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Health Behaviors and Follow-Up Care Among Colorectal Cancer Survivors

Colorectal cancer is one of the most common cancers in the United States. People who are diagnosed with colorectal cancer today are living longer after diagnosis and treatment than they did in the past. More than 1 million Americans alive today are colorectal cancer survivors, or people who have been told they have colorectal cancer. This number is growing as the population ages.

A large and growing number of colorectal cancer survivors are living 5 or more years after diagnosis. This is good news for recently diagnosed patients. But colorectal cancer survivors have a higher risk of their colorectal cancer coming back, getting another kind of cancer, and other health problems. To help lower these risks, survivors can exercise regularly, eat healthy foods, keep a healthy weight, avoid tobacco, and limit alcohol use. Survivors should also go to the doctor for checkups and get cancer screenings so that signs of recurrence or new disease can be found early, when it is easiest to treat.

The Prevention Among Colorectal Cancer Survivors (PACCS) Study

For CDC’s Prevention Among Colorectal Cancer Survivors (PACCS) study, researchers recruited a group of colorectal cancer survivors from California who were living 6 to 7 years after diagnosis. The study group filled out a survey that asked questions about their health, use of medical services, and behaviors like exercise, diet, and alcohol use. The survey responses were used to learn about colorectal cancer survivors’ health behaviors and follow-up care, and their understanding of recommendations about health and care after treatment.

A total of 593 colorectal cancer survivors filled out the survey, of whom half were women and half were men. Their average age at diagnosis was 63 years old, and their average age at the time they took the survey was 70 years old.

Results

Quality of Current Health

Pie chart listing the levels of quality of the survivors' current health.

Most survivors described their health as good (37%) or very good (35%). 14% described it as fair, 12% described it as excellent, and 2% described it as poor.

Following Health Recommendations

Bar chart listing health recommendations and percentages.

Almost all (90%) of the survivors in the study said they were up-to-date with routine medical checkups, but only about two-thirds (69%) were up-to-date on a follow-up colonoscopy. About one-third (35%) were keeping a healthy body weight, and about one-fifth (19%) got the recommended amount of physical activity every week. Most of the women in the study (86%) were up-to-date with Pap tests, but only 71% were up-to-date with mammograms.

Receiving Support

How many patients say that family and friends encourage them to practice healthy behaviors?

Bar chart listing health behaviors that close friends and family encourage respondents.

Most survivors felt their close friends and family members encouraged them to practice healthy behaviors like getting routine checkups or avoiding smoking (82%), followed by eating a healthy diet (79%), keeping a healthy weight and getting regular colonoscopy screening (75%), and exercising (71%). However, fewer felt supported to limit or avoid alcohol (57%).

Getting Follow-Up Care

What was the best way to encourage survivors to get follow-up care?

  • Survivors who received a recommendation from a health care provider for follow-up medical care were more likely to get that follow-up care.
  • Survivors were even more likely to get a follow-up colonoscopy if their provider gave them a written recommendation (such as in a survivorship care plan) rather than just telling them that they should return for follow-up care.

Diet

More than half of survivors knew that they needed to improve their diet, but many did not know about recommendations to limit processed meats and alcohol, which are particularly important for colorectal cancer survivors.

Conclusions

  • Survivors often want to make healthy changes after cancer, but many do not know what to do to reduce future health risks.
  • After finishing treatment, all survivors should receive a survivorship care plan that tells them what follow-up care they need and the healthy behaviors they should follow to improve their health and lower the chances of future disease.
  • Survivors should ask their health care providers any questions they have about when to get follow-up care or who to see for care.
  • Family and friends can help support survivors, and survivors can find out about resources in their community or online to learn about healthy behaviors after cancer.

Citations

Hawkins NA, Conrey F, Rodriguez J (February 2011). Patient satisfaction with cancer care and adherence to medical follow-up and prevention behavior recommendations: a study of long-term colorectal cancer survivors. Oral presentation at the American Psychosocial Oncology Society annual conference, Anaheim, CA. Published in: Psychooncology 2011;20(S1):S1–114.

Hawkins NA, Berkowitz Z, Rodriguez JL. Awareness of dietary and alcohol guidelines among colorectal cancer survivors. American Journal of Preventive Medicine 2015;49(6S5):S509–S517.

Hawkins NA, Berkowitz Z, Rodriguez JL, Miller JW, Sabatino SA, Pollack LA. Examining adherence with recommendations for follow-up in the Prevention Among Colorectal Cancer Survivors study. Oncology Nursing Forum 2015;42(3):233–240.

Li C, Hawkins NA, Rodriguez JL, Berkowitz Z, White MC (June 2014). Factors associated with being sufficiently physically active in colorectal cancer survivors. [PDF-1.5MB] Poster presentation at the Biennial Cancer Survivorship Research Conference in Atlanta, GA.

Rodriguez JL, Hawkins NA, Berkowitz Z, Leadbetter S (June 2014). Assessing non-response bias in the recruitment of cancer survivors from a state-based cancer registry. [PDF-1.5MB] Poster presentation at the Biennial Cancer Survivorship Research Conference in Atlanta, GA.

Rodriguez, JL, Hawkins NA, Berkowitz Z, Li C. Factors associated with health-related quality of life among colorectal cancer survivors. American Journal of Preventive Medicine 2015;49(6S5):S518–S527.

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