National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway.
Systems Epidemiology, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
BMC Complement Med Ther. 2023 Aug 19;23(1):292. doi: 10.1186/s12906-023-04123-4.
Adherence to healthy lifestyle recommendations has positive effects on cancer outcomes yet adherence is low among cancer survivors. Differences in adherence between women and men, phase of survivorship, and other factors that might increase adherence, like the use of traditional and complementary medicine (T&CM), need to be explored. We aimed to study the adherence to national recommendations for a healthy diet (daily intake of ≥ 5 portions of fruit/vegetables), physical activity (150 min of moderate-intensity or 75 min of high-intensity/week), normal body mass index (BMI) (18.5-24.9 kg/m), non-smoking, and low-risk alcohol consumption (women ≤ 10 g/day, men ≤ 20 g/day) among Norwegian cancer survivors and their associations with sex, the use of T&CM, and survivorship phase.
We used logistic regression, independent sample t-test, and chi-square test to study self-reported (diet, physical activity, smoking, alcohol consumption) and measured (BMI) adherence in 1530 cancer survivors (40 years and above, participating in the population-based Tromsø Study conducted in 2015-2016 (65% attendance). We dichotomized all assessed lifestyle recommendations (adherence = 1 point, non-adherence = 0 points), and created a score for every recommendation (0-5 points). Adherence to individual lifestyle recommendations and the use of T&CM as well as the phase of survivorship was adjusted for sex, age, income, and living with a partner.
Adherence to recommendations was 7.5% for diet, 85.3% for physical activity, 30.5% for BMI, 89.3% for non-smoking, and 87.6% for alcohol consumption. In total 2.3% adhered to all five recommendations concurrently (mean score 2.96 [SD = 0.86]). Women adhered to more recommendations concurrently compared to men (3.03 [SD = 0.90] vs. 2.89 [SD = 0.80] points respectively, [p = .012]). In total, 31% reported the use of T&CM and there were no differences in adherence to individual lifestyle recommendations or concurrent adherence in overall T&CM use compared to non-use. Users of self-help techniques were more likely to adhere to the recommendations of diet (aOR 2.69, 95% CI 1.45-4.98) and physical activity (aOR 6.26, 95% CI 1.51-25.92). Users of traditional healers and users of more than one T&CM modality were less likely to adhere to the low-risk alcohol consumption recommendation, (aOR 0.32, 95% CI 0.13-0.77, and aOR 0.53, 95% CI 1.08-2.17, respectively) compared to T&CM non-users. Survivors with cancer previously (1162) had higher odds of adhering to the recommendation of diet (aOR 2.66, 95% CI 1.36-5.19) than survivors with cancer presently (n = 368), but not to other recommendations.
The health of cancer survivors can be improved through adherence to lifestyle recommendations, yet our study found partial adherence among survivors in Norway, in accordance with findings from other countries. Although overall T&CM use was not associated with higher adherence to lifestyle recommendations, differences in adherence were seen among individual modalities like the use of self-help techniques and traditional healers. Our results suggest the need for intensified follow-up of lifestyle with attention to male survivors and diet among all survivors throughout the cancer survivorship continuum.
遵循健康的生活方式建议对癌症结果有积极影响，但癌症幸存者的遵循率很低。女性和男性之间、生存阶段之间的遵循率差异，以及可能增加遵循率的其他因素，如传统和补充医学（T&CM）的使用，需要进一步探讨。我们旨在研究挪威癌症幸存者对健康饮食（每天摄入≥5 份水果/蔬菜）、身体活动（150 分钟中等强度或 75 分钟高强度/周）、正常体重指数（BMI）（18.5-24.9kg/m²）、不吸烟和低风险饮酒（女性≤10g/天，男性≤20g/天）的建议的遵循情况，以及这些建议与性别、T&CM 的使用和生存阶段的关系。
我们使用逻辑回归、独立样本 t 检验和卡方检验，研究了 1530 名癌症幸存者（40 岁及以上，参加了 2015-2016 年进行的基于人群的特罗姆瑟研究（65%的出席率））的自我报告（饮食、身体活动、吸烟、饮酒）和测量（BMI）的依从性。我们将所有评估的生活方式建议进行二分法（依从=1 分，不依从=0 分），并为每个建议创建一个得分（0-5 分）。对于性别的调整包括饮食、T&CM 的使用以及生存阶段的调整，还包括了生活方式建议的依从性和 BMI。
建议的饮食依从率为 7.5%，身体活动依从率为 85.3%，BMI 为 30.5%，不吸烟为 89.3%，饮酒为 87.6%。总共有 2.3%的人同时符合所有五项建议（平均得分 2.96[SD=0.86]）。与男性相比，女性同时符合更多的建议（分别为 3.03[SD=0.90]和 2.89[SD=0.80]分，[p=0.012]）。总共有 31%的人报告使用了 T&CM，与非使用者相比，在使用 T&CM 的个体生活方式建议的依从性或同时的依从性方面没有差异。使用自助技术的人更有可能遵守饮食（优势比 2.69，95%置信区间 1.45-4.98）和身体活动（优势比 6.26，95%置信区间 1.51-25.92）的建议。传统治疗师的使用者和使用多种 T&CM 方式的使用者不太可能遵守低风险饮酒建议（与 T&CM 非使用者相比，优势比分别为 0.32，95%置信区间 0.13-0.77，和 0.53，95%置信区间 1.08-2.17）。与目前患有癌症（n=368）的幸存者相比，以前患有癌症（n=1162）的幸存者更有可能遵守饮食建议（优势比 2.66，95%置信区间 1.36-5.19），但不符合其他建议。
通过遵循生活方式建议，可以改善癌症幸存者的健康状况，但我们的研究发现，挪威的幸存者部分遵循了这些建议，这与其他国家的研究结果一致。尽管 T&CM 的总体使用与更高的生活方式建议依从性无关，但在个别模式（如自助技术和传统治疗师的使用）中，依从性存在差异。我们的研究结果表明，需要加强对所有幸存者的生活方式的随访，特别是男性幸存者和整个癌症幸存者的饮食。
