In this study cancer survivors were on average older than non-cancer patients, perhaps because two-thirds of cancer cases occur in patients aged over 60 years. Older age would also explain why cancer survivors were more likely not to be working and to be on long-term sick leave, although the unemployment rate was lower in this group than in the non-cancer group. Other authors have found that cancer survivors experience difficulties returning to their normal lives, and to work in particular [24]. Islam et al [25] reported that patients with cancer were 1.4 times more likely to be unemployed than healthy patients due to disease- and treatment-related problems, highlighting the importance of support programs to help them return to work when they are able to [26].
Our study shows similar behaviors among cancer survivors and non-cancer patients 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 [27]. 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 [12, 28]. 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 [27] 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 [29]. Lifestyle interventions are known to bring about positive lifestyle changes that result in improved health and functioning [30], and these changes should be a primary goal for cancer survivors.
Cancer survivors had worse self-perceived health than non-cancer patients. 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, 30]. No significant differences were observed for obesity, but this may be because both groups had similar obesity-related risk factors.
The cancer survivors perceived a similar level of social support to non-cancer patients. For some authors, social functioning may be affected in the early years of diagnosis and beyond [31-34] but others have found no differences in perceptions of family support or satisfaction with partners between cancer survivors and non-cancer patients [35]. 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 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.