This study aimed to identify subgroups of recently diagnosed Hispanic/Latino cancer survivors with distinct health behavior patterns and their associated sociodemographic, medical, and psychosocial characteristics. In this study, we demonstrated the application of LCA to identify groups of Hispanic/Latino cancer survivors with distinct health behavior patterns. We identified three classes: Hispanic/Latino cancer survivors who engaged in health behaviors “more” frequently since diagnosis; those who engaged in health behaviors “the same amount” since diagnosis; and a “mixed class,” with a higher or lower engagement across various health behaviors since diagnosis. In addition, we validated these classes in relation to a diverse set of correlates (e.g., income, education, and HRQOL indicators) and found that Hispanic/Latino cancer survivors who engaged in health behaviors “more” frequently since diagnosis were significantly more educated and less likely to be foreign born. Participants engaging in health behaviors “the same amount” since diagnosis were significantly older and more likely to have prostate cancer. Hispanics in the “mixed class” had a significantly lower income and were less educated.
We identified a group of Hispanic/Latino cancer survivors who engaged in health behaviors “more” frequently since diagnosis. For these individuals, cancer might have been perceived as a ‘teachable moment’ and a trigger for health behavior change. These cancer survivors reported significantly better overall HRQOL (including physical, emotional, and functional wellbeing), greater levels of self-efficacy, and lower levels of distress than those in the “mixed class.” These findings support the positive association between psychosocial factors and health behaviors, where positive health behaviors, such as engaging in physical activity, are consistently associated with better psychological, emotional, and physical well-being among cancer survivors [2].
Individuals who engaged in health behaviors “the same amount” since cancer diagnosis were more likely to be older, have prostate cancer and more comorbidities. Given that chronic diseases are generally more common among the elderly, a possible explanation for these findings might be that these individuals were already coping with other chronic diseases by the time of their cancer diagnosis and may have thus already been engaging in healthy behaviors to improve their health and well-being [35]. They may also interact with health care providers more regularly [36] and thereby have increased opportunities for learning about healthy lifestyle behaviors. Because data on their pre-cancer health behaviors were not collected, however, we cannot be certain that these individuals were already engaged in healthy behaviors before their cancer diagnosis and that their behaviors remained unchanged following their cancer diagnosis (as is desired). Another possibility is that because older cancer survivors experience more significant functional and cognitive impairment when compared with younger cancer survivors, they may encounter more challenges changing their existing healthy behaviors (e.g., physical activity) [37]. Previous studies have noted that prostate cancer survivors are less likely to make healthy lifestyle changes than other cancer survivors [38] which may be explained by the fact that prostate cancer treatment (e.g., endocrine therapy, surgery) can lead to debilitative side effects and impaired physical and cognitive functioning [39], and reduce willingness to engage in positive behavior change.
Participants in the “mixed class” had a lower income and were less educated than those in the other two classes. Among Hispanic/Latino cancer survivors, low socioeconomic status and educational attainment are associated with worse cancer morbidity, mortality, and HRQOL outcomes [13]. These sociodemographic differences are also consistent with previous studies examining lifestyle behaviors in cancer survivors, where low education level reduces the odds of making positive behavior changes [40]. Screening for social determinants of health and ensuring referral and linkage to community resources and public services may significantly improve the health and quality of life of Hispanic cancer survivors [41]. Additionally, individuals in this group reported greater unmet supportive care needs, more distress and worry interference, and poorer HROQL. A previous study found that Hispanic/Latino cancer survivors reported greater needs for information (e.g., gaining knowledge on cancer and symptom management), practical assistance (e.g., transportation, family care), emotional support (e.g., stress management), and spiritual resources (e.g., finding meaning and hope) than non-Hispanic whites [8]. Unmet psychosocial needs have been associated with lower HRQOL and higher symptom burden among Hispanic/Latino cancer survivors [42, 43]. Thus, developing culturally informed psychosocial interventions to address these needs are vital. Participants in this class also reported lower self-efficacy for daily activities and symptom management. These findings are in line with previous research that has identified cancer-relevant self-efficacy as a predictor of symptom burden, cancer-specific distress, and functional, emotional, and social well-being among Hispanic breast cancer survivors [44]. Given that individuals with greater self-efficacy are more likely to adopt new health behaviors [45], future interventions should target self-efficacy as a mechanism to adopt healthy behaviors. Potential ways to enhance self-efficacy in Hispanic/Latinos include improving health literacy [46, 47], setting goals [48], providing instrumental support [49], and health coaching [50].
Although we did not find significant differences between classes in acculturation levels, language of preference, country of origin, and years living in the U.S., a smaller proportion of participants who reported engaging in health behaviors “more” frequently since diagnosis were foreign born compared to those who engaged in health behaviors “the same amount” since diagnosis. The reported effects of nativity on health behaviors among Hispanic/Latinos are mixed. A study found that foreign-born cancer survivors living in the U.S. <10 years were less likely to engage in aerobic physical activity compared with second and higher-generation (US-born) Hispanic/Latino cancer survivors [51]. Foreign-born Hispanic/Latinos have reported higher fruit and vegetable consumption [52] as well as lower rates of smoking and obesity than their US-born counterparts [53]. Acculturation is a complex phenomenon, and place of birth, language of preference, socioeconomic status, and length of stay in the U.S. may contribute to different effects on health behaviors and cancer outcomes among Hispanic/Latinos. As such, future studies on lifestyle behaviors among Hispanic/Latino cancer survivors should collect information to provide additional insights into these relationships.
The current study expands our understanding of adherence to multiple healthy behaviors among Hispanic/Latino cancer survivors. Findings from this study highlight the importance of assessing sociodemographic, medical, and psychosocial characteristics when working with Hispanic/Latino cancer survivors (e.g., age, comorbidities, income) as these factors may help identify at-risk cancer survivors in need for interventions to improve their health behaviors. However, study findings should be interpreted in light of several limitations. First, the use of cross-sectional data permits conclusions to be drawn regarding associations, but causal inferences may not be made. Longitudinal studies are needed to improve our understanding of health behavior changes made after cancer among Hispanic cancer survivors and their sustainability over time. In addition, future studies should consider the inclusion of Hispanic cancer survivors with any cancer type. Lastly, these results should be interpreted with caution because they are limited in generalizability (i.e., primarily Mexican American cancer survivors). Although the percentage of Mexicans/Mexican Americans is representative of Hispanics in the U.S. as a whole, there is significant regional variability in the US Hispanic/Latino population (e.g., Cubans in South Florida, vs. Mexicans and Puerto Ricans in the Midwest). Therefore, a larger sample with more diversity in country of origin would allow for a more nuanced examination of within-group differences.