Health Behavior Profiles of Young Adult Cancer Survivors in a Southeastern Cancer Center Open Access

Lowe, Kincaid Adair (2015)

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Background: Young adult cancer survivors (YACS) are vulnerable to adverse health outcomes that may be amplified by health behaviors. Using a mixed-methods approach, this study aimed to define health behavior profiles of YACS and characterize associated sociodemographic and psychosocial characteristics.

Methods: Young adult cancer survivors from a southeastern cancer center were recruited to participate in this study. To inform the quantitative analysis, we collected cross-sectional surveys from 106 YACS and assessed sociodemographics, cancer treatment, health behaviors, healthcare provider interaction, and psychosocial factors using the Profile of Mood States (POMS), the Patient Health Questionnaire-9 (PHQ-9), and the Multidimensional Scale of Perceived Social Support (MSPSS). We conducted a k-means cluster analysis, clustering on health-related behaviors. We characterized these clusters in relation to sociodemographics and psychosocial factors. For the qualitative analysis, we conducted in-depth semi-structured interviews with 26 participants who completed the quantitative survey and discussed how cancer affected their social life, psychological functioning, engagement in health behaviors (e.g., alcohol use, tobacco use, physical activity), and their knowledge about health risks related to these behaviors.

Results: Overall, the sample surveyed was 51.0% male, 78.8% white, with a mean age of 22.13 (SD=3.18). The cluster analysis yielded three distinct health behavior profiles: Transitioning High Risk (n=25), Collegiate Low Risk (n=40), and Post-Collegiate Moderate Risk (n=39). The Transitioning High Risk cluster had the highest current alcohol, tobacco, and marijuana use; PA; and number of sexual partners (p<0.001). They had higher symptoms of tension-anxiety; depression-dejection; fatigue-inertia; and confusion-bewilderment (p<0.05). The Post-Collegiate Moderate Risk cluster had lowest PA, highest FV intake, were oldest, most likely to be employed and had most time passed since their initial diagnosis (p<0.05). The Collegiate Low Risk cluster had the lowest current alcohol, tobacco, and marijuana use; fewest sexual partners; and least FV intake. This group was youngest, most recently diagnosed, and most likely to be students (p<0.05). They had the lowest levels of tension-anxiety; depression-dejection; fatigue-inertia; and confusion-bewilderment (p<0.05). Qualitative interview participants were on average 21.73 (SD=2.96) years of age; 53.8% (n=14) female; 100.0% (n=26) non-Hispanic; 84.6% (n=22) White; 26.9% and 42.3% (n=11) were college students. Qualitative data showed that young adult cancer survivors have a diversity of perspectives on how cancer affected their subsequent health behaviors. Participants said that their experience with cancer has a positive, negative, or neutral affect on health behaviors. However, these distinct perspectives did not consistently align with cluster profile findings. Qualitative findings also show that there is opportunity for improving survivorship care regarding patient and provider interactions around health behaviors and identifying risk groups.

Conclusions: This innovative analytic approach suggests that assessing health behavior profiles, rather single health behaviors, is an informative approach for characterizing YACS and targeting survivorship care. There is opportunity for intervention strategies that target sub-groups based on risk profiles.

Table of Contents



Young Adult and Childhood Cancer Survivors 12

Secondary Effects and Late Effects 13

Health Behaviors 14

Psychosocial Factors 16

Intrapersonal Factors 17

Interpersonal Factors 18

Theoretical Model 18

Study Aim 20


Participants and Procedures 21

Quantitative Survey 21

Measures 22

Data Analysis 25

Qualitative Semi-Structured Interviews 26

Measures 26

Data Analysis 27


Univariate Analysis 27

Cluster Analysis - Profiles of Young Adult Cancer Survivors 29

Cluster 1 - Transitioning High Risk 29

Cluster 2 - Post-Collegiate Moderate Risk 30

Cluster 3 - Collegiate Low Risk 30

Logistic Regression - Predicting Cluster Assignment 31

Qualitative Semi-Structured Interviews 32

Impact of cancer on health-related behaviors 32

Healthcare providers' interactions regarding health-related behaviors 34

Potential resources to address health-related behaviors 35


Health behavior profiles of young adult cancer survivors 36

Role of social support for young adult cancer survivors 41

Interpersonal factors and physician interactions 42

Implications and future directions 44

Limitations and Strengths 49



Table 1. Participant characteristics and health behaviors 60

Table 2. Psychosocial characteristics 61

Table 3. Thematic Analysis and Sample Quotations 63

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