Health behaviors, obesity, and marital status among cancer survivors: a MEPS study.

PURPOSE: Promoting positive health behaviors helps improve cancer survivors' health outcomes during survivorship; however, little is known about whether health behaviors differ by marital status. The purpose is to examine whether health behaviors and obesity among cancer survivors vary by marital status and whether the type of cancer and sociodemographic factors influence the relationship. METHODS: We examined smoking, physical activity, and body mass index (BMI) among 1880 individuals diagnosed with prostate, breast, or colon cancer who were identified from the 2011-2017 Medical Expenditure Panel Survey (MEPS). We used Rao-Scott design-adjusted chi-square tests and weighted multivariable logistic regressions to achieve the research aims. RESULTS: Current smoking behavior and BMI were significantly related to marital status. Survivors who had never married were the most likely to be current smokers across all cancer types. Married survivors were the most likely to be overweight or obese, while widowed survivors were the most likely to have a normal weight. The relationship between BMI and marital status varied by cancer type. Widowed colon cancer survivors were least likely to be overweight or obese; divorced/separated colon cancer survivors were most likely to be obese or overweight. Health behavior disparities were found among cancer survivors of different age, sex, race, and levels of education and income. CONCLUSIONS: There were relationships between marital status, health behaviors, and obesity among cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Our results suggested that relationship status and sociodemographic factors need to be considered in tailoring interventions to promote health behaviors among cancer survivors.

The Challenges of Enrollment and Retention: A Systematic Review of Psychosocial Behavioral Interventions for Patients With Cancer and Their Family Caregivers.

CONTEXT: Psychosocial behavioral interventions (PBIs) that target patients with cancer and their caregivers face challenges in participant enrollment and retention. OBJECTIVES: 1) Describe characteristics of the patient-caregiver PBI studies; 2) examine participant enrollment and retention rates; 3) identify factors influencing participant enrollment and retention rates; and 4) explore the strategies to promote enrollment and retention rates. METHODS: We identified randomized controlled trials that tested PBIs among adult patients with cancer and caregivers in five electronic databases. We conducted narrative and quantitative analyses to synthesize our findings. RESULTS: Among 55 qualified studies reviewed, most tested the efficacy of PBIs (n = 42) and used two study arms (n = 48). In-person meeting was the most common PBI delivery mode. The primary outcomes included quality of life, physical health, and symptoms. The average of enrollment rates of patient-caregiver dyads was 33% across studies (range 8%-100%; median = 23%). The average retention rate at the end of follow-ups was 69% (range 16%-100%; median = 70%). The number of study arms, recruitment method, type of patient-caregiver relationship, and intervention duration influenced enrollment rates. Study design (efficacy vs. pilot), follow-up duration, mode of delivery, type of relationship, and intervention duration influenced retention rates. Sixteen studies reported retention strategies, including providing money/gift cards upon study completion and/or after follow-up survey, and excluding patients with advanced cancer. CONCLUSION: Researchers need to incorporate effective strategies to optimize enrollment and retention in patient-caregiver PBI trials. Researchers need to report detailed study processes and PBI information to improve research transparency and increase consistency.