Online Exclusive Article

Health-Promotion Behaviors and Psychological Distress in Cancer Survivors

Mariann M. Harding

psychosocial support systems, survivors
ONF 2012, 39(2), E132-E140. DOI: 10.1188/12.ONF.E132-E140

Purpose/Objectives: To determine whether cancer survivors engage in health-promotion behaviors, to evaluate the extent of their experience of psychological distress, and to investigate the relationship between the practice of health-promotion behaviors and psychological distress.

Design: Cross-sectional secondary data analysis.

Setting: A national, face-to-face interview conducted by personnel of the U.S. Census Bureau using a random sampling of American adults.

Sample: 1,784 survey respondents who reported a previous cancer diagnosis.

Methods: Data from the 2009 National Health Interview Survey were used to examine the prevalence of smoking, physical inactivity, alcohol use, and reports of psychosocial distress. Interviews pertained to the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kinds of health services people receive.

Main Research Variables: Age, current smoking prevalence, alcohol consumption, physical activity, and the experience of feeling hopelessness, sadness, and anxiety.

Findings: Cancer survivors continue to smoke at a rate similar to the national average. Overall, most respondents reported no symptoms of psychological distress. However, age appears to play a major role, showing significant differences in the prevalence of current smoking, participation in physical activity, alcohol use, and reported level of distress.

Conclusions: This study provides estimates of the prevalence of health-promotion behaviors and experience of psychological distress among American cancer survivors. The results reveal opportunities for interventions among cancer survivors.

Implications for Nursing: Nurses should be proactive in providing guidance to survivors regarding the adoption of healthy lifestyle behaviors. Those who encounter younger cancer survivors need to be alert to the higher potential for distress in that population, perform appropriate screenings, and be prepared to offer guidance, supportive care, and referrals for psychological care if needed.

