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Gynecologic Cancer Survivors: A Study Of Lifestyle Factors

Gynecologic Cancer Survivors: A Study Of Lifestyle Factors



Promoting positive outcomes for gynecologic cancer survivors hinges on upholding a healthy lifestyle. We scrutinized behaviors among gynecologic cancer survivors (n = 1824) and non-cancer individuals via cross-sectional analysis, using 2020 Behavioral Risk Factor Surveillance System data. Colorectal cancer screening rates were 7.9% (95% CI: 4.0–11.9) higher in gynecologic cancer survivors, and 15.0% (95% CI: 4.0–11.9) higher in other cancer survivors, compared to 65.2% in those without cancer history. Breast cancer screening showed negligible differences between gynecologic cancer survivors (78.5%) and those without cancer history (78.7%). Influenza vaccination coverage was slightly elevated in gynecologic cancer survivors (increase of 4.0%, 95% CI: 0.3–7.6) but lower than in other cancer survivors (decrease of 11.6%, 95% CI: 7.6–15.6). Pneumonia vaccination rates were akin to other groups.


Regarding modifiable risk behaviors, smoking prevalence was notably higher among gynecologic cancer survivors (increase of 12.8%, 95% CI: 9.5–16.0) compared to other cancer survivors and non-cancer individuals, accentuated in rural areas (increase of 17.4%, 95% CI: 7.2–27.6). Disparities in heavy drinking were inconspicuous. Gynecologic and other cancer survivors exhibited reduced physical activity propensity (Δ = −12.3, 95% CI: −15.8 to −8.8 and Δ = −6.9, 95% CI: −8.5 to −5.3, respectively) compared to those without cancer history.


Notably high smoking prevalence among gynecologic cancer survivors necessitates urgent interventions for smoking cessation and mitigating hazardous alcohol use. Educating gynecologic malignancy patients about the significance of physical activity is pivotal.




Advances in therapies led to more gynecologic (uterine, cervical, ovarian) cancer survivors. Uterine cancer ranks fourth among U.S. women, with ~66,570 new cases in 2021. There were ~14,480 new cervical and ~21,410 ovarian cancer cases. An estimated 807,860 uterine, 283,120 cervical, and 249,230 ovarian cancer survivors existed as of Jan 1, 2019.


Maintaining a healthy lifestyle is crucial for positive outcomes. Physical activity, limiting alcohol, avoiding smoking, vaccinations, and cancer screenings enhance health and life quality. They reduce recurrence and chronic diseases.


Gynecologic cancer survivors, after primary treatment, require vigilant care for recurrences and complications. Rural survivors face barriers to follow-up care due to income and insurance disparities, with higher mortality risks.


We studied preventive behaviors in gynecologic cancer survivors via 2020 BRFSS data. We compared them to other cancer survivors and those without cancer history, hypothesizing similar or higher preventive measures. Rural-urban differences were also anticipated.




The study is based on data extracted from the Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional telephone-based survey encompassing U.S. residents aged 18 years and above. The dataset consists of 110,820 adult women from 28 states: Arizona, Connecticut, Delaware, Georgia, Hawaii, Indiana, Kansas, Louisiana, Massachusetts, Maryland, Maine, Michigan, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Jersey, New Mexico, New York, Ohio, Oklahoma, Rhode Island, South Dakota, Utah, Virginia, Vermont, and Wisconsin.


Inclusion Criteria

– Adult women aged 18 years and above.

– Residing in one of the 28 states mentioned above.

– Participation in the 2020 BRFSS cancer survivorship module.

– Provided information on types of cancer and health-related factors.


Exclusion Criteria

– Individuals under 18 years of age.

– Residents outside the selected 28 states.

– Lack of participation in the 2020 BRFSS cancer survivorship module.

– Incomplete or missing information on types of cancer or health-related factors.


The study focused on evaluating preventive behaviors and modifiable risk factors among gynecologic cancer survivors, female survivors of other cancer types, and women without a history of cancer. Key health measures included colorectal cancer screening, breast cancer screening, influenza and pneumonia vaccination, smoking, heavy drinking, and leisure time physical activity.


Statistical analyses were conducted using Stata 17.0, accounting for complex survey weights. Multivariable logistic regression models were employed, adjusting for sociodemographic variables such as age, race, ethnicity, education, income, marital status, and employment status. Urban and rural sub-groups were also examined, and relationships among different types of gynecologic cancer were explored.


It is important to note that this study utilized de-identified BRFSS public use data and was exempt from review by the Augusta University Institutional Review Board due to the absence of personal identifiers.


Overall, this research sheds light on preventive behaviors and risk factors among gynecologic cancer survivors, providing valuable insights into enhancing survivorship care and improving health outcomes in this population.


Statistical Analysis


From our sample of 110,820 women, 1824 were gynecologic cancer survivors, and 9843 were survivors of other cancers. Around 90% had no cancer history. Among gynecologic cancer respondents, 904 had cervical cancer, 556 had endometrial cancer, and 364 had ovarian cancer.


