Are physicians helping cancer survivors live healthy lives?

Some physicians who care for patients with cancer don’t promote healthy lifestyle changes to cancer survivors, fearing such advice would overwhelm them, reports a new Northwestern Medicine study. 

The findings are noteworthy because maintaining a healthy lifestyle is especially important to the long-term health of cancer survivors.

Cancer survivors face increased risks of cardiovascular disease and other conditions, and guidelines advise physicians—including oncologists—to encourage cancer survivors to adopt healthy lifestyles to help protect their long-term health. But less than 30 percent of oncologists in the study said they do so.

“Even though oncologists clearly believe that cancer survivors should adopt a healthy lifestyle, they said they don’t have the time to address more than cancer care,” said lead author Tammy Stump, a postdoctoral fellow in the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine. 

The study was published online August 26 in CANCER, a peer-reviewed journal of the American Cancer Society.

Stump and senior author Bonnie Spring, among others, investigated the extent to which physicians make healthy lifestyle recommendations. They surveyed 91 physicians: 30 primary care physicians; 30 oncologists; and 31 specialists (urologists, gynecologists and dermatologists) who treat survivors of prostate cancer, breast cancer and melanoma, respectively. They also conducted interviews with 12 of the oncologists who were sent the survey.

Among primary care physicians, 90 percent reported recommending health promotion such as weight loss and smoking cessation to at least some cancer survivors. However, only 26.7 percent of oncologists and 9.7 percent of specialists said they do.

In interviews, oncologists expressed fear that promoting healthy lifestyle changes would distress or overwhelm patients. They also noted they often lack the time and training to make such recommendations to patients. Most physicians believed at least half of cancer survivors would take their medications properly to prevent cancer recurrence, but patients would not do so if they were also trying to lose weight.

“Ultimately, we believe that healthy lifestyle support can be provided to cancer survivors most effectively as part of integrated survivorship care delivered by health promotionists trained in nutrition, physical activity and behavioral coaching in a program designed with the input of oncologists to meet the specific needs of cancer survivors,” said Spring, chief of behavioral medicine in the preventive medicine and a professor of preventive medicine at Feinberg. 

Spring is co-leader of the Cancer Prevention Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.  

Dr. June Robinson, research professor of dermatology at Feinberg; Betina Yanez, assistant professor of medical social sciences at Feinberg; and Sheetal Kircher, assistant professor of hematology and oncology at Feinberg, were co-authors on the study. All are members of the Lurie Cancer Center. Additionally, Kircher is  medical co-director of the Cancer Survivorship Institute at the Lurie Cancer Center.

The study was funded by National Institutes of Health grants CA193193 and CA60553.