Jump to a section


    Adkins, B. W. (2009). Maximizing exercise in breast cancer survivors. Clinical Journal of Oncology Nursing, 13, 695-700. doi:10.1188/09.CJON.695-700
    American Cancer Society. (2012). Cancer facts and figures 2012. Retrieved from
    Bandura, A. (2005). The primacy of self-regulation in health promotion. Applied Psychology, 54, 245-254.
    Bellizzi, K. M., Rowland, J. H., Jeffery, D. D., & McNeel, T. (2005). Health behaviors of cancer survivors: Examining opportunities for cancer control intervention. Journal of Clinical Oncology, 23, 8884-8893. doi:10.1200/JCO.2005.02.2343
    Blacklock, R. M., Rhodes, R., Blanchard, C. M., & Gaul, C. (2010). Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. Oncology Nursing Forum, 37, 206-212. doi:10.1188/10.onf.206-212
    Blanchard, C. M., Courneya, K. S., & Stein, K. (2008). Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: Results from the American Cancer Society's SCS-II. Journal of Clinical Oncology, 26, 2198-2204.
    Blanchard, C. M., Denniston, M. M., Baker, F., Ainsworth, S. R., Courneya, K. S., Hann, D. M., … Kennedy, J. S. (2003). Do adults change their lifestyle behaviors after a cancer diagnosis? American Journal of Health Behavior, 27, 246-256.
    Burke, L., Miller, L., Saad, A., & Abraham, J. (2009). Smoking behaviors among cancer survivors: An observational clinical study. Journal of Oncology Practice, 5, 6-9.
    Centers for Disease Control and Prevention. (2012a). Adult cigarette smoking in the United States: Current estimates. Retrieved from
    Centers for Disease Control and Prevention. (2012b). National Health Interview Survey. Retrieved from
    Costanzo, E. S., Ryff, C. D., & Singer, B. H. (2009). Psychosocial adjustment among cancer survivors: Findings from a national survey of health and well-being. Health Psychology, 28, 147-156.
    Coughlin, S. (2008). Surviving cancer or other serious illness: A review of individual and community resources. CA: A Cancer Journal for Clinicians, 58, 60-64. doi:10.3322/CA.2007.0001
    Coups, E. J., & Ostroff, J. S. (2005). A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Preventive Medicine, 40, 702-711.
    Deimling, G. T., Wagner, L. J., Bowman, K. F., Sterns, S., Kercher, K., & Kahana, B. (2006). Coping among older-adult, long-term cancer survivors. Psycho-Oncology, 15, 143-159. doi:10.1002/pon.931
    Demark-Wahnefried, W., Aziz, N. M., Rowland, J. H., & Pinto, B. M. (2005). Riding the crest of the teachable moment: Promoting long-term health after the diagnosis of cancer. Journal of Clinical Oncology, 23, 5814-5830. doi:10.1200/JCO.2005.01.230
    Demark-Wahnefried, W., Morey, M. C., Sloane, R., Snyder, D. C., & Cohen, H. J. (2009). Promoting healthy lifestyles in older cancer survivors to improve health and preserve function. Journal of the American Geriatrics Society, 57, S262-S264.
    Doyle, C., Kushi, L. H., Byers, T., Courneya, K. S., Demark-Wahnefried, W., Grant, B, … American Cancer Society. (2006). Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. CA: A Cancer Journal for Clinicians, 56, 323-353.
    Evangelista, L. S., Sarna, L., Brecht, M. L., Padilla, G., & Chen, J. (2003). Health perceptions and risk behaviors of lung cancer survivors. Heart and Lung, 32, 131-139. doi:10.1067/mhl.2003.12
    Fairley, T. L., Hawk, H., & Pierre, S. (2010). Health behaviors and quality of life of cancer survivors in Massachusetts, 2006: Data use for comprehensive cancer control. Preventing Chronic Disease, 7, A09-A09.
    Foster, C., Wright, D., Hill, H., Hopkinson, J., & Roffe, L. (2009). Psychosocial implications of living 5 years or more following a cancer diagnosis: A systematic review of the research evidence. European Journal of Cancer Care, 18, 223-247. doi:10.1111/j.1365-2354.2008.01001.x
    Helgesson, O., Lissner, L., Mansson, J., & Bengtsson, C. (2007). Quality of life in cancer survivors as observed in a population study of Swedish women. Scandinavian Journal of Primary Health Care, 25, 220-225. doi:10.1080/02813430701669535
    Hewitt, M., Greenfield, S., & Stovall, E. (Eds.). (2005). From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.
    Hoffman, K. E., McCarthy, E. P., Recklitis, C. J., & Ng, A. K. (2009). Psychological distress in long-term survivors of adult-onset cancer. Archives of Internal Medicine, 169, 1274-1281.