In rural areas, the prevalence of gynecologic cancer was higher by 0.75%-points (95% CI: 0.32–1.19). Demographics varied across groups. Colorectal cancer screening was more prevalent in gynecologic and other cancer survivors than those without cancer history, especially in urban areas. Similarly, influenza vaccination rates were higher in cancer survivors, except for gynecologic cancer survivors in urban settings.


Breast cancer screening saw no difference between gynecologic cancer survivors and those without cancer history. Pneumonia vaccination was higher in both cancer survivor groups. Smoking prevalence was notably higher among gynecologic cancer survivors, particularly in rural areas. Heavy drinking rates were comparable across groups. Physical activity was less likely in gynecologic and other cancer survivors than those without cancer history, especially in urban areas.


Regarding gynecologic cancer types, endometrial cancer survivors showed higher colorectal cancer screening rates than cervical cancer survivors. Influenza vaccination rates were similar between cervical and ovarian cancer survivors, but higher among endometrial cancer survivors. Cervical cancer survivors exhibited higher tobacco use than other cancer survivors. Rates of heavy drinking were lower among endometrial cancer survivors.


Adjusted odds ratios revealed higher colorectal cancer screening, influenza, and pneumonia vaccination odds for gynecologic cancer survivors compared to those without cancer history. Smoking odds were significantly higher for gynecologic cancer survivors, lower for other cancer survivors. Physical activity odds were lower for both cancer groups.


In comparison, survivors of other cancer types had higher odds of colorectal cancer screening, mammography, influenza, and pneumonia vaccination, and lower odds of smoking and physical activity. These findings consistently support various health behaviors and preventive measures among gynecologic cancer survivors and other cancer survivors compared to those without cancer history.



When compared to respondents without cancer history, survivors of endometrial cancer exhibited notably higher adjusted odds of receiving a flu shot (AOR = 2.0, 95% CI: 1.5–2.7). Pneumonia vaccination likelihood was elevated among survivors of other gynecologic cancer types, with the exception of ovarian cancer.


Among cervical cancer survivors, the adjusted odds of smoking were significantly heightened (AOR = 4.0, 95% CI: 3.2–5.0). In contrast, survivors of endometrial cancer displayed a substantially lower likelihood of heavy drinking (AOR = 0.4, 95% CI: 0.2–0.7).


Lastly, the diminished odds of engaging in physical activity among gynecologic cancer survivors were consistent across all three types of gynecologic cancer. These findings highlight distinctive health behavior patterns among survivors of different gynecologic cancer types, underlining the importance of tailored interventions to promote healthier lifestyles and well-being.




The outcomes of our comprehensive study underscore significant implications for healthcare providers, the healthcare team, and researchers in the realm of gynecologic cancer survivorship. Notably, our investigation reveals noteworthy disparities and avenues for targeted interventions.


Our findings unveil that adherence to colorectal cancer screening and pneumonia vaccination recommendations among gynecologic cancer survivors is commendably comparable to individuals without a cancer history. However, adherence to breast cancer screening and influenza vaccination did not vary between the two groups. Intriguingly, compliance with these recommendations was generally lower among gynecologic cancer survivors when contrasted with survivors of different cancer types.


We spotlight a concerning facet: an alarming prevalence of current cigarette smoking (25.97%) among gynecologic cancer survivors, signifying heightened risks of cancer recurrence, secondary malignancies, and chronic ailments. Noteworthy, even though alcohol consumption may not directly impact ovarian and endometrial cancer risks, heavy alcohol use may exacerbate cervical cancer recurrence risks. Our study underscores the pivotal roles of oncologists and primary care providers in galvanizing cancer survivors towards embracing healthier lifestyle modifications.


Furthermore, our exploration revealed that gynecologic cancer survivors, especially those residing in rural areas, exhibited reduced engagement in physical activity compared to individuals without cancer history or survivors of other cancer types. Despite data limitations concerning physical activity assessments, our findings consolidate with existing literature highlighting lower physical activity levels in cancer survivors.


Structural barriers at individual, social, and environmental levels can impede the adoption and maintenance of healthy behaviors. Addressing these barriers can substantially enhance healthy behaviors among gynecologic cancer survivors. While the study’s results offer valuable insights, some limitations warrant consideration. The low response rate of the Behavioral Risk Factor Surveillance System (BRFSS) might curtail the generalizability of our findings to all U.S. gynecologic cancer survivors. Moreover, self-reported information could introduce misclassification bias.


We acknowledge the cross-sectional nature of our data, preventing the assessment of behavioral changes during pre- and post-diagnosis phases. Insights into cancer characteristics, treatment patterns, and phases of care were absent, influencing our evaluation of preventive and risky health behaviors. Future endeavors, utilizing robust longitudinal data, may holistically address these critical factors.


In conclusion, our study holds considerable implications for healthcare stakeholders. While certain screening and immunization adherence favorably align with individuals without cancer history, the elevated prevalence of smoking among gynecologic cancer survivors necessitates targeted interventions. The imperative of quitting smoking and moderating alcohol consumption beckons intervention studies. Notably, heightened awareness of health risk behaviors, such as smoking’s impact on cancer treatments, physical activity’s importance, and the significance of preventive practices should be unequivocally emphasized by the entire healthcare team. These endeavors stand as keystones for enhancing the well-being of women grappling with gynecologic malignancies.


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