Abstract C30: Examining racial and ethnic disparities in health behaviors and cancer-related problems among male colorectal cancer survivors
Authors: Cooper Dexter L. , Alcaraz Kassandra I. , Stein Kevin D. 
Published: May 2015

Background: Colorectal cancer (CRC) is the second leading cause of cancer death among men, with Black and Hispanic men leading in mortality and incidence. Among CRC survivors, health behavior is particularly important because certain behaviors may help reduce risk of recurrence and developing a secondary cancer. Compared to Non-Hispanic White survivors, evidence suggests cancer survivors from racial/ethnic minority groups have more cancer-related problems (e.g., physical distress), which may have deleterious effects on health behavior. The purpose of this study was to examine (1) health behaviors by race/ethnicity and (2) associations between cancer-related problems and health behaviors in a national sample of male CRC survivors.

Methods: This study analyzed data from the American Cancer Society's Study of Cancer Survivors II, a cross-sectional, population-based study of 9,170 short- and long-term survivors of seven cancers. Included in the current study were 875 male survivors of CRC who had been diagnosed 2-10 years prior to enrollment. The study analyzed self-reported data on participants' demographics, health insurance, and health behaviors (smoking, physical activity, and fruit/vegetable intake). Responses to items from the Cancer Problems in Living Scale (CPILS) were analyzed to assess the number and type of cancer-related problems experienced by survivors. Chi-square tests and one-way ANOVAs were conducted to examine racial/ethnic differences in health behaviors and total number of cancer-related problems (i.e., total CPILS score). Binomial logistic regression analyses examined associations between health behaviors and the total number of cancer-related problems while adjusting for demographics, health insurance status, stage at diagnosis, and time since diagnosis. Outcomes of interest were current smoking, not meeting national recommendations for physical activity (PA), and not meeting national recommendations for fruit/vegetable (FV) intake.

Results: On average participants were 63.1 years old (SD=10.6), and the racial/ethnic composition of the sample was 80% Non-Hispanic White (NHW), 11% Non-Hispanic Black (NHB), and 9% Hispanic. Smoking prevalence varied by race/ethnicity: 17.7% of NHB survivors were smokers, compared to only 6.6% of Hispanic survivors and 7.6% of NHW survivors (p=0.003). Physical activity also varied by race/ethnicity, with 46.2% of Hispanic survivors meeting PA recommendations compared to only 26.0% of NHW survivors and 25.0% of NHB survivors (p=0.023). However, FV intake did not vary by race (p=0.206). Compared to NHW and NHB survivors, Hispanic survivors had more cancer problems related to physical distress, emotional distress, and employment/finances (all p&lt;0.05). In logistic regression analyses, the total number of cancer-related problems was associated with current smoking (aOR=1.05; 95% CI=1.01-1.08) and not meeting PA recommendations (aOR=1.04; 95% CI=1.01-1.07). No association was found between the total number of cancer-related problems and not meeting recommendations for FV intake (aOR=1.03; 95% CI=0.99-1.06).

Conclusion: Racial/ethnic differences were found in smoking behavior, physical activity, and cancer-related problems among male CRC survivors. Findings suggest interventions that reduce cancer-related problems among Hispanic and Non-Hispanic Black male CRC survivors may be promising for positive health behavior change. Future research should examine the association between cancer problems and health behavior longitudinally to establish causal effects.

Citation Format: Dexter L. Cooper, Kassandra I. Alcaraz, Kevin D. Stein. Examining racial and ethnic disparities in health behaviors and cancer-related problems among male colorectal cancer survivors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C30. doi:10.1158/1538-7755.DISP13-C30