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Greenlee H, Rillamas-Sun E, Yung RL, Cobos S, Donzella SM, Huang Y, Schattenkerk L, Ueland K, VanDoren M, Myers SA, Garcia G, King T, Santiago-Torres M, Di C, Dey N, Guthrie KA, Davidson NE. Cook and Move for Your Life, an eHealth intervention for women with breast cancer. NPJ Breast Cancer 2024; 10:62. [PMID: 39054321 PMCID: PMC11272921 DOI: 10.1038/s41523-024-00662-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/14/2024] [Indexed: 07/27/2024] Open
Abstract
We tested the feasibility and preliminary efficacy of an online diet and physical activity program for women with early-stage breast cancer who had completed surgery, chemotherapy, and radiation therapy (ongoing endocrine therapy allowed). Participants with low fruit and vegetable (F/V) consumption and/or low moderate-to-vigorous physical activity (MVPA) levels were randomized to one of two doses - low (one Zoom group session) or high (12 Zoom group sessions) - of an online lifestyle program with the goal of improving F/V intake and MVPA. All participants received eHealth communications (text messages, study website access), a Fitbit, and a WiFi-enabled scale. Primary objectives evaluated feasibility. Secondary objectives compared the 6-month change in F/V intake and MVPA between the two dose groups. Seventy-four women (mean age = 58.4 years; 87% non-Hispanic White; mean time since diagnosis = 4.6 years) were accrued. Among women in the low dose group, 94% attended the single session; among women in the high dose group, 84% attended at least 8 of the 12 sessions. Retention at 6 months was 93%. High relative to low dose participants consumed 1.5 more servings/day of F/V at 6 months (P = 0.007) but MVPA levels did not differ between groups. We successfully implemented an online lifestyle program for early-stage breast cancer survivors. The high dose intervention demonstrated preliminary efficacy in improving F/V consumption in early-stage breast cancer survivors. Future trials can test the intervention in a larger and more diverse population of breast cancer survivors.
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Affiliation(s)
- Heather Greenlee
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
- University of Washington, Seattle, WA, USA.
| | | | - Rachel L Yung
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Sofia Cobos
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sidney M Donzella
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Yuhan Huang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | | | | | | | | | - Gino Garcia
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | - Chongzhi Di
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | - Nancy E Davidson
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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2
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Dinas PC, Karaventza M, Liakou C, Georgakouli K, Bogdanos D, Metsios GS. Combined Effects of Physical Activity and Diet on Cancer Patients: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1749. [PMID: 38892682 PMCID: PMC11175154 DOI: 10.3390/nu16111749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The purpose of our systematic review was to examine the effects of any physical activity/exercise intervention combined with any diet/nutrition intervention on any biological/biochemical index, quality of life (QoL), and depression in breast, lung, colon and rectum, prostate, stomach, and liver cancer patients and/or cancer survivors. METHODS A systematic review and meta-analysis were undertaken, using PRISMA guidelines and the Cochrane Handbook. The systematic review protocol can be found in the PROSPERO database; registration number: CRD42023481429. RESULTS We found moderate-quality evidence that a combined intervention of physical activity/exercise and nutrition/diet reduced body mass index, body weight, fat mass, insulin, homeostatic model assessment for insulin resistance, C-reactive protein, triglycerides, and depression, while it increased high-density lipoprotein, the physical component of QoL, and general functional assessment of cancer therapy. CONCLUSIONS We conclude that a combined intervention of physical activity/exercise and diet/nutrition may decrease body weight, fat mass, insulin levels, and inflammation, and improve lipidemic profile, the physical component of QoL, and depression in cancer patients and survivors. These outcomes indicate a lower risk for carcinogenesis; however, their applicability depends on the heterogeneity of the population and interventions, as well as the potential medical treatment of cancer patients and survivors.
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Affiliation(s)
- Petros C. Dinas
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
- FAME Laboratory, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42131 Trikala, Greece
| | | | - Marianthi Karaventza
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
| | - Christina Liakou
- School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42131 Trikala, Greece;
| | - Kalliopi Georgakouli
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
| | - Dimitrios Bogdanos
- Department of Internal Medicine, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece;
| | - George S. Metsios
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
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Hu S, Guinan E, Mockler D, O'Neill L. Retention rates and reasons for non-retention in exercise oncology trials in the post-treatment phase-a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01569-4. [PMID: 38570403 DOI: 10.1007/s11764-024-01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Retention is a key marker of trial success. Poor retention can induce bias, reduce statistical power and minimise the validity of trials. This review examined retention rates in exercise trials in cancer survivors, reasons for non-retention and retention strategies utilised. METHODS A systematic review was conducted using a predefined search strategy in EMBASE RCTs, MEDLINE OVID, CINAHL, Web of Science-Core Collection and Cochrane Central Register of Controlled Trials (CENTRAL). The search was conducted on 27/03/2023. Title and abstract screening, full text review and data extraction were completed in duplicate. RESULTS Of 17,524 studies identified, 67 trials involving 6093 participants were included. The median overall retention rate immediately post-intervention was 89.85%, range (52.94-100%) and mean 87.36% (standard deviation 9.89%). Trials involving colorectal cancer survivors only had the highest median retention rate (94.61%), followed by breast (92.74%), prostate (86.00%) and haematological cancers (85.49%). Studies involving mixed cancer cohorts had the lowest retention rate (80.18%). The most common retention strategies were wait-list control groups, regular check-ins/reminders and free exercise equipment. Common reasons for non-retention were lost to follow-up, health problems, personal reasons including family/work commitments and travel burden, and disease progression. CONCLUSIONS Retention rates in exercise oncology trials are approximately 90% immediately post-interventions. Our previous work highlighted variable suboptimal recruitment rates of median 38% (range 0.52-100%). Recruitment rather than retention should be prioritised for methodology research in exercise oncology. IMPLICATIONS FOR CANCER SURVIVORS Optimising the quality of exercise oncology trials is critical to informing high quality survivorship care. PROSPERO registration number: CRD42023421359.
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Affiliation(s)
- S Hu
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, University of Dublin, Dublin 8, Ireland
| | - E Guinan
- Trinity St. James's Cancer Institute, Dublin, Ireland
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - D Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - L O'Neill
- Trinity St. James's Cancer Institute, Dublin, Ireland.
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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Johnston EA, Ayre SK, Au-Yeung YT, Goodwin BC. A Scoping Review of Group Nutrition Education and Cooking Programs for People Affected by Cancer. J Acad Nutr Diet 2024:S2212-2672(24)00090-X. [PMID: 38395356 DOI: 10.1016/j.jand.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Group nutrition education and cooking programs for people affected by cancer have the potential to address commonly reported unmet needs for dietary information, as well as provide opportunities for practical and social support. OBJECTIVE To report the nutrition-related content, delivery methods, and outcomes measured in group nutrition education and cooking programs for people affected by cancer in the published literature, and describe how these programs were developed, implemented, and evaluated. METHODS A scoping review of academic literature is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. Key terms such as cancer, nutrition education, and cooking were searched across 4 databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, and Web of Science) on June 1, 2023, for records published over the past 10 years. Records were independently screened by 2 reviewers. Data extracted included program participants, components, nutrition-related content, delivery methods, outcomes measured, and information about how the program was developed, implemented, and evaluated. RESULTS Of 2,254 records identified, 41 articles met eligibility criteria, reporting on 37 programs. Most programs were designed for adult cancer survivors (89%) and conducted after primary treatment (81%). Four programs invited caregivers to attend. Almost all programs (97%) included a nutrition education component, and more than half (59%) included cooking activities, with a predominant focus on recommendations and practical skills for healthy eating. Most programs were delivered byregistered dietitians and/or nutritionists (54%) and included group discussions (57%) and active involvement in cooking activities (57%) in program delivery. The participant outcomes that were measured covered dietary, psychosocial, clinical, and anthropometric domains. Many programs were developed with cancer survivors, dietitians or nutritionists, and researchers. No studies reported on sustainability of program implementation or overall costs. Programs were evaluated using data from surveys, focus groups, interviews, and field notes, with articles typically reporting on participation rates, reasons for nonparticipation, program acceptability, aspects of the nutrition-related programs valued by participants, and suggestions for improvement. CONCLUSIONS Future research should prioritize assessing the effectiveness of these programs for participants. Future development, implementation, and evaluation of these programs should include family members and friends and assess the sustainability of program delivery, including cost-effectiveness.
