The aim of this study was to compare differences in health status, lifestyle habits, and perceived social support between cancer survivors and controls with similar characteristics that have never had cancer. Several differences were observed for sociodemographic variables. In addition, cancer survivors reported worse health than non-cancer controls, probably because they had a higher number of comorbidities and a higher rate of long-term sick leave.
The 4.46% prevalence rate for cancer survivors in our study is similar to previously reported rates [28], and higher than that reported by Bray et al [29]. In this last case, the difference is probably due to the differences in age (Bray et al included individuals aged over 14 years).
Cancer survivors were on average older than controls, perhaps because two-thirds of cancer cases occur in people aged over 60 years. Older age would also explain why cancer survivors were more likely not to be working and to have permanent disability, although the unemployment rate was lower in this group than in the control group. Other authors have found that cancer survivors experience difficulties returning to their normal lives, and to work in particular [30]. Islam et al [31] reported that patients with cancer were 1.4 times more likely to be unemployed than healthy people due to disease- and treatment-related problems, highlighting the importance of support programs to help them return to work when they are able to [32].
Our study shows similar behaviors among cancer survivors and controls without a history of cancer in terms of exercise, diet, and smoking, with very high levels of unhealthy behaviors and overweight/obesity in both groups. This observation supports previous reports that modifiable cardiovascular risk factors such as hypertension, obesity, smoking, and physical inactivity are more common in cancer survivors than in the general population.33 One would expect people who have survived cancer to be more motivated to lead a healthy lifestyle and one would also expert them to receive guidance from their health care providers on how to make suitable changes, particularly in terms of diet and exercise, to prevent recurrent and new cancers, reduce cardiovascular risk factors, and improve quality of life [13, 34]. Nevertheless, healthy lifestyle choices among cancer survivors and support from health care providers in making these choices would appear to be suboptimal. Weaver et al [33], found that just one in three cancer survivors reported having had a health promotion discussion with their health care provider. It has also been found that some survivors are unsure about how to make changes and perceive a lack of support from their health care team [35]. Lifestyle interventions are known to bring about positive lifestyle changes that result in improved health and functioning [36], and these changes should be a primary goal for cancer survivors.
In our study, cancer survivors had worse perceived health than patients without a history of cancer. Depression, COPD, and chronic non-malignant conditions were all more common in this group, supporting previous findings showing a higher prevalence of chronic lifestyle- or treatment-related diseases in cancer survivors compared with members of the general population [6, 36]. No significant differences were observed for obesity, but this may be because both groups had similar obesity-related risk factors.
Although one might expect a patient who has had cancer to experience social functioning difficulties, in our series, the cancer survivors perceived a similar level of social support to people without a history of cancer. For some authors, social functioning may be affected in the early years of diagnosis and beyond [37–40] but others have found no differences in perceptions of family support or satisfaction with partners between cancer survivors and members of the general population [41]. It may be that adults who survive a cancer become more resilient to adverse situations and learn mechanisms to maintain their self-esteem and continue to enjoy good social and personal relationships.
The main limitations of this study are related to the nature of the sample: as the participants were recruited for a clinical trial, they are not representative of the general population. The clinical trial participants had to have at least two modifiable risk behaviors or factors and this means that unhealthy behaviors will have been overrepresented in our sample, preventing us from making population-based estimates of differences between cancer survivors and patients without a history of cancer. Worse health status and higher permanent disability rates among survivors could have been influenced by the older age of this group, although it should be noted that poor self-perceived health remained a significant predictor of cancer survivorship after adjusting for confounders.
Another limitation of our study is the relatively small size of the cancer survivor group. Even though the study was powered at close to 80%, the small sample will have prevented us from detecting significant differences between certain subgroups of patients (e.g., patients with a given non-prevalent chronic disease). This lack of stratified data on some of the more uncommon diseases in the CCI also prevented us from gaining a broader perspective of health problems that may affect cancer survivors.
The main strength of our study was the use of a comparison group with similar characteristics to the cancer survivor group, as this enabled us to discern differences possibly attributable to a history of cancer rather than other factors such as sex or other sociodemographic variables.
The results of this study indicate a need to encourage cancer survivors to make positive lifestyle changes that will bring them better general health and protect against recurrent and new cancers and other chronic diseases. Primary care providers should systematically evaluate lifestyle behaviors of patients with cancer, advise them on associated health risks and benefits, and encourage them to cultivate healthy habits. Further research is needed to investigate why more cancer survivors do not engage in healthy lifestyle behaviors.