Healthier Energy Balance Behaviors Most Important for Health-Related Quality of Life in Rural Cancer Survivors in Central Pennsylvania

Purpose: Rural cancer survivors experience poorer health-related quality of life (HRQoL) than urban cancer survivors. Lifestyle behaviors can improve HRQoL; however, the combination of behaviors most important for HRQoL in rural survivors is unclear. This study aimed to identify clusters of lifestyle behaviors in rural cancer survivors, and differences in HRQoL between behavioral clusters. Methods: : Rural cancer survivors in the United States ( N = 219) completed a cross-sectional survey. Lifestyle behaviors were classified into unhealthy/healthy binary categories (i.e., inactive/active, longer/shorter sedentary time, excessive/acceptable fat intake, very low/higher fruit and vegetable intake, some/no alcohol consumption, poor/good sleep quality). Behavioral clusters were identified by latent class analysis. Differences between behavioral clusters and HRQoL were assessed by ordinary-least-squares regression. Results: : The two-class model demonstrated the best fit and interpretability. The ‘mostly unhealthy behaviors’ class (38.5% of sample) had higher probabilities of all unhealthy behaviors, except alcohol consumption. The ‘healthier energy balance’ class (61.5% of sample) had higher probabilities of active, shorter sedentary, higher fruit and vegetable, excessive fat intake, some alcohol consumption, and poor sleep categories, and reported better HRQoL. Conclusion: The combination of healthier energy balance behaviors appears to be particularly relevant for HRQoL in rural cancer survivors. Multiple behavior change interventions to improve HRQoL in rural cancer survivors should focus on supporting energy balance behaviors. Many rural cancer survivors may lead very unhealthy lifestyles, placing them at high risk of adverse outcomes. This sub-population should be prioritized to help alleviate cancer health disparities.