Relationships Between Psychosocial Factors and Health Behavior Change in Cancer Survivors: An Integrative Review Crystal L. Park, Ph.D. and Allison E. Gaffey, B.A. University of Connecticut ABSTRACT Background: Adaptive health behavior changes follow- ing cancer diagnosis and treatment are associated with better psychological and physical well-being. However, little is known about the roles that psychosocial factors play in facil- itating or inhibiting these changes. A better understanding of health behavior change will allow the development of more effective interventions. Purpose: Our goal was to conduct a systematic and exhaustive review of research examining rela- tionships among psychosocial factors and health behavior change in cancer survivors. Method: We searched electronic databases and reference sections of relevant article and chap- ters to locate all studies that met our criteria (i.e., examined at least one psychosocial variable and one health behavior change in a sample of cancer survivors). Results: We located 30 studies that met criteria. Social support, locus of control, and distress were the focus of most of this literature. Although findings are inconsistent, social support appears to be helpful in making adaptive changes, particularly in exercise; internal locus of control facilitates positive health behavior changes but may depend on survivors’ perceptions of links between behaviors and cancer or recurrence, and can- cer-related distress may facilitate adaptive changes although more general distress may impede them. Studies based on theoretical models of health behavior change have demon- strated that stage of readiness to change, intentions, and self-efficacy may be powerful determinants of improvements in health behaviors. Conclusions: Much remains to be learned about the influence of psychosocial factors in survivors’ health behavior change. We describe the limitations of the current state of the research and conclude with suggestions for future research and intervention. (Ann Behav Med 2007, 34(2):115–134) There are over 10 million cancer survivors 1 in the United States, a number increasing rapidly, largely due to early detection and effective treatments (1). These increasingly favorable survivorship statistics provide hope to millions of people. However, along with survivorship comes a vulnerability to subsequent health problems. In addition to risk of recurrence, survivors are at heightened risk for developing second cancers due to many factors, including genetic predisposition or immunodeficiency, clustering of risk factors, common carcinogenic exposure, and previous cancer treatment toxicity (2). Further, survivors are also at heightened risk for many other serious diseases and health conditions, including osteoporosis, obesity, diabetes, and cardiovascular disease (2). Cancer survivors’ health behaviors, such as exercise and dietary habits, may have important implications for their responses to treatment, recovery, recurrence, and sub- sequent general health. According to the 2003 American Cancer Society (ACS) Guide for Informed Choices, Nutrition and Physical Activity During and After Cancer Treatment (3), although no consensus exists to support ‘‘convincing evidence of benefit’’ as it relates to either dis- ease-free or overall survival, current data do provide sup- port for ‘‘probable’’ and ‘‘possible’’ benefit for several health behaviors, such as eating more fruits and vegetables and less saturated fat and increasing physical activity (2,4,5). The 2006 ACS guidelines noted that although the scientific evidence for advice on nutrition and physical activity after cancer is much less certain than for cancer prevention, it is likely that following the ACS Guidelines on diet, nutrition, and cancer prevention may be helpful for reducing the risk of developing second cancers. (6, p. 327) In addition, health behaviors are strongly related to many aspects of quality of life. For example, survivors who exercise regularly experience higher levels of physical and emotional well-being than those who do not (7,8). Further, there is some evidence that not only are health behaviors important determinants of well-being in cancer survivors, but postcancer changes in health behaviors may be even more powerful determinants. For example, a study of colorectal cancer survivors found that change in exercise was a stronger determinant of quality of life than was mean level of exercise (9). Another study demonstrated that increases in exercise were related to better physical quality of life in long-term breast cancer survivors an aver- age of 13 years after diagnosis (10). In fact, the period following cancer diagnosis has been called ‘‘the teachable moment’’ (11) because, at this time, 1 Per the definition of survivorship of the National Cancer Insti- tute (104), we define survivor as anyone who has been diagnosed with cancer, regardless of the length of time since diagnosis or cur- rent treatment or health status. Reprint Address: Crystal L. Park, Department of Psychology, University of Connecticut, Storrs, CT 06269-1020. E-mail: crystal.park@uconn.edu. # 2007 by The Society of Behavioral Medicine. 115