Social support, nutrition intake, and physical activity in cancer survivors.

Approximately 64.8% of individuals diagnosed as of 2007 with cancer can expect to survive at least 5 years, joining the estimated 13.7 million people living with a history of cancer in the US.1 With increased survival rates and more people living longer after their cancer diagnosis, there is expected to be an increase in the number of people with a history of cancer.2 Life after cancer diagnosis and treatment can impact physical, psychosocial, and financial well-being.2 Unfortunately, complications affecting these dimensions can arise due to cancer and its therapy. Second malignancies are the most serious complication for this high-risk group, accounting for 16% of all cancer incidence.3 Many behavioral changes have been researched as ways to affect the health, quality of life, and survival rate of cancer survivors. Specifically, physical activity and a healthy diet are 2 of the main behavioral lifestyle changes that have been previously researched, showing the potential impact they can have on life after cancer diagnosis and treatment.4,5 Encouraging cancer patients to be more physically active and consume more fruits and vegetables could be a way to impact cancer survivors’ survivorship and the potential for second malignancies.4,5 The current study examines depressive symptoms, hope, social support, and quality of life in relation to fruit and vegetable (FV) intake and physical activity (PA) among cancer survivors. The Theory of Planned Behavior (TPB) provides the theoretical framework for this study.6 TPB suggests that the primary predictor of behavior is behavioral intention and a person’s intention to perform a behavior is influenced by: (1) the attitudes towards that particular behavior, (2) beliefs about the subjective norms of significant others around them, and (3) the perceived behavioral control around the performance of the particular behavior.6 Thus, these variables also predict behavior through behavioral intention. Applying TPB, it can be said that depressive symptoms, hope, social support, and quality of life may influence FV intake and PA among cancer survivors. Depressive symptoms have been linked with self-efficacy attitudes, normative beliefs, and behavioral capability.7 Likewise, quality of life has been linked with self-efficacy, a component of perceived behavioral control.8–10 Social support has been linked to all 3 of the constructs: attitude, subjective norms, and perceived behavioral control.7,11 Hope, one’s ability to set challenging goals and enlist the requisite pathways and agency to reach them, is related to attitudes towards the behavior and perceived behavioral control.12 In light of these findings, a cancer survivor’s level of depressive symptoms, hope, and social support may impact their attitudes and normative beliefs about the impact of lifestyle changes on their treatment outcomes and overall subsequent health outcomes. These factors, as well as the survivor’s quality of life, also may impact the survivor’s behavioral capability for making a lifestyle change. Based on the aforementioned literature and this theoretical framework, we examined the role of depressive symptoms, hope, social support, and quality of life in FV intake and PA among cancer survivors. We hypothesized that lower depressive symptoms, higher levels of hope, greater social support, and greater quality of life would relate to higher levels of FV intake and greater PA.