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Abstract Background Detecting a health-promoting lifestyle in colorectal cancer (CRC) survivors is of paramount importance to manage disease complications, prevent their recurrence, and enhance survival; however, no specialized tool has yet been provided to measure the lifestyle of these patients. Accordingly, this study aimed to develop and determine the psychometric properties of the Health-Promoting Lifestyle Scale in CRC Survivors (HPLS-CRCS). Methods This study was a mixed study with an exploratory sequential design in two phases. Concept analysis was performed in the first phase according to Schwartz-Barcott and Kim’s (2000) hybrid model to explain the concept, identify dimensions, and generate items. In the second phase, psychometrics including validity (face, content, and construct) and reliability (internal consistency and stability) were determined. Responsiveness, interpretability, ease of use, item weighting, and scale scoring were also determined. Results After explaining the concept, an initial scale encompassing 211 items was developed, content and item analyses were conducted, and the items decreased to 89 items after the face validity assessment. For construct validity, confirmatory factor analysis (CFA) was conducted with a sample size of 500 survivors, and convergent validity was performed for the Persian version of the Health-Promoting Lifestyle Profile II (HPLP-II). Accordingly, 80 items were classified into six factors: activity and rest, spiritual growth, health responsibility, nutrition, interpersonal relationships, and psychological management, with RMSEA = 0.055, χ2/df = 2.484, and χ2 = 6816.516. The reliability of the scale was confirmed, Cronbach’s alpha was between 0.865 and 0.928, and the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal important change (MIC), and the smallest detectable change (SDC) were 0.896, 3.36, 13.86, and 19.87, respectively. Conclusion The HPLS-CRCS consists of 80 items in six dimensions and is a valid and reliable scale for evaluating the health-promoting lifestyle in CRC survivors. Using this scale to evaluate the healthy lifestyle in these survivors can lead healthcare providers to detect deficiencies and plan the lifestyle of CRC survivors during the post-treatment period.

Introduction: Health-promoting lifestyle (HPL) among the survivors of colorectal cancer (CRC) is essential to reduce CRC complications, prevent its recurrence, and improve survival. Nonetheless, there is no comprehensive definition for the concept of HPL in CRC survivors. This study aimed to define the concept of HPL among CRC survivors based on the existing literature. Methods: This integrative review was conducted in 2021 using Whittemore and Knafl’s method. The national and international databases of SID, Magiran, ProQuest, Medline, ScienceDirect, Web of Science, and Scopus were searched. Quality appraisal was performed using the Mixed Methods Appraisal Tool (MMAT) and the data were analyzed using the four-step approach proposed by Whittemore and Knafl. Results: After data evaluation, 167 documents were included in final analysis. In total, 1863 codes were generated and categorized into eighteen main categories and the three main themes of antecedents, attributes, and consequences. Accordingly, HPL among CRC survivors was defined as "a set of behaviors in the areas of health responsibility, physical activity, nutrition, spiritual growth, psychological management, and interpersonal relations which are affected by socio-demographic characteristics, clinical characteristics, psychological status, physical conditions, time and place limitations, and patient education, and lead to better disease prognosis, better general health status, better bio-psycho-social status, and better quality of life". Conclusion: The definition of HPL among CRC survivors provided in the present study can be used in counseling, educational, supportive, and care programs for CRC survivors in order to improve their quality of life and survival.

Abstract Background Precise examination of breast cancer survivors’ lifestyles can lead to improved planning and implementation of care and counseling interventions to increase their survival rate and improve their quality of life. Therefore, a valid and reliable instrument needs to be developed. Therefore, the present study aimed to determine the psychometric properties of the Persian version of the Healthy Lifestyle Instrument for Breast Cancer Survivors (HLI-BCS). Methods This methodological study was conducted on 420 Iranian breast cancer survivors between May and November 2022. Participants were selected using convenience sampling. The face, content, construct validity, convergent, and reliability of the Persian version of the HLI-BCS were assessed. Results After assessing face, content, and construct validity, the Persian version of the HLI-BCS with five factors and 20 items was provided. The total Cronbach’s alpha and intra-class correlation coefficient (ICC) were calculated as 0.86 and 0.79, respectively, which were at acceptable levels. A healthy lifestyle in breast cancer survivors was observed to have strong and significant relationships with quality of life in general (p