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Affiliation(s)
- Elizabeth A Johnston
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
| | - Susannah K Ayre
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Yin To Au-Yeung
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
| | - Belinda C Goodwin
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Kudiarasu C, Lopez P, Galvão DA, Newton RU, Taaffe DR, Mansell L, Fleay B, Saunders C, Fox-Harding C, Singh F. What are the most effective exercise, physical activity and dietary interventions to improve body composition in women diagnosed with or at high-risk of breast cancer? A systematic review and network meta-analysis. Cancer 2023; 129:3697-3712. [PMID: 37788151 DOI: 10.1002/cncr.35043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/28/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Obesity has been recognized as a risk factor in the development and recurrence of breast cancer and is also associated with poor prognostic outcomes. This systematic review and network meta-analysis aimed to identify the most effective exercise, physical activity, and dietary interventions to reduce fat mass, body fat percentage and body weight as well as potentially increase lean mass in women diagnosed with or at high risk of breast cancer. METHODS A systematic search of databases was performed up to May 2022. Eligible randomized controlled trials examined the effects of exercise, physical activity and/or dietary interventions on fat mass and lean mass in women diagnosed with or at high risk of breast cancer. A random-effects network meta-analysis was conducted to determine the effects of different interventions across outcomes when sufficient studies were available. RESULTS Eighty-four studies (n = 6428) were included in this review. Caloric restriction and combined exercise + caloric restriction significantly reduced fat mass (range, -3.9 to -3.7 kg) and body weight (range, -5.3 to -4.7 kg), whereas physical activity + caloric restriction significantly reduced body fat percentage (-2.4%; 95% confidence interval [CI], -3.4% to -13%) and body mass index (-2.2 kg × m-2 ; 95% CI, -3.0 to -1.4 kg × m-2 ) in breast cancer patients. Resistance exercise was the most effective intervention to increase lean mass (0.7 kg; 95% CI, 0.5-1.0 kg) in breast cancer patients. CONCLUSION Multimodal exercise and diet programs were the most effective interventions to reduce fat mass, body fat percentage, and body weight and increase and/or preserve lean mass.
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Affiliation(s)
- Christine Kudiarasu
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Pedro Lopez
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Lorna Mansell
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Brianna Fleay
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Christobel Saunders
- Department of Surgery, University of Melbourne (Royal Melbourne Hospital), Parkville, Victoria, Australia
| | - Caitlin Fox-Harding
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Favil Singh
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Johnson CM, Stubblefield E, Godinich BM, Walker M, Salcedo Price R, Allicock MA. A Scoping Review to Explore the Potential Benefits of Nutrition Interventions for Latino/a Adult Cancer Survivors in the US. Nutrients 2023; 15:4963. [PMID: 38068821 PMCID: PMC10708293 DOI: 10.3390/nu15234963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Despite evidence for the role of healthy diets in preventing cancer, little is known about how nutrition can support positive health outcomes after a cancer diagnosis for Latino/a cancer survivors in the United States (U.S.). The purpose of this scoping review is to understand the potential benefits of nutrition interventions in supporting healthy survivorship among Latino/a cancer survivors in the U.S. A team compiled, evaluated, and summarized the available evidence. Potentially relevant studies were identified from a comprehensive search of peer-reviewed databases and the gray literature. Eligible studies included Latino/a adult cancer survivors with a nutrition education, dietary change, or behavioral intervention; and a nutrition-related health outcome. Data were extracted and summarized using tables. The review included 10 randomized controlled trials, with samples or subsamples of Latino/a cancer survivors. Interventions mostly focused on breast cancer survivors. The results showed some evidence that dietary behaviors, like fruit and vegetable intake, were related to positive outcomes, like a decreased risk of cancer (through changes in DNA methylation), decreased risk breast cancer recurrence (through changes in inflammatory biomarkers), or improved perception of health status. The findings highlight a need for community-engaged and culturally relevant nutrition interventions for Latino/a adults, especially for rural communities; and innovative intervention approaches, including m/ehealth approaches with long-term follow-up.
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Affiliation(s)
- Cassandra M. Johnson
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Emily Stubblefield
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Brandon M. Godinich
- Center for Health Promotion and Prevention Research and Center for Pediatric Population Health, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX 75207, USA; (B.M.G.); (M.A.A.)
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Ave, El Paso, TX 79905, USA
| | - Miranda Walker
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Ramona Salcedo Price
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Marlyn A. Allicock
- Center for Health Promotion and Prevention Research and Center for Pediatric Population Health, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX 75207, USA; (B.M.G.); (M.A.A.)
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7
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Gonzalo-Encabo P, Sami N, Wilson RL, Kang DW, Ficarra S, Dieli-Conwright CM. Exercise as Medicine in Cardio-Oncology: Reducing Health Disparities in Hispanic and Latina Breast Cancer Survivors. Curr Oncol Rep 2023; 25:1237-1245. [PMID: 37715884 PMCID: PMC10640421 DOI: 10.1007/s11912-023-01446-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE OF REVIEW This review aims to access the current state of the evidence in exercise as medicine for cardio-oncology in Hispanic and Latina breast cancer survivors and to provide our preliminary data on the effects of supervised aerobic and resistance training on cardiovascular disease (CVD) risk in this population. RECENT FINDINGS Breast cancer survivors have a higher risk of CVD; particularly Hispanic and Latina breast cancer survivors have a higher burden than their White counterparts. Exercise has been shown to reduce CVD risk in breast cancer survivors; however, evidence in Hispanic and Latina breast cancer survivors is scarce. Our review highlights a clear need for exercise oncology clinical trials in Hispanic and Latina breast cancer survivors targeting CVD risk factors. Moreover, our exploratory results highlight that 16 weeks of aerobic and resistance training may reduce the 10-year risk of developing CVD by 15% in Hispanic and Latina breast cancer survivors.
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Affiliation(s)
- Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Madrid, Spain
| | - Nathalie Sami
- Department of Internal Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Salvatore Ficarra
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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Puklin LS, Harrigan M, Cartmel B, Sanft T, Gottlieb L, Zhou B, Ferrucci LM, Li FY, Spiegelman D, Sharifi M, Irwin ML. Randomized Trial Evaluating a Self-Guided Lifestyle Intervention Delivered via Evidence-Based Materials versus a Waitlist Group on Changes in Body Weight, Diet Quality, Physical Activity, and Quality of Life among Breast Cancer Survivors. Cancers (Basel) 2023; 15:4719. [PMID: 37835412 PMCID: PMC10571774 DOI: 10.3390/cancers15194719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Lifestyle interventions for breast cancer survivors have proved effective at stimulating positive behavior change and promoting healthy weight loss, although integrating these programs into clinical practice is challenging. We evaluated the effect of a 6-month, unsupervised, self-guided, lifestyle intervention using printed materials and online videos vs. waitlist group on body weight for breast cancer survivors. Methods: The Lifestyle, Exercise and Nutrition (LEAN) Self-Guided trial randomized breast cancer survivors with a body mass index ≥25 kg/m2 to a 6-month lifestyle intervention (N = 102) or waitlist group (N = 103). Effects of the intervention on self-reported body weight, physical activity (PA), diet quality (via Health Eating Index-2010 (HEI-2010)), and quality of life were assessed using mixed model repeated measures analysis. Results: At 6 months, the intervention arm had significantly greater weight loss compared with the waitlist group (mean difference = -1.3 kg, 95% confidence interval [CI] = -2.5, -0.13). We observed suggestive improvements in PA (mean difference = 18.7 min/week, 95% CI = -24.2, 61.6), diet quality (mean difference in HEI = 3.2 points, 95% CI = -0.20, 6.5), and fatigue (mean difference in Functional Assessment of Chronic Illness Therapy-Fatigue scale = 1.4 points, 95% CI = -1.1, 3.9). Conclusions: The LEAN Self-Guided intervention led to favorable weight changes over 6 months. Low-resource-intensive programs have the potential to be delivered in diverse healthcare settings and may support breast cancer survivors in achieving a healthy body weight.
