A longitudinal examination of the interrelationships between multiple health behaviors in cancer patients

Purpose A healthy lifestyle following a cancer diagnosis is associated with reduced risk for a cancer recurrence. Better understanding the interrelationships between multiple health behaviors (HB) in cancer survivors could inform the development of more effective interventions to promote a healthy lifestyle. Methods This prospective study assessed the longitudinal interrelationships between smoking, physical activity, alcohol intake, and caffeine consumption among patients with mixed cancer sites at the peri‐operative period and 2, 6, 10, 14, and 18 months later. A cross‐lagged design and structural equation modeling were used to assess the relationships between all four HBs over time. Results The study included 962 participants. The model showed a good fit to the data. For all four HBs, continuity paths consistently indicated that one particular health behavior was significantly predicted by the same health behavior at the previous time point. However, no consistent pattern of cross‐lagged relationships between HBs emerged. Physical activity at 14‐ and 18‐month evaluations was the HB most consistently involved either as a predictor as a predicted variable. Conclusion Overall, this study indicates that HBs assessed following cancer surgery are mostly independent and that interventions promoting HB changes during the cancer treatment trajectory need to target each health behavior separately.