Health behaviors, quality of life, and psychosocial health among survivors of adolescent and young adult cancers

Echo L. Warner, Gina E. Nam, Yingying Zhang, Molly McFadden, Jennifer Wright, Holly Spraker-Perlman, Anita Y. Kinney, Kevin C. Oeffinger, Anne C. Kirchhoff

Survivors of adolescent and young adult (AYA) cancer may engage in unhealthy lifestyles (e.g., smoking), potentially heightening their risk for long-term health problems. We assessed health behaviors and constructs including quality of life (QOL) and psychosocial well-being among survivors of AYA cancer compared to the general population. We used 2009 Behavioral Risk Factor Surveillance System data to evaluate health behaviors for survivors of AYA cancer compared to AYAs without cancer. Multivariable regressions assessed health behaviors (smoking, binge drinking, physical inactivity, and low fruit/vegetable intake) by sex and age between AYA survivors and controls, and among survivors to determine the effects of demographic, QOL, psychosocial, and cancer factors on behaviors. A greater proportion of female survivors of AYA cancer smoked than controls (currently aged 20-39: 27 vs. 14.3%, respectively; currently aged 40-64: 29.3 vs. 18.4%, respectively). Generally, survivors and controls were non-adherent to national health behavior guidelines. Uninsured survivors were at greater risk of smoking vs. insured (females, Relative Risk (RR) = 1.64, 95 % confidence interval (CI) 1.43-1.90; males, RR = 2.62, 95 % CI 1.71-4.02). Poor social/emotional support was associated with smoking (RR = 1.26, 95 % CI 1.07-1.48) among female survivors and was associated with low fruit/vegetable intake among male (RR = 1.12, 95 % CI 1.01-1.23) and female (RR = 1.12, 95 % CI 1.05-1.19) survivors. Female survivors >10 years from diagnosis had higher risk of smoking (RR = 1.26-1.91, all p < 0.01) than survivors 5-10 years from diagnosis. Unhealthy lifestyle behaviors are common in survivors of AYA cancer. AYA survivors require health behavior support.