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Modifiable health-related factors (smoking, physical activity and body mass index) and health care use and costs among adult cancer survivors



To examine the associations between modifiable health-related factors, such as smoking, low physical activity and higher body mass index (BMI), and annual health care visits and expenditures among adult cancer survivors in the United States.


Using data from the 2010–2014 Medical Expenditures Panel Survey, we identified 4920 cancer survivors (aged 18–64 years) and a matched comparison group. Our outcomes were number of annual health care visits [i.e., outpatient/office-based, hospital discharges and emergency department (ED) visits] and total health care expenditures. We examined health-related factors, demographics, insurance and health status (i.e., comorbidity and mental distress). Bivariate and multivariable analyses examined the associations between outcomes and health-related factors.


Of survivors, approximately 21% were current smokers, 52% reported low physical activity and 35% were obese, vs. 19.6, 49.5 and 36.7%, respectively, of the comparison group. These factors were associated with greater comorbidity and mental distress in both groups. Current smokers among survivors were less likely to have outpatient visits [marginal effect on the number of visits (ME) = −3.44, 95% confidence interval (CI) −5.02 to −1.86, P < 0.001] but more likely to have ED visits (ME = 0.11, 95% CI 0.05–0.18, P = 0.001) than non-smokers. Physically active individuals in both groups had fewer ED visits, and lower total expenditures than those who reported low physical activity.


Regular assessments of health-related factors should be incorporated in survivorship care to reduce the burden of cancer. Modification of survivors’ health-related factors (e.g., low physical activity) may help improve their health outcomes and reduce financial burden.

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We acknowledge the support provided by the Department of Preventive Medicine and Community Health, University of Texas Medical Brach, for conducting this research.

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Author contributions

All authors have approved the final version. Contributions include: Kaul (conceptualization, data acquisition, statistical analyses, data interpretation, and writing); Avila (literature review, methodology, and writing); Jupiter, Rodriguez, Kirchhoff, and Kuo (methodology, data interpretation, and writing).

Correspondence to Sapna Kaul.

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Authors have no conflict of interest to report.

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This study used publicly available secondary data to conduct the analyses and does not fall under human subject research as per the University of Texas Medical Branch.

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Kaul, S., Avila, J.C., Jupiter, D. et al. Modifiable health-related factors (smoking, physical activity and body mass index) and health care use and costs among adult cancer survivors. J Cancer Res Clin Oncol 143, 2469–2480 (2017).

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  • Health care burden
  • Smoking
  • Physical activity
  • Body mass index
  • Adult cancer survivors