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Affiliation(s)
- Leah S. Puklin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Maura Harrigan
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT 06510, USA
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Linda Gottlieb
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Bin Zhou
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Leah M. Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Fang-Yong Li
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Donna Spiegelman
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Mona Sharifi
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Melinda L. Irwin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
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9
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Pichardo MS, Sanft T, Ferrucci LM, Romero-Ramos YM, Cartmel B, Harrigan M, Velazquez AI, Fayanju OM, Winer EP, Irwin ML. Diet and physical activity interventions in Black and Latina women with breast cancer: A scoping review. Front Oncol 2023; 13:1079293. [PMID: 36994212 PMCID: PMC10040823 DOI: 10.3389/fonc.2023.1079293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/30/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundA growing number of lifestyle interventions are being developed to promote weight loss and adoption of a healthful lifestyles among breast cancer survivors; yet Black and Latina women remain underrepresented.PurposeWe performed a scoping review of the available peer-reviewed literature to describe and compare the content, design, methods, and primary outcomes of current diet and/or physical activity (PA) interventions after a breast cancer diagnosis among Black and Latina women.MethodsWe queried PubMed, EMBASE, CINAHL, MEDLINE, and Clinicaltrials.gov up to October 1, 2022, to identify all randomized controlled trials of diet and/or PA after diagnosis of breast cancer with a majority (>50%) of Black or Latina participants.ResultsTwenty-two randomized controlled trials were included in this review (five efficacy, twelve pilot, five on-going). Nine trials were among Latinas (two diet, four PA, and three diet/PA), six among Blacks (one PA and five diet/PA) and seven included both populations (five PA and two diet/PA), all of which examined different endpoints. Two of the five efficacy studies achieved their a priori outcome (one diet trial improved short term dietary intake; one PA trial achieved clinically significant improvements in metabolic syndrome score), both in Latinas. Eight pilot trials intervened on both diet and PA and three of them found favorable behavioral changes. Three (two for Latinas and one for Blacks) out of the nine diet and PA trials and three (all for Latinas) efficacy trials incorporated a culturally focused approach (i.e., traditional foods, music, Spanish content, bicultural health coaches, spirituality). Overall, four trials, including one efficacy trial, had one-year follow-up data, with three finding sustained behavior change. Electronic/mobile components were incorporated in five trials and one involved informal care givers. Most of the trials were geographically limited to the Northeast USA (n=8, NY, NC, DC, NJ) and Texas (n=4).ConclusionsMost of the trials we identified were pilot or feasibility studies and of short duration, demonstrating the need for large randomized controlled efficacy lifestyle interventions among Black and Latina breast cancer survivors. Culturally tailored programing was limited but is an important component to incorporate in future trials in these populations.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Margaret S. Pichardo,
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, United States
- Deparment of Medical Oncology, Yale School of Medicine, New Haven, CT, United States
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| | | | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| | | | - Ana I. Velazquez
- Department of Medicine, Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | | | - Eric P. Winer
- Yale Cancer Center, New Haven, CT, United States
- Deparment of Medical Oncology, Yale School of Medicine, New Haven, CT, United States
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
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10
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Pérez-Bilbao T, Alonso-Dueñas M, Peinado AB, San Juan AF. Effects of Combined Interventions of Exercise and Diet or Exercise and Supplementation on Breast Cancer Patients: A Systematic Review. Nutrients 2023; 15:nu15041013. [PMID: 36839371 PMCID: PMC9964362 DOI: 10.3390/nu15041013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
This systematic review investigated the effects of exercise interventions combined with diet and/or dietary supplement interventions on anthropometry, body composition, metabolic biomarkers, physical function, healthy lifestyles, quality of life, psychosocial variables and fatigue for women with breast cancer. A systematic search was performed in the PubMed and Web of Science databases (from inception to 1 March 2022). A review was carried out following the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. The methodological quality and the risk of bias of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale. A total of 13 randomised controlled trial studies were included, comprising 1569 breast cancer patients. The main finding of this systematic review is that groups performing interventions combining exercise plus diet show significant improvements in cardiorespiratory fitness, muscular strength, body composition, quality of life, fatigue, anxiety, depression and sleep compared to control groups. On the other hand, the use of interventions combining exercise plus supplementation does not result in an improvement compared to groups using exercise alone or supplementation alone.
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Affiliation(s)
- Txomin Pérez-Bilbao
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - María Alonso-Dueñas
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
- GEICAM Spanish Breast Cancer Group, 28703 Madrid, Spain
| | - Ana B. Peinado
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
- LFE Research Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Alejandro F. San Juan
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Correspondence:
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11
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Cho HJ, Song S, Kim Z, Youn HJ, Cho J, Min JW, Kim YS, Choi SW, Lee JE. Associations of body mass index and weight change with circulating levels of high-sensitivity C-reactive protein, proinflammatory cytokines, and adiponectin among breast cancer survivors. Asia Pac J Clin Oncol 2023; 19:113-125. [PMID: 35590398 DOI: 10.1111/ajco.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 01/20/2023]
Abstract
AIM This study examined the associations of body mass index (BMI) and weight change with inflammatory markers among breast cancer survivors in Korea. METHODS A total of 495 women were included who had been diagnosed with primary breast cancer and survived for at least 6 months since the surgery. Information on the body weight and height of the participants was collected both at the study enrollment and diagnosis. The plasma levels of inflammatory markers were measured, including high-sensitivity C-reactive protein, interleukin (IL)-6, IL-8, tumor necrosis factor-α, and adiponectin. A summary z-score was calculated by summing up the z-scores of each biomarker. The least-square means and 95% confidence intervals (CIs) were calculated using a generalized linear model and odds ratios (ORs) and 95% CIs for the elevated levels of inflammatory markers with a multivariate logistic regression model. RESULTS Participants with a BMI ≥27.5 kg/m2 at the study enrollment and at diagnosis were significantly associated with elevated summary z-scores compared to those with a BMI < 23 kg/m2 ; the ORs (95% CIs) were 5.42 (2.15-13.71) for current BMI and 3.66 (1.68-7.98) for BMI at diagnosis, respectively. Additionally, a weight loss > 5% since diagnosis was associated with a lower prevalence of high summary z-scores; the OR (95% CI) was .20 (.08-.52) compared to a stable weight. CONCLUSIONS A high BMI at diagnosis and current BMI with a greater degree were associated with unfavorable levels of inflammatory markers among breast cancer survivors. Additionally, weight loss since diagnosis was inversely associated with these markers.
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Affiliation(s)
- Hyun Jeong Cho
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Sihan Song
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jihyoung Cho
- Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jun Won Min
- Department of Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Yoo Seok Kim
- Department of Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Sang-Woon Choi
- Chaum Life Center, CHA University, Seoul, Republic of Korea.,Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.,Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
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12
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Pichardo MS, Irwin ML, Sanft T, Ferrucci LM, Ginader A, Nguyen TH, Esserman D, Cartmel B, Molina Y. A qualitative study identifying challenges resulting from complex evidence on lifestyle factors and cancer: perspectives from Black and Latina cancer survivors and healthcare providers. Support Care Cancer 2023; 31:111. [PMID: 36633678 PMCID: PMC9912693 DOI: 10.1007/s00520-022-07539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Most breast cancer survivors have challenges with adopting healthy lifestyle behaviors. This may be due to contextual challenges that result from the complex nature of the evidence. To address this gap, we explored the experiences of breast cancer survivors of color and oncology healthcare providers. METHODS Content analysis with inductive and deductive approaches was used for semi-structured interviews with 26 female breast cancer survivors and 10 oncology healthcare providers from Greater New Haven, Connecticut. RESULTS Survivors identified substantial confusion on the evidence regarding lifestyle behaviors and breast cancer, stemming from inadequate healthcare provider counseling and an overreliance on informal sources of information. Providers identified lack of evidence-based knowledge as a barrier to counseling on these topics. There was a mixed perspective regarding the consistency of evidence, stemming from a combination of gaps in the available evidence and accessing evidence-based knowledge from a wide range of professional resources. Some providers perceived the guidelines as consistent; others felt guidelines were constantly changing, impacting how and on what they counseled. Therefore, many healthcare providers in oncology care relied on generic messaging on lifestyle behaviors after a cancer diagnosis. CONCLUSIONS Inconsistent information sources, the rapidly changing evidence, and gaps in the current evidence contribute to generic messaging about lifestyle behaviors and may inhibit a survivor's ability to engage in behavior change. Consistent and uniform healthy lifestyle guidelines for cancer outcomes may address both provider and patient level barriers to knowledge.
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Affiliation(s)
- Margaret S Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, PA, 19104, Philadelphia, USA.
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, USA
- Department of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Abigail Ginader
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Thai Hien Nguyen
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, IL, Chicago, USA
- University of Illinois Cancer Center, Chicago, IL, USA
- Mile Square Health Center, Chicago, IL, USA
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13
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Contento I, Paul R, Marin-Chollom AM, Ogden Gaffney A, Sepulveda J, Dominguez N, Gray H, Haase AM, Hershman DL, Koch P, Greenlee H. Developing a Diet and Physical Activity Intervention for Hispanic/Latina Breast Cancer Survivors. Cancer Control 2022; 29:10732748221133987. [PMID: 36254717 PMCID: PMC9583197 DOI: 10.1177/10732748221133987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives There is limited guidance on how to effectively educate cancer survivors to adopt and maintain specific diet and physical activity recommendations, especially among underserved and under-resourced populations. Here, the objective is to present the development of a behavioral and theoretically-based multi-modal diet and physical activity intervention program for Hispanic/Latina breast cancer survivors, Mi Vida Saludable (My Healthy Life). Methods The development process was based on the 6 steps of the Nutrition Education DESIGN Procedure: (1). Decide behaviors; (2). Explore determinants; (3). Select theory-based model; (4). Indicate objectives; (5). Generate plans; and (6). Nail down evaluation. The theoretical framework for the intervention is Social Cognitive Theory. Results The resulting behavioral intervention consists of 2 components. The first component is in-person group education consisting of 4 lessons over 1 month. Each 4-hour group lesson includes a hands-on cooking component, a physical activity component, and facilitator-led nutrition education and discussion, with 2 field trips to a local grocery store and farmers’ market. The second component is an e-Health program that includes weekly text messages, biweekly emailed newsletters, and ongoing website access. Conclusion The systematic DESIGN Procedure provided practical guidance for developing a behaviorally-focused, theory-based, and culturally sensitive program that addresses both dietary and physical activity behaviors for delivery both in-person education and through eHealth. The Procedure may be useful for developing other behaviorally focused and theory-based interventions.
