Historically, comprehensive cancer control programs have relied on cancer incidence, mortality, and local survey data to describe cancer in relation to cancer survivorship. The use of self-reported cancer prevalence data for cancer control at the state level is rare because few programs have the capacity to collect these data. We found that most cancer survivors were aged 55 years or older, regardless of sex. This pattern was similar to that documented in the Massachusetts Cancer Registry (MCR) (Helen Hawk, PhD, written communication, December 18, 2008). The distribution of self-reported cancers was also similar to that documented in the MCR (Helen Hawk, PhD, written communication, December 18, 2008). However, we observed variation in rankings of these cancers between these 2 systems. Lung cancers were more frequently documented by the MCR than the BRFSS. Lung cancer patients may be institutionalized or too sick to participate in the BRFSS telephone interviews. Their absence from survey data should be investigated through studies of data from, for example, caregivers and hospitals.
Time since diagnosis affected self-reported health status and quality of life among cancer survivors. These findings are similar to those of a previous study that assessed variation in HRQOL by time since diagnosis (10
). However, they differ from findings from several other studies (11
) that described health-related behaviors, HRQOL, and access to care among cancer survivors, indicating that cancer survivors have a lower quality of life than respondents without cancer.
Cancer survivors are also at increased risk of developing second cancers because of risk factors that led to the first cancer or as a consequence of therapy (14
). These risk factors have also been linked to treatment complications, reduced quality of life, and mortality among cancer survivors (3
). Since smoking cessation and increased exercise are associated with lower levels of cancer recurrence (8
), appropriate activities aimed at improving or modifying these health behaviors may improve the health of Massachusetts cancer survivors.
Cancer survivors may also have increased risk for chronic conditions such as heart disease (3
), diabetes (16
), obesity-related asthma (17
), and disability (18
). Little is known about the effect of comorbid health conditions on diagnosis, treatment, subsequent health, or quality of life of cancer survivors; thus, further investigation into these relationships is warranted.
Cancer survivors in Massachusetts were more likely than respondents without cancer to receive age-appropriate screening for colorectal and cervical cancers, a finding similar to one in a previous study (19
). However, the respondents did not differ significantly in receipt of screening for prostate and breast cancers, which differs from the findings in a study reporting that survivors were more likely to receive breast and prostate cancer screening than other respondents (19
). Although screening guidelines recommend that young survivors receive screening at earlier ages (20
), the small sample size prevented us from examining screening use in this population. Future analyses, which will include multiple years of data, may allow us to assess screening behavior in younger respondents.
Influenza vaccination is recommended for people with chronic diseases (21
). Cancer survivors are at increased risk of developing complications from influenza (22
). Therefore we examined vaccination use among Massachusetts survivors. We found that cancer survivors were significantly more likely than respondents without cancer to report receipt of the influenza vaccine. Although we did not assess the effect of age on vaccine use, prior studies noted that even in age-appropriate adults (23
) only 59.2% of cancer survivors reported receiving an influenza vaccination. These rates may be appropriate, however, depending on the time since diagnosis and whether cancer patients are being actively treated for cancer (23
Our findings are subject to several limitations. First, the survey may not be representative of people who do not have a land-line telephone, which is required for participation in the BRFSS survey (24
). Second, BRFSS data are self-reported and subject to recall bias, which could lead to inaccurate estimates of cancer prevalence (25
). Third, because our findings are limited to noninstitutionalized US citizens, cancer survivors who may have advanced disease and are living in nursing homes, long-term–care facilities, or hospice are not included in our study. Fourth, because this survey does not collect information from people younger than 18 years; thus, we are unable to describe the health behaviors of this population. Fifth, low cooperation for the Massachusetts BRFSS survey may also limit the generalizability of our study findings to all cancer survivors living in Massachusetts. Although studies have concluded that the national survey findings are reliable and valid (26
), the reliability and validity of state-level data have not been directly assessed. To accurately do so, state-level BRFSS prevalence estimates must be compared with prevalence estimates from state cancer registries. Sixth, we also lacked information about cancer stage at diagnosis and whether the cancer diagnosis led to the development of other chronic conditions (eg, heart disease, diabetes, asthma) or vice versa. Also, the number and intensity of HRQOL issues vary with the type of cancer (27
). Finally, the experience of cancer survivors in Massachusetts may differ from that of others in the United States because more than 95% of Massachusetts residents have health insurance (28
). Increased access to health care as a result of health care reform initiatives may affect the health behaviors, health status, and overall survivorship of people with cancer. Studies are needed to assess the effect of increased health care access on the health behaviors of cancer survivors.
State-level population-based data on the health and care of cancer survivors may be used by cancer control programs to tailor programs that meet the needs of cancer survivors. For example, the Massachusetts Comprehensive Cancer Prevention and Control Program (MCCPCP) and the Massachusetts Comprehensive Cancer Control Coalition's Survivorship Workgroup used their BRFSS data to help address potential challenges in the provision of health care and preventive services for cancer survivors (eg, treatment of chronic disease, risk factor education). The MCCPCP has continued to support the collection of BRFSS data for cancer survivors. The additional data may be used to identify the needs of Massachusetts cancer survivors in certain subpopulations (eg, racial/ethnic minority groups) or with certain cancer types (eg, breast, colorectal, melanoma). Such information will help us to develop interventions to improve the quality of care and quality of life of cancer survivors.