Unhealthy behaviors after breast cancer: Capitalizing on a teachable moment to promote lifestyle improvements
Authors: Di Meglio Antonio , Gbenou Arnauld S. , Martin Elise , Pistilli Barbara , Ligibel Jennifer A. , Crane Tracy E. , Flaysakier Jean‐Daniel , Minvielle Etienne , Vanlemmens Laurence , Guenancia Charles , Rigal Olivier , Fournier Marion , Soulie Patrick , Mouret‐Reynier Marie‐Ange , Tarpin Carole , Boiffard Florence , Guillermet Sophie , Everhard Sibille , Martin Anne‐Laure , Giacchetti Sylvie , Petit Thierry , Dalenc Florence , Rouanet Philippe , Arnaud Antoine , Andre Fabrice , Vaz‐Luis Ines 
Published: April 2021

Background

This study assessed the prevalence and risk factors of unhealthy behaviors among survivors of early‐stage breast cancer.

Methods

Women (n = 9556) from the CANcer TOxicity cohort (NCT01993498) were included. Physical activity (PA), tobacco and alcohol consumption, and body mass index were assessed at diagnosis and at years 1 and 2 after diagnosis. A behavior was defined as unhealthy if patients failed to meet PA recommendations (≥10 metabolic equivalent task hours per week), reduce/quit tobacco, or decrease alcohol consumption to less than daily, or if they gained substantial weight over time. Multivariable‐adjusted generalized estimating equations explored associations with unhealthy behaviors.

Results

At diagnosis, 41.7% of patients were inactive, 18.2% currently used tobacco, 14.6% consumed alcohol daily, and 48.9% were overweight or obese. At years 1 and 2, unhealthy PA behavior was reported among 37.0% and 35.6% of patients, respectively, unhealthy tobacco use behavior was reported among 11.4% and 9.5%, respectively, and unhealthy alcohol behavior was reported among 13.1% and 12.6%, respectively. In comparison with the previous assessment, 9.4% and 5.9% of underweight and normal‐weight patients had transitioned to the overweight or obese category at years 1 and 2, respectively, and 15.4% and 16.2% of overweight and obese patients had gained ≥5% of their weight at years 1 and 2, respectively. One in 3 current tobacco smokers and 1 in 10 daily alcohol users reported improved behaviors after diagnosis. Older women (5‐year increment) were more likely to be inactive (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 1.01‐1.05) and report unhealthy alcohol behavior (aOR, 1.28; 95% CI, 1.23‐1.33) but were less likely to engage in unhealthy tobacco use (aOR, 0.81; 95% CI, 0.78‐0.85). Being at risk for depression (vs not being at risk for depression) was associated with reduced odds of unhealthy tobacco use (aOR, 0.67; 95% CI, 0.46‐0.97) and with a higher likelihood of unhealthy alcohol behavior (aOR, 1.58; 95% CI, 1.14‐2.19). Women with a college education (vs a primary school education) less frequently reported an unhealthy PA behavior (aOR, 0.61; 95% CI, 0.51‐0.73) and were more likely to report unhealthy alcohol behavior (aOR, 1.85; 95% CI, 1.37‐2.49). Receipt of chemotherapy (vs not receiving chemotherapy) was associated with higher odds of gaining weight (aOR, 1.51; 95% CI, 1.23‐1.87) among those who were overweight or obese at diagnosis.

Conclusions

The majority of women were adherent to healthy lifestyle behaviors at the time of their breast cancer diagnosis, but a significant subset was nonadherent. Unhealthy behaviors tended to persist after the breast cancer diagnosis, having varying clinical, psychological, sociodemographic, and treatment‐related determinants. This study will inform more targeted interventions to promote optimal health.