title: Grasping the 'teachable moment': time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors.
abstract: BACKGROUND
  A cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3-5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors.
  
  
  METHODS
  We analyzed cross-sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors.
  
  
  RESULTS
  Respondents were mostly female (55%) and non-Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = -0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = -0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors.
  
  
  CONCLUSIONS
  We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: University of Texas School of Public Health, Houston, TX, USA.|University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Bluethmann
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Basen-Engquist
authors.affiliation: University of Texas School of Public Health, Houston, TX, USA.
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cox
authors.affiliation: University of Texas School of Public Health, Houston, TX, USA.
authors.forename: Kelley Pettee
authors.initials: KP
authors.lastname: Gabriel
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Stansberry
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Carmack
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Janice A
authors.initials: JA
authors.lastname: Blalock
authors.affiliation: University of Alabama-Birmingham Comprehensive Cancer Center, Birmingham, AL, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Demark-Wahnefried
keywords: lifestyle behaviors; oncology; psychosocial; survivors; symptoms