The Salience of Cancer in the Dietary Behaviors of Prostate Cancer Survivors

ABSTRACT Background. Prostate cancer survivors are at risk for cancer recurrence, a second cancer, and other chronic conditions, including cardiovascular disease and diabetes. Some of these health risks are attributable to behavioral risk factors, including obesity, physical inactivity, and unhealthy diet. Although a cancer diagnosis is potentially a teachable moment when one might be more motivated to make behavioral changes, many prostate cancer survivors are not adhering to dietary and physical activity guidelines. Purpose. This dissertation study examined influences on the healthfulness of prostate cancer survivors’ diets and investigated the ways in which a prostate cancer diagnosis might impact men’s dietary behaviors. Methods. A purposive sample of 20 prostate cancer survivors who were at least 3 years post-diagnosis and not currently in active treatment was constructed. Over a period of approximately a month, participants completed a socio-demographic questionnaire; took part in an in-depth interview about their cancer experience and the current impact of cancer on their lives; completed three on-line dietary recalls; and participated in an in-depth interview about their dietary practices and determinants of diet. Wives/partners of eight participants were also interviewed. In-depth interviews were analyzed using a constant comparison approach. Dietary recall data were analyzed quantitatively to assess men’s diet quality, and qualitatively to characterize men’s dietary patterns. Results. For many men, ‘cancer survivor’ was not a salient identity. Additionally, many men did not perceive a relationship between diet and recurrence; consequently, men described factors other than their history of cancer as more influential in their food choices. Taste and health were brought up as key determinants of food choices. Men with healthier diets described a higher level of motivation to make healthy food choices, often for weight loss, and fewer barriers to health eating. Wives/partners were frequently described as being primarily responsible for food provision activities and therefore an important influence on the healthfulness of men’s diets. Conclusions. These findings suggest that health promotion programs focused on the multiple health benefits of healthy eating (e.g., weight loss, co-morbidities, longevity) might be more suitable for some men than ‘cancer survivor’ centered programs. Couples-based programs should also be considered