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Affiliation(s)
- Isobel Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Rachel Paul
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Amanda M. Marin-Chollom
- Department of Psychological Sciences, Central Connecticut State University, New Britain, CT, USA
| | | | | | | | - Heewon Gray
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anne M. Haase
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Pamela Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Heather Greenlee
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,Heather Greenlee, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M4-B402, Seattle, WA 98109-1024, USA.
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14
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Baguley BJ, Dalla Via J, Fraser SF, Daly RM, Kiss N. Effectiveness of combined nutrition and exercise interventions on body weight, lean mass, and fat mass in adults diagnosed with cancer: a systematic review and meta-analysis. Nutr Rev 2022; 81:625-646. [PMID: 36206176 DOI: 10.1093/nutrit/nuac079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Changes in body weight and composition (fat and lean mass) are prominent side effects of cancer treatment. Nutrition and exercise interventions are both key strategies to protect against these adverse effects, yet their impact when combined has not been comprehensively reviewed in adults with cancer. OBJECTIVE This systematic review and meta-analysis aims to assess the effects of combined nutrition and exercise interventions on body weight and composition in adults with cancer. DATA SOURCES Four databases were searched until January 2021. Combined nutrition and exercise randomized controlled trials that detailed the nutrition and exercise prescription and reported body weight and composition outcomes were eligible. DATA EXTRACTION Risk of bias was assessed through the Cochrane Collaboration tool. The number of participants, mean values, and standard deviations of the outcome variables were extracted. Mean differences (MDs) were pooled using random-effects models. Predetermined subgroup analyses included cancer type, intervention intent, exercise modality, and use of behavior change strategies. DATA ANALYSIS Twenty-three RCTs were included. Nutrition plus exercise interventions significantly reduced body weight (MD - 2.13 kg; 95%CI, - 3.07 to - 1.19), fat mass (MD - 2.06 kg; 95%CI, - 3.02 to - 1.09), and lean mass (MD - 0.43; 95%CI, - 0.82 to - 0.04). Subgroup analyses in women with breast cancer showed that weight loss interventions and interventions incorporating behavior change strategies significantly reduced body weight and fat mass but also reduced lean mass. Interventions aiming to maintain body weight showed no changes in body weight, as intended. CONCLUSION Combined nutrition and exercise interventions successfully reduce body weight and fat mass in adults with cancer but also reduce lean mass. In contrast, weight loss-focused interventions are associated mostly with reduced lean mass. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020161805.
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Affiliation(s)
- Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Jack Dalla Via
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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15
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Santiago-Torres M, Contento I, Koch P, Tsai WY, Gaffney AO, Marín-Chollom AM, Shi Z, Ulanday KT, Shen H, Hershman D, Greenlee H. Associations Between Acculturation and Weight, Diet Quality, and Physical Activity Among Latina Breast Cancer Survivors: The ¡Mi Vida Saludable! Study. J Acad Nutr Diet 2022; 122:1703-1716. [PMID: 35398558 PMCID: PMC10030055 DOI: 10.1016/j.jand.2022.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Among Latinos, greater acculturation to the United States (US) is associated with risk of obesity and obesity-related comorbidities. Less is known about the associations between acculturation and obesity-related modifiable risk factors, such as diet quality and physical activity (PA) among Latina breast cancer survivors. OBJECTIVE The aim of this study was to explore associations between acculturation and weight status, diet quality, and PA among Latina breast cancer survivors. DESIGN This is a cross-sectional secondary analysis of baseline data on demographic and clinical characteristics, acculturation, anthropometric measures, diet quality, and PA collected from Latina breast cancer survivors enrolled in the ¡Mi Vida Saludable! (My Healthy Life) behavioral diet and PA intervention trial. PARTICIPANTS/SETTING Participants were Latina women (n = 167) residing in New York City, with a medical history of stage 0 to III breast cancer, no evidence of recurrent or metastatic disease, and at least 90 days post cancer treatment who participated in the ¡Mi Vida Saludable! randomized controlled trial between July 2016 and October 2018. MAIN OUTCOME MEASURES Acculturation status was measured by the Short Acculturation Scale for Hispanics score, language preference, place of birth, and duration of US residence. Weight, height, and waist and hip circumferences were measured at an in-person clinic visit. Diet information was collected via 3 telephone-based 24-hour dietary recalls and PA information was collected via staff administered 7-day recalls. STATISTICAL ANALYSES PERFORMED Linear regression models examined associations between acculturation and weight status, diet quality, and PA. RESULTS Based on the Short Acculturation Scale for Hispanics acculturation score, more acculturated compared with less acculturated Latinas were younger in age, more educated, and had higher annual household incomes (all, P < .05). Compared with Spanish-speaking Latinas, English-speaking Latinas had larger waist circumference (103 vs 96.1 cm; P = .01) and poorer-quality diets (Healthy Eating Index 2015 scores, 57.3 vs 71.5; P < .001). Greater levels of acculturation were also associated with higher levels of leisure walking at a moderate-to-vigorous intensity (265.8 vs 179.0 min/wk; P =.04). CONCLUSIONS Greater levels of acculturation were associated with higher central obesity and poorer-quality diets. Future lifestyle modification trials tailored to the unique role of acculturation on adopting behavior change recommendations is a promising next step in this line of research.
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Affiliation(s)
- Margarita Santiago-Torres
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Isobel Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Pamela Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Amanda M Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, New Britain, Connecticut
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Kathleene T Ulanday
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Hanjie Shen
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Dawn Hershman
- College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Heather Greenlee
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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16
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Kiplagat K, Antoine F, Ramos R, Nahid M, Forte V, Taiwo E, Godfrey K, Butryn M, Phillips E. An Acceptance Based Lifestyle Intervention in Black Breast Cancer Survivors with Obesity. J Immigr Minor Health 2022; 24:645-655. [PMID: 34355298 PMCID: PMC11290457 DOI: 10.1007/s10903-021-01261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/01/2022]
Abstract
To assess the feasibility and early efficacy of a combined lifestyle and acceptance-based therapy (ABT) intervention on weight loss at 16 weeks among Black breast cancer (BC) survivors with obesity. Thirty black breast cancer survivors with a BMI ≥ 30 kg/m2 at least 6 months post-treatment were enrolled. Outcomes included feasibility process measures, physical well-being assessed using the subscale of QOL-Breast Cancer (QOL-BC), physical activity assessed by Global Physical Activity Questionnaire (GPAQ), and weight. Fisher's Exact/Chi-Squared tests and Wilcoxon rank-sum tests were used to explore differences between responders and non-responders, as well as within-group changes during the intervention. Within the first 4 weeks, responders (participants who lost any weight) lost a median of 2.6 lbs. compared to non-responders (no weight loss) who gained a median of 2.6 lbs. At 16 weeks, participants reported greater physical well-being (p < 0.0001), increased time in recreational activities (p = 0.03), and a median weight loss of 5.6 pounds in responders vs. 0.7 pounds in non-responders (p ≤ 0.001). Non-responders were more likely to have developed a new health condition compared to responders (44% vs. 0%; p = 0.014). In this study, weight loss at 4 weeks and new-onset health conditions were significant factors associated with non-response to the combined intervention. Black BC with obesity are at high risk for recurrent cancer and secondary health conditions. ABT may be a suitable adjunct therapeutic option to lifestyle interventions implemented soon after a cancer diagnosis to improve physical well-being, increase physical activity, and promote weight loss.
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Affiliation(s)
- Kimberly Kiplagat
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Francesse Antoine
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA
| | - Rosio Ramos
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA
| | - Musarrat Nahid
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA
| | - Victoria Forte
- Division of Hematology-Oncology, King's County Hospital Center, New York, USA
| | - Evelyn Taiwo
- Division of Hematology-Oncology, Department of Medicine Weill Cornell, New York, USA
| | - Kathryn Godfrey
- Department of Psychology, Drexel University, Philadelphia, USA
| | - Meghan Butryn
- Department of Psychology, Drexel University, Philadelphia, USA
| | - Erica Phillips
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA.
