic regression to examine the association between meeting physical activity guidelines and having functional impairment among GCS. For study aim 3, we conducted a systematic review of the published literature from inception to June 2014 using Medline, PubMed, CINAHL and PsycINFO electronic databases to examine the rates of adherence to surveillance mammography among BCS. The results of study aim 1 indicate that the levels of comorbidity burden and poor health status were moderately higher among middle-aged BCS compared to women without a history of cancer. Productivity loss was not found to be different for BCS compared to women without a history of cancer. The results of study aim 2 indicate that more than half of the GCS did not meet physical activity guidelines and one thirds of this population faced significant burdens of functional impairment. The data indicate that functional impairment was associated with not meeting physical activity guidelines. The systematic review conducted for study aim 3 indicates that adherence to surveillance mammography is sub-optimum among BCS and decreases as time since diagnosis increases. Overall, this study provides population estimates of the health burdens facing breast and GCS and enhances our understanding of the potential barriers to the adoption of preventive health behaviors among understudied subgroups of female cancer survivors. It informs public health practitioners of the need to implement targeted interventions and develop evidence-based intervention strategies for physical activity and surveillance mammography programs, so as to lower the health burden among this growing population of cancer survivors. Adherence to health behavior should be integral part of cancer care for survivors. Future studies should focus on identifying modifiable factors including individual, clinical, and psychosocial factors to develop personalized interventions.
Subject Area
Behavioral psychology|Public health|Oncology
Recommended Citation
Nayak, Pratibha, "Comorbidity burden and adherence to preventive health behavior among cancer survivors" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3665034.
https://digitalcommons.library.tmc.edu/dissertations/AAI3665034