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
50
60
40
60.83%
20
40
30
45.0%
20
10
17.5%
15.83%
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.
5.83%
5.0%
Less than once
per week
1-2 times
weekly
2.5%
0
0
10.0%
14.17%
10.0%
9.17%
3 times weekly
4 times weekly
0
Less than once
per week
1-2 times
weekly
3 times weekly
4 times weekly
Ostomy
Surgery
Chemotherapy
Radiation Therapy
101 (84.2)
64 (53.3)
23 (19.2)
33 (27.5)
81 (67.5)
4 (3.3)
34 (28.3)
Percentage of respondents
23.3
a
Ongoing
Completed <=6months
Completed >6months
Overall treatment status when the survey was completed
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).
“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.”
30
40.83%
20
39.17%
“I need to remember that everything I put into my mouth needs to nourish my body; not just
give me calories.”
10.83%
3.33%
1.67%
0
0
None
100 IU
4.17%
200 IU
400 IU
“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.”
1000 IU or more
I take vitamin D supplement daily
Figure 2. Respondents tended to take either the recommended level of Vitamin D or none.
“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.”
Percentage of respondents
40
30
20
35.83%
20.83%
10
19.17%
15.0%
7.5%
Figure 8. Approximately 45% of survey respondents provided written comments
along with their lifestyle checklists.
1.67%
0
0
20+ lbs over or
under my ideal
weight
15-19 lbs over
or under my
ideal weight
10-14 lbs over
or under my
ideal weight
6-9 lbs over or
under my ideal
weight
At (or within 5
lbs of) my ideal
weight
My weight is
Final Comments
Figure 3. While many people were at their ideal weight, a portion were considerably outside of this
range.
• 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.
40
Percentage of respondents (%)
Percentage of respondents (%)
• Mail-out surveys are a feasible way to acquire patient feedback from this
population.
50
30
40
20
10
30
41.7
20
19.2
19.2
12.5
5.8
0
8.3
6.7
0
Made healthier
dietary choices
Increased
exercise/physical
activity
Quit smoking
Applied stress
management
strategies
Made other
changes
Figure 4. Of the 50% of people who made
lifestyle changes since diagnosis, many
had already made healthier dietary
choices.
Overall Lifestyle Score
80.00
*This research has been funded by BC Cancer
Foundation/Vancouver Island Research and Development Catalyst Program.
20
“Using local recreation centre, gym, and pool. Joined a walking group.”
5
71 (59.2)
49 (40.8)
28 (23.3)
83 (69.2)
9 (7.5)
13 (10.8)
5 (4.2)
71.4
66.7
51.7
5 or more times
weekly
40
10
Number (%)
a,b
“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.”
11.7
Category
Mean 67.5 (SD 10.4)
Male
Female
Yes
No
Previously had one- now reversed
No
Completed surgery(s) and
scheduled for other surgery(s)
Completed
No
Ongoing
Completed
No
Ongoing
Completed
40
I am vigorously active for at least 30 min. per day eg. running, cycling, etc.
40
Characteristic
Age
Sex
b
Pretreatment
10
• 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).
b
0
Figure 1. Most people are moderately active frequently, but vigorously active less than one time per
week.
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.
Table 1. Population demographics for the preliminary sample population
60
0
5 or more times
weekly
I am moderately active (gardening, climbing stairs, walking, housework)
Material and Methods
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.
80
4.17%
50
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:
Percentage of subjects who have made lifestyle changes
(%)
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:
Percentage of respondents
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.
Percentage of respondents
Introduction
Want to make
healthier dietary
choices
Want to increase
exercise/physical
activity
Want to quit
smoking
Want to apply
Want to make other
stress management
changes
strategies
Figure 5. Of the 52% of people who wanted
to make future lifestyle changes, most
wanted to increase physical activity
• 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 populationbased programs.
*
References
70.00
60.00
50.00
Pretreatment
Ongoing
Completed <=6months
Completed >6months
Overall treatment status when the survey was completed
Figure 6.The mean lifestyle score for the pretreatment group was significantly higher
than that of the other 3 groups combined (P= 0.001).
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