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, USA.
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17
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Kwarteng JL, Matthews L, Banerjee A, Sharp LK, Gerber BS, Stolley MR. The association of stressful life events on weight loss efforts among African American breast cancer survivors. J Cancer Surviv 2022; 16:604-613. [PMID: 33977342 PMCID: PMC11322957 DOI: 10.1007/s11764-021-01054-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examined whether stressful life events were associated with weight loss, central adiposity, and health behavior changes of African American breast cancer survivors (AABCS) participating in a weight loss intervention. METHODS We conducted a secondary-data analyses of Moving Forward, a weight loss efficacy trial for AABCS conducted in 2011-2014. Two-hundred forty-six eligible women were randomized to a 6-month interventionist-guided (IG) or self-guided (SG) weight loss intervention. Data was collected on height, weight, self-reported diet, and self-reported physical activity. Stress (e.g., financial, legal, employment, relationships, safety, prejudice) was measured using an abbreviated version of the Crisis in Family Systems (CRISYS) urban life stress measure. Generalized linear models stratified by group examined the degree to which stress was associated with weight loss or changes in central adiposity, physical activity, and diet during the intervention (Months 1-6) or maintenance (Months 7 to 12) phases. RESULTS Participants reported a median of 3.0 life stressors (range 0 to 22) mostly relating to relationships, safety concerns, and financial problems. In the IG group during the intervention phase, exposure to life stressors was not associated with weight loss (p = 0.15) or change in central adiposity (p = 0.69), physical activity (p = 0.15), or diet (p = 0.26). We found similar associations for the maintenance phase and in the SG group. CONCLUSION/IMPLICATIONS Despite facing stress across a myriad of domains (e.g., relationships, safety, finances), AABCS were successful at initiating and maintaining behaviors to achieve weight loss, reductions in central adiposity, and behavioral changes. Future randomized controlled trials are warranted that include more strategies to address the challenges that AABCS face, to determine whether AABCS in particular might benefit from interventions that address barriers (e.g., stress management) to weight loss. Such strategies are critical for improving quality of life and lowering the risk of cancer recurrence.
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Affiliation(s)
- Jamila L Kwarteng
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - L Matthews
- Cancer Center and Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A Banerjee
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - L K Sharp
- Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - B S Gerber
- Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - M R Stolley
- Cancer Center and Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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18
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Raji Lahiji M, Vafa S, de Souza RJ, Zarrati M, Sajadian A, Razmpoosh E, Jaberzadeh S. Effect of Dietary-Based Lifestyle Modification Approaches on Anthropometric Indices and Dietary Intake Parameters in Women with Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2022; 13:1974-1988. [PMID: 35641019 PMCID: PMC9526840 DOI: 10.1093/advances/nmac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/26/2022] [Accepted: 05/26/2022] [Indexed: 01/28/2023] Open
Abstract
This systematic review and meta-analysis aimed to investigate the effect of dietary-based lifestyle modification interventions ("diet," or "diet + exercise," or "diet + exercise + behavioral" intervention) on the measures of anthropometric and dietary intake parameters in women with breas cancer (BC). Databases were searched until June 2021. Inclusion criteria were randomized controlled trials that enrolled only women with BC. Studies that used exercise or behavioral interventions alone were not included. Mean ± SD changes were extracted for each outcome, and pooled using a random-effects model; 7315 studies were identified. Fifty-one studies (n = 7743) were included. The median ± SD duration of treatment was 24 ± 16.65 wk. Dietary-based interventions significantly reduced body weight [45 studies (n = 7239), weighted mean difference (WMD) (95% CI): -2.6 (-3.2, -2.1) kg], BMI [31 studies (n = 5384); WMD (95% CI): -1.0 (-1.3, -0.7) kg/m2], lean body mass [15 studies (n = 1194); WMD (95% CI): -0.6(-0.7, -0.4) kg], fat mass [11 studies (n = 913); WMD (95% CI): -2.6 (-3.3, -1.8) kg], fat percentage [17 studies (n = 897); WMD (95% CI): -1.5 (-1.9, -1.3)%], hip circumference [9 studies (n = 489); WMD (95% CI): -2.43 (-3.34, -1.54) cm], and waist circumference [7 studies (n = 309); WMD (95% CI): 0.02 (-0.03, -0.005) cm]. Significant reductions in energy intakes [20 studies (n = 4608), WMD (95% CI): -162 (-220, 104) kcal/d] and fat intakes [7 studies (n = 4316), WMD (95% CI): -7.5 (-7.8, -7.2)% of energy/d], and an increase in fiber intakes [11 studies (n = 4241), WMD (95% CI): 2.4 (0.7, 4.1) g/d] were observed. No significant changes were seen in protein, carbohydrate, and fruit and vegetable intakes. Subgroup analyses showed that changes in anthropometric and dietary intake indices were significant in studies that enrolled patients with both obesity and normal weight, studies that used diet therapy in combination with exercise and behavioral therapy, and studies that started the intervention during the treatment period. Overall, a multimodal dietary-based lifestyle intervention had significant effects on anthropometric and dietary intake parameters in women with BC, specifically when started as early as the diagnosis. This meta-analysis was registered at PROSPERO as CRD42021291488.
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Affiliation(s)
- Mahsa Raji Lahiji
- Deparment of Integrative Oncology and Quality of Life, Breast Cancer Research Center, Motamed Cancer Institute, Academic Centre for Education, Culture, and Research, Tehran, Iran,Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Population Health Research Institute, Hamilton, ON, Canada
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Sajadian
- Deparment of Integrative Oncology and Quality of Life, Breast Cancer Research Center, Motamed Cancer Institute, Academic Centre for Education, Culture, and Research, Tehran, Iran
| | | | - Shapour Jaberzadeh
- Non-invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
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19
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Halpern B, Mendes TB. Obesity, weight loss and gynecologic neoplasms: a narrative review. Women Health 2022; 62:372-383. [DOI: 10.1080/03630242.2022.2066747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bruno Halpern
- Weight Control Group, Hospital 9 de Julho, São Paulo, SP, Brazil
| | - Thiago Bosco Mendes
- Department of Internal Medicine, Hospital das Clínicas, São Paulo State University (UNESP), Botucatu, Brazil
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20
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Male D, Fergus K, Yufe S. 'Weighing' Losses and Gains: Evaluation of the Healthy Lifestyle Modification After Breast Cancer Pilot Program. Front Psychol 2022; 13:814671. [PMID: 35401377 PMCID: PMC8992775 DOI: 10.3389/fpsyg.2022.814671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This pilot study sought to develop and evaluate a novel online group-based intervention (Healthy Lifestyle Modification after Breast Cancer; HLM-ABC) to help breast cancer survivors (BCSs) make healthy lifestyle changes intended to yield not only beneficial physical outcomes (i.e., weight loss, reduced body mass index) but also greater behavioral (e.g., increased physical activity, healthier eating), and psychosocial well-being (e.g., self-efficacy, motivation, body image). Methods An exploratory single-arm, mixed-method triangulation design was employed to evaluate the feasibility and preliminary effectiveness of the HLM-ABC intervention for overweight BCSs. Fourteen women participated in the 10-week intervention and completed quantitative measures of the above-mentioned outcomes at baseline, post-treatment, 6-month, and 12-month follow-up time points. Qualitative data were obtained post-treatment via semi-structured interviews and a treatment satisfaction questionnaire. Results Participants lost an average of 2.83% of their baseline weight (M = 196.65; SD = 38.59) by 1-year follow-up (M = 191.29; SD = 33.91), equal to a small effect size (d = -0.37). Despite achieving only modest weight loss, participants achieved meaningful gains in the form of increased physical activity (d = 0.2), discovery of gratifying movement, more intuitive eating habits (d = 1.12), greater bodily and emotional awareness, and positive shifts in beliefs about being able to make healthy choices regarding food (d = 0.63) and physical activity (d = 0.38). Furthermore, they demonstrated a slight improvement in body image (d = 0.36) and described feeling more self-compassionate, empowered, and acknowledging of variables beyond control (i.e., hormonal therapy, unsatisfactory surgery) that can present barriers to change. Conclusion After completing a 10-week online program, participants achieved meaningful and lasting changes on a number of healthful indicators, even when this did not correspond with a significant reduction in weight. Findings highlight the complex, multifaceted nature of "health" and lend support for promotion of healthier lifestyle following cancer treatment that encompasses not only physical weight, but also behavior, psychosocial well-being, and (often unmodifiable) circumstances such as life-preserving hormonal treatments.
