Diet and supplement use changes among male cancer survivors during the COVID-19 pandemic

ABSTRACT

Introduction: The COVID-19 pandemic has disrupted the lives of cancer survivors who may be at higher risk than people without cancer of other adverse health outcomes. For many individuals, a cancer diagnosis leads to lower physical activity and change in mental health status. Modifiable health behaviors, such as consumption of a healthy diet, can positively affect cancer survivorship outcomes. Aim: To investigate the individual-level changes in diet and supplement use among male cancer survivors during the COVID-19 pandemic and compared to men without cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID October 2020, first follow-up January 2021, second follow-up April 2021). Diet and supplement use were analyzed descriptively between cancer survivors and individuals without a history of cancer. Further, outcomes were dichotomized to reflect whether a change was healthful or unchanged/unhealthful;for example, lower fast food consumption was classified as a healthful change. To assess the associations between cancer survivors and other men, logistic regression was used, adjusting for age, race, pre-pandemic body mass index, pre-pandemic physical activity, and other health information. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Across all eligible men (median age 78 years), there were considerable proportions of men engaging in healthful changes following the start of the pandemic in intake of fast food (19% decreased), sugary drinks (14% decreased), fresh fruit (26% increased), fresh vegetables (19% increased), fish (13% increased), and red meat (12% decreased) consumption. Similar changes in diet were reported on the second follow-up questionnaire. For most foods, a similar percentage of cancer survivors and individuals without a history of cancer increased healthy eating. Findings from multivariable logistic regression models were reflective of higher odds of cancer survivors to engage in a healthful diet change for unhealthy food categories (i.e., less fast food, less frozen food), though none of which were statistically significant. There was little change in supplement use during the pandemic, except for 6% who started use of vitamin D supplements between the baseline and first follow-up questionnaire. Conclusion: Our findings suggest that older men engaged in healthful diet changes during the COVID-19 pandemic, without noticeable differences among cancer survivors.