title: Health Behaviors in Cervical Cancer Survivors and Associations with Quality of Life.
abstract: OBJECTIVE
  Improvement in health behaviors following cancer diagnosis may contribute to better prognosis and well-being. This study examines the prevalence of health behaviors in cervical cancer survivors who have completed treatment, and associations between health behaviors and quality of life (QOL).
  
  
  METHODS
  We recruited 204 women who had completed treatment for cervical cancer to participate in a randomized counseling intervention. Participants provided information on health behaviors (smoking, physical activity, and alcohol consumption); QOL (Functional Assessment of Cancer Therapy-Cervical questionnaire); and depression (Patient-Reported Outcomes Measurement Information System), anxiety (Patient-Reported Outcomes Measurement Information System), and distress (Brief Symptom Inventory) at baseline (9-30 months after diagnosis) and subsequent to the intervention. Data were analyzed using multivariate general linear models.
  
  
  RESULTS
  Participants ranged in age from 20 to 72 years at diagnosis (mean = 43 years), 41% were Hispanic, and 52% were non-Hispanic white. Three-fourths were stage 1 at diagnosis and 51% were treated with radiation with or without chemotherapy. At baseline, 15% of patients were current smokers, 4% reported alcohol consumption of >10 drinks per week, and 63% reported exercising <3 hours per week. Overall, 67.4% of cervical cancer survivors did not meet recommended national guidelines for at least 1 of these health behaviors. QOL scores were significantly higher for patients with greater physical activity (128 vs 118; P = 0.002) and increased with the number of recommended guidelines met (P for trend = 0.030). Associations between patient-reported outcomes and smoking and alcohol consumption did not reach statistical significance. Participants who met guidelines for all health behaviors also had less depression (P = 0.008), anxiety (P = 0.051), and distress (P = 0.142). Participants who improved their aggregate health behaviors during the 4-month follow-up experienced a greater improvement in QOL than those who did not improve their health behaviors (10.8 vs 4.5; P = 0.026).
  
  
  CONCLUSIONS
  Results indicate that two-thirds of cervical cancer survivors are not meeting national guidelines for smoking, physical activity, and alcohol consumption following completion of definitive treatment. These adverse health behaviors were associated with impaired QOL and higher levels of depression and distress. Positive changes in health behaviors are associated with significant improvement in QOL.
authors.affiliation: Program in Public Health, University of California Irvine, Irvine, California.
authors.forename: Neel S
authors.initials: NS
authors.lastname: Iyer
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Irvine, California; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California. Electronic address: kosann@uci.edu.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Osann
authors.affiliation: Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California; Department of Medicine, General Internal Medicine, University of California Irvine, Irvine, California.
authors.forename: Susie
authors.initials: S
authors.lastname: Hsieh
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Irvine, California.
authors.forename: Jo A
authors.initials: JA
authors.lastname: Tucker
authors.affiliation: Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Monk
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Irvine, California; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California; Institute for Immunology, University of California Irvine, Irvine, California.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Nelson
authors.affiliation: Program in Public Health, University of California Irvine, Irvine, California; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California; Department of Medicine, General Internal Medicine, University of California Irvine, Irvine, California.
authors.forename: Lari
authors.initials: L
authors.lastname: Wenzel
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D015444:Exercise / Q000523:psychology; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D015438:Health Behavior; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012907:Smoking / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D002583:Uterine Cervical Neoplasms / Q000523:psychology*; D044465:White People; D055815:Young Adult
keywords: cancer; health behaviors; oncology; physical activity; quality of life; survivorship