    Kohno, Y., Maruyama, M., Matsuoka, Y., Matsushita, T., Koeda, M., & Matsushima, E. (2010). Relationship of psychological characteristics and self-efficacy in gastrointestinal cancer survivors. Psycho-Oncology, 19, 71-76.
    Kornblith, A. B., Herndon, J. E., 2nd, Weiss, R. B., Zhang, C., Zuckerman, E. L., Rosenberg, S., … Holland, J. C. (2003). Long-term adjustment of survivors of early-stage breast carcinoma 20 years after adjuvant chemotherapy. Cancer, 98, 679-689. doi:10.1002/cncr.11531
    Kornblith, A. B., Powell, M., Regan, M. M., Bennett, S., Krasner, C., Moy, B., … Winer, E. (2007). Long-term psychosocial adjustment of older versus younger survivors of breast and endometrial cancer. Psycho-Oncology, 16, 895-903.
    Lown, E. A., Goldsby, R., Mertens, A. C., Greenfield, T., Bond, J., Whitton, J., … Zeltzer, L. K. (2008). Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers. Addiction, 103, 1139-1148. doi:10.1111/j.1360-0443.2008.02242.x
    Mayer, D. K., Terrin, N. C., Menon, U., Kreps, G. L., McCance, K., Parsons, S. K., & Mooney, K. H. (2007). Health behaviors in cancer survivors. Oncology Nursing Forum, 34, 643-651. doi:10.1188/07.ONF.643-51
    McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175, 34-41.
    Miller, S. J., Alam, M., Andersen, J., Berg, D., Bichakjian, C. K., Bowen, G., … Zic, J. (2010). Basal cell and squamous cell skin cancers. Journal of the National Comprehensive Cancer Network, 8, 836-864.
    Montgomery, M. (2010). Uncertainty during breast diagnostic evaluation. Oncology Nursing Forum, 37, 77-83. doi:10.1188/10.ONF.77-83
    Mosher, C., Lipkus, I., Sloane, R., Kraus, W. E., Snyder, D. C., Peterson, B., … Demark-Wahnefried, W. (2008). Cancer survivors' health worries and associations with lifestyle practices. Journal of Health Psychology, 13, 1105-1112. doi:10.1177/1359105308095964
    Mosher, C. E., Fuemmeler, B. F., Sloane, R., Kraus, W. E., Lobach, D. F., Snyder, D. C., & Demark-Wahnefried, W. (2008). Change in self-efficacy partially mediates the effects of the FRESH START intervention on cancer survivors' dietary outcomes. Psycho-Oncology, 17, 1014-1023.
    Mullens, A. B., McCaul, K. D., Erickson, S. C., & Sandgren, A. K. (2004). Coping after cancer: Risk perceptions, worry, and health behaviors among colorectal cancer survivors. Psycho-Oncology, 13, 367-376. doi:10.1002/pon.751
    Pinto, B. M., & Trunzo, J. J. (2005). Health behaviors during and after a cancer diagnosis. Cancer, 104(11, Suppl.), 2614-2623. doi:10.1002/cncr.21248
    Pinto, B. M., Trunzo, J. J., Reiss, P., & Shiu, S. Y. (2002). Exercise participation after diagnosis of breast cancer: Trends and effects on mood and quality of life. Psycho-Oncology, 11, 389-400. doi:10.1002/pon.594
    Rabin, C., & Pinto, B. M. (2006). Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives. Psycho-Oncology, 15, 701-712. doi:10.1002/pon.1000
    Richardson, L. C., Wingo, P. A., Zack, M. M., Zahran, H. S., & King, J. B. (2007). Health-related quality of life in cancer survivors between ages 20 and 64 years: Population-based estimates from the Behavioral Risk Factor Surveillance System. Cancer, 112, 1380-1389. doi:10.1002/cncr.23291
    Rogers, L. Q., Courneya, K. S., Robbins, K. T., Malone, J., Seiz, A., Koch, L., … Nagarkar, M. (2006). Physical activity and quality of life in head and neck cancer survivors. Supportive Care in Cancer, 1012-1019. doi:10.1007/s00520-006-0044-7
    Schlairet, M., Heddon, M. A., & Griffis, M. (2010). Piloting a needs assessment to guide development of a survivorship program for a community cancer center. Oncology Nursing Forum, 37, 501-508. doi:10.1188/10.ONF.501-508
    Schmitz, K. H., Courneya, K. S., Matthews, C., Demark-Wahnefried, W., Galvao, D. A., Pinto, B. M., … Schwartz, A. L. (2010). American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise, 42, 1409-1426. doi:10.1249/MSS.0b013e3181e0c112
    Thomas, C. (2011). SDA: Survey documentation and analysis. Retrieved from
    Whitehead, S., & Lavelle, K. (2009). Older breast cancer survivors' views and preferences for physical activity. Qualitative Health Research, 19, 894-906.
    Yabroff, K., Lawrence, W., Clauser, S., Davis, W., & Brown, M. (2004). Burden of illness in cancer survivors: Findings from a population based national sample. Journal of the National Cancer Institute, 96, 1322-1330. doi:10.1093/jnci/djh255