Health Status and Health Behaviors of Cancer Survivors by Time Since Cancer Diagnosis: Based on the Korea National Health and Nutrition Examination Survey

Abstract

Objectives: This study aimed to compare health status and behaviors between cancer undiagnosed group and cancer survivors groups by time since cancer diagnosis, and investigate the association between this time and aerobic physical activity by employment status.Methods: We analyzed data from the 2015-2024 Korea National Health and Nutrition Examination Survey (KNHANES), excluding 2022 and 2023, for adults aged ≥30 years. To ensure comparability, 952 cancer survivors were propensity-score matched with 952 cancer undiagnosed controls (n=1,904) based on age, marital status, education, income, region, and national health insurance type. Cancer survivors were categorized by time since diagnosis (<1, 1 to <3, 3 to <5, and ≥5 years). We examined differences in health status and behaviors, and conducted logistic regression stratified by employment status, adjusting for age and activity limitation.Results: Cancer survivors were more likely than cancer undiagnosed controls to report poor self-rated health, recent discomfort, and activity limitations. Significant differences were also observed in the mobility, usual activities, and pain/discomfort dimensions of the EuroQol-5 Dimension (EQ-5D) (p<0.05). Regarding health behaviors, current smoking and monthly alcohol consumption were lower among survivors (p<0.05), whereas weekly walking and aerobic physical activity did not differ significantly by time since diagnosis. Among unemployed participants, those 3 to 5 years post-diagnosis had significantly higher odds of engaging in aerobic physical activity than controls (OR=1.447, 95% CI=1.046-2.003, p=0.026). No significant association was observed among employed participants. The odds ratios for the 3 to 5 years group differed significantly by employment status (p=0.009).Conclusions: Despite favorable smoking and alcohol habits, survivors faced persistent physical discomfort and activity limitations, with aerobic activity levels comparable to cancer undiagnosed controls. Furthermore, the association between physical activity and time since diagnosis varied by employment status. Consequently, tailored health management strategies incorporating time since diagnosis, functional status, and employment conditions are essential to support optimal physical activity and healthy behaviors in cancer survivors.