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Affiliation(s)
- Dana Male
- Tom Baker Cancer Centre (TBCC), Department of Psychosocial Oncology, Alberta Health Services, Calgary, AB, Canada
- Psychosocial Oncology Laboratory, Department of Psychology, York University, Toronto, ON, Canada
| | - Karen Fergus
- Psychosocial Oncology Laboratory, Department of Psychology, York University, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shira Yufe
- Psychosocial Oncology Laboratory, Department of Psychology, York University, Toronto, ON, Canada
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21
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Latin dance and Qigong/Tai Chi effects on physical activity and body composition in breast cancer survivors: A pilot study. Complement Ther Clin Pract 2022; 47:101554. [DOI: 10.1016/j.ctcp.2022.101554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 12/26/2022]
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22
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Wang S, Yang T, Qiang W, Zhao Z, Shen A, Zhang F. Benefits of weight loss programs for breast cancer survivors: a systematic reviews and meta-analysis of randomized controlled trials. Support Care Cancer 2022; 30:3745-3760. [PMID: 35022884 DOI: 10.1007/s00520-021-06739-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/03/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity and weight gain have been associated with poor disease-specific and health-related outcomes in breast cancer survivors (BCS). But the benefits of weight loss in managing BCS have not been elucidated. OBJECTIVE To evaluate the beneficial effects of weight loss programs in randomized controlled trials on BCS. METHODS We searched English databases PubMed, the Cochrane Library, EMBASE, Scopus, Web of Science, CINAHL, and Chinese databases China National Knowledge Infrastructure (CNKI), Weipu Information Chinese Periodical Service Platform (VIP), China Biomedical Literature Service System (SinoMed), and Wanfang from the inception to January 2021 and collected randomized controlled trials (RCTs) of weight loss programs for BCS. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. The data synthesis was performed on RevMan (version 5.3), and the publication bias was calculated with STATA (version 15.1). RESULTS Ten RCTs were included in the meta-analysis. The current study showed that diet and exercise interventions resulted in significant improvements in body weight (MD = - 4.43 kg, 95%CI: - 6.23 to - 2.63, P < 0.00001), waist circumference (MD = - 2.81 cm, 95%CI: - 4.37 to - 1.26, P = 0.004), hip circumference (MD = - 3.01 cm, 95%CI: - 4.24 to - 1.77, P < 0.0001), body mass index (MD = - 1.69 kg/m2, 95%CI: - 2.16 to - 1.21, P < 0.00001), systolic blood pressure (MD = - 12.12 mmHg, 95%CI: - 18.97 to - 5.27), p = 0.0005), C-reactive protein (MD = - 1.83 mg/L, 95% CI: - 2.74 to - 0.91, p < 0.0001), body fat (MD = - 1.19 kg, 95%CI: - 1.75 to - 0.63, P < 0.001), fat mass (MD = - 2.29 kg, 95%CI: - 3.12 to - 1.46, P < 0.0001), and lean body mass (MD = - 2.15 kg, 95%CI: - 3.66 to - 0.65, P = 0.005). Alternatively, compared with the effects of control interventions, weight loss programs did not affect fat-free mass, total cholesterol, low-density leptin cholesterol, glucose, insulin, and leptin (P > 0.05). CONCLUSIONS This review summarizes the benefits of weight loss programs for BCS. The results indicated that weight loss programs could significantly improve specific anthropometric outcomes but not affect biochemical indicators. Researchers should tailor weight loss interventions to the body fat status of BCS. Evidence to support the translation of effective weight loss intervention programs into wider-scale implementation is needed to be part of routine survivorship care.
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Affiliation(s)
- Shurui Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ting Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wanmin Qiang
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
| | - Zihan Zhao
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Aomei Shen
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Fangyuan Zhang
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
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23
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Hailey V, Rojas-Garcia A, Kassianos AP. A systematic review of behaviour change techniques used in interventions to increase physical activity among breast cancer survivors. Breast Cancer 2022; 29:193-208. [PMID: 34989962 PMCID: PMC8885559 DOI: 10.1007/s12282-021-01323-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 12/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite evidence that physical activity (PA) can help reduce recurrence and mortality, many breast cancer survivors are less active than recommended levels. The aim of this systematic review is to advance our understanding of which behaviour change techniques (BCTs) have been used in interventions promoting breast cancer survivors' PA and to evaluate their potential to increase PA. METHODS A systematic search was conducted in five databases (Medline; PsycInfo; Embase; CINAHL and Scopus) for studies published between 2005 and 2019. Following a rigorous screening process, 27 studies were retained. These were reviewed and analysed for quality, coded for BCTs (k = 0.65) and interventions categorised according to their potential to increase PA using an established methodology. RESULTS The majority of studies were moderate quality (64%). Demonstration on how to perform the behaviour was the most commonly used BCT (n = 23). Adding objects to the environment, (pedometer or accelerometer) was the BCT with the highest potential to increase PA. This was followed by, goal setting and self-monitoring of behaviour. A theory-based approach to evaluation was used in only 59% (n = 16) of the studies. CONCLUSIONS The results of this review inform which BCTs have the potential to increase PA for breast cancer survivors and inform intervention development. Future research, is encouraged to properly report intervention procedures around dose and frequency of intervention components to allow for review and replication.
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Affiliation(s)
- Verity Hailey
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Antonio Rojas-Garcia
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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24
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Boyages J, Cave AE, Naidoo D, Ee CCL. Weight Gain and Lymphedema After Breast Cancer Treatment: Avoiding the Catch-22? Lymphat Res Biol 2021; 20:409-416. [PMID: 34748426 DOI: 10.1089/lrb.2020.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Overweight and obesity are strongly implicated in breast cancer (BC) development and are also a risk factor for BC-related lymphedema (BCRL). Materials and Methods: An online cross-sectional survey was conducted between November 2017 and January 2018. Analyses were restricted to women with localized BC, who provided information about BCRL (n = 238). Most women were not experiencing BCRL (55.46%). Results: Mean self-reported weight at diagnosis was 68.55 kg for women without BCRL and 74.43 kg for women with BCRL (p = 0.0021). In this study, 50.9% with BCRL were overweight/obese at diagnosis (body mass index [BMI] ≥25) compared with 36.4% of women without BCRL (p = 0.003). For women without BCRL, 12.12% were classified as obese (BMI ≥30) versus 20.75% with BCRL. Women with BCRL were more likely to have gained >5% of body weight (p = 0.03), be currently overweight or obese (p = 0.004), and less active (48.11%) than they were at diagnosis than women without BCRL (33.33%) (p = 0.042). Having a structured exercise program, following a prescribed diet, and being accountable to someone else were identified as the main facilitators to successful weight loss and weight maintenance. Conclusions: Clinicians should consider obesity when personalizing axillary treatment and encourage lifestyle interventions and lymphedema screening after BC treatment.
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Affiliation(s)
- John Boyages
- ICON Cancer Centre, Sydney Adventist Hospital, Wahroonga, Australia.,Australian Lymphoedema Education Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Adele E Cave
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Dhevaksha Naidoo
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Carolyn C L Ee
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
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25
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Santiago-Torres M, Contento I, Koch P, Tsai WY, Brickman AM, Gaffney AO, Thomson CA, Crane TE, Dominguez N, Sepulveda J, Marín-Chollom AM, Paul R, Shi Z, Ulanday KT, Hale C, Hershman D, Greenlee H. ¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods. Contemp Clin Trials 2021; 110:106524. [PMID: 34365016 PMCID: PMC8595705 DOI: 10.1016/j.cct.2021.106524] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors. METHODS Latinas with a history of stage 0-III breast cancer, no evidence of recurrent/metastatic disease, and > 90 days post-treatment were primarily identified via cancer registries and physician referral. Participants were randomized to four arms: 1) 4 weeks of in-person group sessions plus 11 months of eHealth communication, 2) in-person group sessions alone, 3) eHealth alone, or 4) control. All participants received a Fitbit to self-monitor PA. Assessments at baseline, 6 and 12 months include diet, PA, anthropometrics, predictors and mediators of behavior change, psychosocial and quality of life outcomes, and blood draw. RESULTS Of 884 women screened between January 2016 and September 2018, 27% were eligible. Primary reasons for ineligibility included not being willing/able to participate due to work/life responsibilities, health reasons, or transportation. Of 241 eligible women, 167 completed baseline assessment and enrolled. CONCLUSIONS We successfully enrolled a diverse group of breast cancer survivors representing more than 15 Latin American nationalities to a diet and physical activity trial. If effective, the ¡Mi Vida Saludable! program can be implemented by community groups and medical centers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02780271, registered May 2016.