Objective: Understanding the experiences of survivors and healthcare providers about health-promoting lifestyle (HPL) in colorectal cancer (CRC) survivors is important in planning for coping with the disease, managing treatment side effects, increasing survival, and improving quality of life (QOL). This study was conducted to explore the experiences and perspectives of CRC survivors and healthcare providers about HPL in CRC survivors. Methods: This descriptive qualitative study was performed in 2020 at Omid and Imam Reza Hospitals in Mashhad, Iran. Participants were CRC survivors (n = 12) and healthcare providers (n = 33) who were selected by purposive sampling. Data were collected using in-depth semi-structured interview by face to face and then analyzed by Zhang and Wildemuth content analysis method. MaxQDA software was used to organize the data. Results: Following the treatment of cancer, CRC survivors seek to make changes in lifestyle and they choose a HPL that maintains or improves their health. HPL in CRC survivors includes nutrition, activity and rest, health responsibility, interpersonal relations, spiritual growth, and psychological management. The results showed that HPL can lead to motivation, the ability to self-care and improve daily performance, reduce treatment complications, and increase the QOL. Conclusions: CRC survivors can help change their lifestyle patterns with healthy eating, treatment adherence, regular physical activity, and good sleep habits. Furthermore, effective personal and social relationships, spiritual growth, and management of psychological disorders develop health-promoting behaviors in them. CRC survivors also face challenges and limitations in their life after treatment; identifying the components of a HPL in CRC survivors can lead to desirable care, treatment, education, and counseling services.

Dear Editor, After treatment, Colorectal cancer (CRC) survivors often seek to improve their lifestyle and dietary patterns. One of the common habits adopted for this purpose is the use of dietary supplements (1) attempted by survivors to prevent recurrence of the disease, reduce side effects, improve physical and mental health, strengthen the immune system, cope with stress, and improve life expectancy (2). After the diagnosis of cancer and completion of treatment, at least 50% of survivors tend to use more than two or three supplements. Nonetheless, the beneficial effect of dietary supplements after CRC is a debated issue (1, 2). Supplement use is also controversial due to its unknown association with chemotherapy and radiotherapy. Moreover, clinical guidelines for using dietary supplements are not elucidated. According to the European Society for Clinical Nutrition and Metabolism (ESPEN) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), the use of supplements is recommended only in case of specific deficiencies. American Cancer Society (ACS) recommends that patients avoid the overdose of dietary supplements. National Cancer Institute (NCI) also recommends avoiding vitamin and mineral supplements during and after treatment (3). The literature is void of sufficient and conclusive evidence to support or rule out the association of post-diagnosis dietary supplements with progression and recurrence of cancer, and the published results are contradictory. Calcium and vitamin D supplements have been demonstrated to reduce the risk of recurrent adenomas, cancer-specific mortality, and all-cause mortality. Nevertheless, the use of multivitamins, vitamin C, calcium, vitamin D, and vitamin E supplements is not associated with the prevention of colon adenoma recurrence. Furthermore, the use of B vitamins was reported to cause intestinal adenomas but did not indicate pathological findings of disease progression (4). On the other hand, calcium, vitamin D, and folic acid (B9) are effective in reducing the rate of intestinal polyps and improving the side effects of treatment, while the effects of zinc and selenium consumption are not clear (5). In some studies, however, no protective role was attributed to folic acid supplements. There is even a possibility of adverse effects of folic acid on cancer progression, increased recurrence, and metastases (3, 6). Not until further studies clarify the relationship between dietary supplements and treatment effectiveness, recurrence, and survival improvement in CRC survivors, should health care providers exercise caution in recommending dietary supplements. In addition, CVR survivors should be assessed for supplement use and be aware of the precautions for using supplements. We do not yet have a comprehensive understanding of the effects of the type and dosage of vitamin and mineral supplements and how they are used after cancer diagnosis and during treatment. This requires the design and implementation of targeted and comprehensive studies to understand the diverse and potential effects of dietary supplements. Therefore, both health care providers and survivors should understand the potential risks regarding the use of dietary supplements and be careful about their recommendations and use. Conflicts of Interest The authors declare that they have no conflict of interest.