EP272 - A Second Chance or Bad Luck? A Qualitative Study of Health Habits among Colorectal Cancer Survivors

Purpose/Background: Healthy physical habits, such as exercising, following a plant-predominant whole food diet, getting adequate sleep, and avoiding tobacco and alcohol, are associated with longer disease-free and overall survival while healthy psychosocial habits, such as stress reduction and maintaining social connections, are associated with improved quality of life. However, not all cancer survivors adopt or maintain healthy behaviors after completing treatment. Understanding the factors that drive individual health behaviors among cancer survival is critical to designing effective interventions, reducing the risk of cancer recurrence, and improving health-related quality of life. The aim of this study was to understand the experience and perspectives of colorectal cancer survivors as they relate to health habits.

Methods/Interventions: English- and Spanish-speaking adult patients who had undergone definitive treatment for colorectal cancer were invited to participate in semi-structured interviews. Participants were compensated for their time. Interviews were audio-recorded, transcribed verbatim, translated as needed, and coded inductively. The research team discussed codes internally to reach consensus and to assess for thematic saturation, at which point recruitment was stopped. We used thematic analysis to integrate the codes into broader themes.

Results/Outcomes: Twenty-one patients were interviewed, ranging in age from 39-79 years with 57% women. The racial and ethnic composition of study participants mirrored that of California's population. Five factors appeared to impact the likelihood that a survivor would adopt health habits: 1. Interpretation of cancer diagnosis: Patients who interpreted their cancer diagnosis as related to their pre-diagnosis health habits or who saw their diagnosis as a second chance were more likely to follow positive health habits. Those who interpreted their cancer diagnosis as unrelated to their health habits or who saw themselves as the victim of bad luck were less interested in improving on health habits. 2. Emotional response to illness: Subjects with a positive outlook and proactive coping strategies were more likely to follow health behavior guidance. 3. Learning from treatment experience: Patients who learned about the relationship between health habits and colorectal cancer were more likely to adopt healthy habits. Others experienced the impact of health habits on how they felt physically while they were going through treatment, and that was particularly motivating to continue healthy habits. 4. Support from family or friends increased interest in positive health habits. 5. Physical and logistical limitations, such as chronic injuries or financial strain, were powerful barriers to adoption of health habits.

Conclusion/Discussion: While colorectal cancer treatment may be an overwhelming experience, it may also be the impetus for patients to adopt health habits that may improve both their cancer-related and non-cancer-related health outcomes. Surgeons are in an ideal position to influence the adoption of evidence-based health habits; however, effective perioperative interventions must identify and adjust to how patients interpret the meaning of their illness. Future interventions may benefit from integrating treatment experiences into actionable new habits and leveraging social support all while acknowledging and addressing physical and logistical barriers to healthy living.

Conceptual Model of Health Habit Adoption in Colorectal Cancer Survivors
Positive lessons about the effect of health habits from the treatment experience facilitated adoption of habits. The interpretation of what a cancer diagnosis signified in one's life, emotional responses to illness, and the influence of family and friends were factors that could act as facilitators or barriers. Physical limitations, financial strain, and job responsibilities often acted as barriers.