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Affiliation(s)
- Margarita Santiago-Torres
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Isobel Contento
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Pamela Koch
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Cynthia A Thomson
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Tracy E Crane
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | | | | | - Amanda M Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, Connecticut, CT, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel Paul
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA; Rachel Paul Nutrition LLC, New York, NY, USA
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Kathleene T Ulanday
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Christiane Hale
- Columbia University Irving Medical Center, New York, NY, USA
| | - Dawn Hershman
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Heather Greenlee
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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26
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Effect of the Lifestyle, Exercise, and Nutrition (LEAN) Study on Long-Term Weight Loss Maintenance in Women with Breast Cancer. Nutrients 2021; 13:nu13093265. [PMID: 34579142 PMCID: PMC8469752 DOI: 10.3390/nu13093265] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Lifestyle interventions among breast cancer survivors with obesity have demonstrated successful short-term weight loss, but data on long-term weight maintenance are limited. We evaluated long-term weight loss maintenance in 100 breast cancer survivors with overweight/obesity in the efficacious six-month Lifestyle, Exercise, and Nutrition (LEAN) Study (intervention = 67; usual care = 33). Measured baseline and six-month weights were available for 92 women. Long-term weight data were obtained from electronic health records. We assessed weight trajectories between study completion (2012-2013) and July 2019 using growth curve analyses. Over up to eight years (mean = 5.9, SD = 1.9) of post-intervention follow-up, both the intervention (n = 60) and usual care (n = 32) groups declined in body weight. Controlling for body weight at study completion, the yearly weight loss rate in the intervention and usual care groups was -0.20 kg (-0.2%/year) (95% CI: 0.06, 0.33, p = 0.004) and -0.32 kg (-0.4%/year) (95% CI: 0.12, 0.53, p = 0.002), respectively; mean weight change did not differ between groups (p = 0.31). It was encouraging that both groups maintained their original intervention period weight loss (6% intervention, 2% usual care) and had modest weight loss during long-term follow-up. Breast cancer survivors in the LEAN Study, regardless of randomization, avoided long-term weight gain following study completion.
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27
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Anderson EA, Armer JM. Factors Impacting Management of Breast Cancer-Related Lymphedema (BCRL) in Hispanic/Latina Breast Cancer Survivors: A Literature Review. HISPANIC HEALTH CARE INTERNATIONAL 2021; 19:190-202. [PMID: 33550878 PMCID: PMC8353654 DOI: 10.1177/1540415321990621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breast cancer-related lymphedema (BCRL) is a treatment sequela with negative physical and psychological implications. BCRL is a lifetime concern for survivors and is currently incurable. With the increase in the Latino population in the United States, it is critical for the cancer care community to address factors that increase BCRL risk and negatively impact long-term quality of life. This literature review undertook to identify successful intervention strategies for BCRL among Latina survivors. METHODS Multiple databases were searched for published articles from 2006 to 2020. PRISMA guidelines were utilized. Data were extracted related to physical activity, diet, and psychosocial stress concerns of Latinas at risk for or living with BCRL. RESULTS Eleven interventions combined education and skill-building techniques to address physical activity, diet, and stress management for BCRL. Family involvement, peer-mentoring, culturally tailored education, and self-care skill development were identified as important for Latina survivors. CONCLUSION Latina survivors may benefit from culturally tailored BCRL education programs and self-management interventions. Health care professionals and researchers should consider cultural influences when developing clinical intervention strategies to enhance outcomes for Latinas at risk for living with BCRL. In addition, including family members and/or peers in such strategies may be helpful to Latina survivors.
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Affiliation(s)
| | - Jane M. Armer
- S312 Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Neil-Sztramko SE, Smith-Turchyn J, Fong A, Kauffeldt K, Tomasone JR. Community-based exercise programs for cancer survivors: A scoping review of program characteristics using the Consolidated Framework for Implementation Research. Arch Phys Med Rehabil 2021; 103:542-558.e10. [PMID: 34375631 DOI: 10.1016/j.apmr.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/10/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the characteristics of exercise programs for cancer survivors conducted outside of a research laboratory (i.e., home-based, or community-based settings). DATA SOURCES A systematic search of published literature was conducted using Medline, Pubmed, CINAHL, PsychINFO, SPORTdiscus, and Embase from 1980 to January 2021. Where conference abstracts were identified, authors were contacted for other articles. STUDY SELECTION Two independent reviewers screened titles and abstracts, and full texts of potentially relevant studies with discrepancies resolved by discussion. Included studies were reports of exercise programs or interventions in which participants exercise at home, or in a community-based setting, and including individuals diagnosed with cancer either undergoing treatment or who had completed treatment. DATA EXTRACTION Data were extracted using the Oxford Implementation Index and coded under the five domains of the Consolidated Framework for Implementation Research (CFIR). Extraction and coding were completed by two independent reviewers, with discrepancies resolved through discussion. Data were synthesized narratively according to CFIR. DATA SYNTHESIS A total of 58 publications describing 34 individual programs from around the world were included. Of these, only 14 publications had the specific goal of reporting on program implementation and development. A variety of intervention characteristics and characteristics of individuals involved in the intervention were described. Reporting of factors related to the CFIR domains of inner setting, outer setting and implementation process were minimal. CONCLUSIONS This review summarizes the characteristics of existing programs that have been reported in the literature and finds that partnerships and collaboration in the inner and outer setting, and as part of the process of implementation. This review highlights key knowledge gaps to be answered in order to support the development of future community-based interventions.
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Affiliation(s)
| | | | - Angela Fong
- School of Kinesiology and Health Studies, Queens University
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29
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Bandera EV, Alfano CM, Qin B, Kang DW, Friel CP, Dieli-Conwright CM. Harnessing Nutrition and Physical Activity for Breast Cancer Prevention and Control to Reduce Racial/Ethnic Cancer Health Disparities. Am Soc Clin Oncol Educ Book 2021; 41:1-17. [PMID: 33989021 DOI: 10.1200/edbk_321315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are well-known racial/ethnic disparities in the prevalence of obesity and physical inactivity, as well as breast cancer risk and survival. However, most of the current scientific evidence that serves as a foundation for nutrition and physical activity guidelines is based on studies conducted in predominantly non-Hispanic White populations. Similarly, exercise, diet, or lifestyle intervention trials for breast cancer prevention and survivorship are scarce in racial/ethnic minority populations. We review the current evidence for racial/ethnic disparities in obesity and breast cancer risk and survival (we are focusing on obesity, because this is considered an ASCO priority, and studies conducted in the United States), discuss the evolution of nutrition/physical activity guidelines for cancer prevention and control, and provide an overview of lifestyle interventions, including barriers and facilitators in implementation and dissemination science among minority populations underrepresented in research. There is a critical need to include racially/ethnically diverse populations in cancer prevention and control research or to specifically target minority populations in which disparities are known to exist to achieve much needed health equity.
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Affiliation(s)
- Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Catherine M Alfano
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY.,Northwell Health Cancer Institute, New York, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Dong-Woo Kang
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ciarán P Friel
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY
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LeVasseur N, Cheng W, Mazzarello S, Clemons M, Vandermeer L, Jones L, Joy AA, Barbeau P, Wolfe D, Ahmadzai N, Hersi M, Stober C, Shorr R, Hilton J, Hutton B. Optimising weight-loss interventions in cancer patients-A systematic review and network meta-analysis. PLoS One 2021; 16:e0245794. [PMID: 33539414 PMCID: PMC7861370 DOI: 10.1371/journal.pone.0245794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Excess weight has been associated with increased morbidity and a worse prognosis in adult patients with early-stage cancer. The optimal lifestyle interventions to optimize anthropometric measures amongst cancer patients and survivors remain inconsistent. Objective To conduct a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the effects of exercise and dietary interventions alone or in combination on anthropometric measures of adult cancer patients and survivors. Methods A systematic search of Medline, Embase and the Cochrane Trials Registry was performed. Outcomes of interest included changes in weight, body mass index (BMI), and waist circumference. Screening and data collection were performed by two reviewers. Bayesian NMAs were performed. Results Overall, 98 RCTs were included; 75 were incorporated in NMAs (n = 12,199). Groups of intervention strategies included: 3 exercise interventions, 8 dietary interventions, 7 combination interventions of diet and exercise and standard care. Median intervention duration was 26 weeks. NMA suggested that diet alone (mean difference [MD] -2.25kg, 95% CrI -3.43 to -0.91kg) and combination strategies (MD -2.52kg, 95% CrI -3.54 to -1.62kg) were associated with more weight loss compared to standard care. All dietary interventions achieved a similar magnitude of weight loss (MD range from -2.03kg to -2.52kg). Both diet alone and combination strategies demonstrated greater BMI reductions versus standard care, and each of diet alone, exercise alone and combination strategies demonstrated greater reductions in waist circumference than standard care. Conclusion Diet and exercise alone or in combination are effective lifestyle interventions to improve anthropometric measures in cancer patients and survivors. All reputable diets appear to be similarly effective to achieve weight loss.
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Affiliation(s)
- Nathalie LeVasseur
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sasha Mazzarello
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark Clemons
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lisa Vandermeer
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Lee Jones
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Weill Cornell Medical Center, New York, New York, United States of America
| | - Anil Abraham Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Canada
| | | | - Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Mona Hersi
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Carol Stober
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | | | - John Hilton
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Canada
- * E-mail:
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Hasan M, Singh H, Haffizulla F. Culturally Sensitive Health Education in the Caribbean Diaspora: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041476. [PMID: 33557252 PMCID: PMC7913987 DOI: 10.3390/ijerph18041476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
Context: The Caribbean diaspora in the United States is a diverse community that is afflicted with high morbidity and mortality due to preventable chronic diseases. Objective: Our goal is to determine which culturally sensitive health and nutrition educational modalities have the highest efficacy for improving general health in the Caribbean diaspora. Methods: A scoping literature review was performed on the MEDLINE, CINAHL, and Web of Science databases using terms related to health and nutrition in the Caribbean population. Original, peer-reviewed research published from 2010 to 2020, which took place in the U.S. and Caribbean countries, were included in our review. Results: We identified a total of nine articles that met our inclusion criteria. Rate differences for individual education program features were calculated to assess the likelihood of a positive impact on diet, physical activity, and diabetes. Conclusion: Our review helps to identify key educational modalities targeting diabetes, diet, and physical activity levels that can be used to meet the health and nutritional needs of the Caribbean diaspora population.
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Affiliation(s)
- Mashtura Hasan
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
- Correspondence: (M.H.); (F.H.)
| | - Harmandip Singh
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
| | - Farzanna Haffizulla
- Department of Internal Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Correspondence: (M.H.); (F.H.)
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Owusu C, Nock NL, Feuntes V, Margevicius S, Hergenroeder P, Austin K, Bennet E, Cerne S, Moore HCF, Petkac J, Schluchter M, Schmitz KH, Webb Hooper M, Coccia S, Nagy C, Wimbley L, Berger NA. IMPROVE, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and Non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Recruitment strategies and baseline characteristics. Cancer 2021; 127:1836-1846. [PMID: 33539554 DOI: 10.1002/cncr.33430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Behavioral intervention studies in older breast cancer survivors, particularly older African American (AA) and socioeconomic status-disadvantaged breast cancer survivors, are lacking. To inform future studies, the authors examined recruitment strategies in older breast cancer survivors who participated in an exercise intervention study. METHODS IMPROVE is a randomized trial designed to evaluate a group-based exercise intervention versus a support group (ClinicalTrials.gov identifier, NCT02763228). Participants were aged ≥65 years who had survived stage I through III breast cancer and were within 5 years of treatment completion. Participants were recruited through multiple approaches, including peripheral, linguistic, and constituent-involving strategies that incorporated the identification of potentially eligible patients from 3 local hospitals and from State of Ohio registries and through direct clinician and community organization referrals. RESULTS Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, and 213 were randomized into the study. The eligible:randomization rates were 4.4% overall and 84%, 8%, and 2% for recruitment using direct referrals, hospital registries, and state registries, respectively. The median age of the randomized cohort was 70 years (range, 65-88 years) and included 44% AA and 44% socioeconomic status-disadvantaged breast cancer survivors. Compared with all registry-eligible patients, directly referred-eligible patients were more likely to be AA versus Non-Hispanic White (41% vs 19%; P = .006), to be contacted successfully (100% vs 33%; P < .0001), and to accept study participation (88% vs 16%; P < .0001). CONCLUSIONS Direct referrals appeared to be the most efficient strategy for recruiting AA survivors. Behavioral intervention studies seeking to target older AA and socioeconomic status-disadvantaged breast cancer survivors should include strategies that foster direct referrals to study participation.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Nora L Nock
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Vanessa Feuntes
- Washington University School of Medicine, St Louis, Missouri
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | - Halle C F Moore
- Department of Hematology/Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Jean Petkac
- Physical Medicine and Rehabilitation, University Hospitals of Cleveland, Cleveland, Ohio
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | - Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Sarah Coccia
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Caitlin Nagy
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Leonard Wimbley
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nathan A Berger
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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Shaikh H, Bradhurst P, Ma LX, Tan SYC, Egger SJ, Vardy JL. Body weight management in overweight and obese breast cancer survivors. Cochrane Database Syst Rev 2020; 12:CD012110. [PMID: 33305350 PMCID: PMC8094215 DOI: 10.1002/14651858.cd012110.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies suggest that overweight and obese breast cancer survivors are at increased risk of cancer recurrence and have higher all-cause mortality. Obesity has an impact on breast cancer survivor's quality of life (QOL) and increases the risk of longer-term morbidities such as type 2 diabetes mellitus and cardiovascular disease. Many cancer guidelines recommend survivors maintain a healthy weight but there is a lack of evidence regarding which weight loss method to recommend. OBJECTIVES To assess the effects of different body weight loss approaches in breast cancer survivors who are overweight or obese (body mass index (BMI) ≥ 25 kg/m2). SEARCH METHODS We carried out a search in the Cochrane Breast Cancer Group's (CBCG's) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6), MEDLINE (2012 to June 2019), Embase (2015 to June 2019), the World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov on 17 June 2019. We also searched Mainland Chinese academic literature databases (CNKI), VIP, Wan Fang Data and SinoMed on 25 June 2019. We screened references in relevant manuscripts. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials evaluating body weight management for overweight and obese breast cancer survivors (BMI ≥ 25 kg/m2). The aim of the intervention had to be weight loss. DATA COLLECTION AND ANALYSIS Two review authors independently performed data extraction and assessed risk of bias for the included studies, and applied the quality of the evidence using the GRADE approach. Dichotomous outcomes were analysed as proportions using the risk ratio (RR) as the measure of effect. Continuous data were analysed as means with the measure of effect being expressed as the mean differences (MDs) between treatment groups in change from baseline values with 95% confidence intervals (CIs), when all studies reported exactly the same outcomes on the same scale. If similar outcomes were reported on different scales the standardised mean difference (SMD) was used as the measure of effect. Quality of life data and relevant biomarkers were extracted where available. MAIN RESULTS We included a total of 20 studies (containing 23 intervention-comparisons) and analysed 2028 randomised women. Participants in the experimental groups received weight loss interventions using the core element of dietary changes, either in isolation or in combination with other core elements such as 'diet and exercise', 'diet and psychosocial support' or 'diet, exercise and psychosocial support'. Participants in the controls groups either received usual care, written materials or placebo, or wait-list controls. The duration of interventions ranged from 0.5 months to 24 months. The duration of follow-up ranged from three months to 36 months. There were no time-to-event data available for overall survival, breast cancer recurrence and disease-free survival. There was a relatively small amount of data available for breast cancer recurrence (281 participants from 4 intervention-comparisons with 14 recurrence events; RR 1.95, 95% CI 0.68 to 5.60; low-quality evidence) and the analysis was likely underpowered. Overall, we found low-quality evidence that weight loss interventions for overweight and obese breast cancer survivors resulted in a reduction in body weight (MD: -2.25 kg, 95% CI: -3.19 to -1.3 kg; 21 intervention-comparisons; 1751 women), body mass index (BMI) (MD: -1.08 kg/m2, 95% CI: -1.61 to -0.56 kg/m2; 17 intervention-comparisons; 1353 women), and waist circumference (MD:-1.73 cm, 95% CI: -3.17 to -0.29 cm; 13 intervention-comparisons; 1193 women), and improved overall quality of life (SMD: 0.74; 95% CI: 0.20 to 1.29; 10 intervention-comparisons; 867 women). No increase was seen in adverse events for women in the intervention groups compared to controls (RR 0.94, 95% CI: 0.76 to 1.17; 4 intervention-comparisons; 394 women; high-quality evidence). Subgroup analyses revealed that decreases in body weight, BMI and waist circumference were present in women regardless of their ethnicity and menopausal status. Multimodal weight loss interventions (which referred to 'diet, exercise and psychosocial support') appeared to result in greater reductions in body weight (MD: -2.88 kg, 95% CI: -3.98 to -1.77 kg; 13 intervention-comparisons; 1526 participants), BMI (MD: -1.44 kg/m2, 95% CI: -2.16 to -0.72 kg/m2; 11 studies; 1187 participants) and waist circumference (MD:-1.66 cm, 95% CI: -3.49 to -0.16 cm; 8 intervention-comparisons; 1021 participants) compared to dietary change alone, however the evidence was low quality. AUTHORS' CONCLUSIONS Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias regarding blinding of participants and assessors. Further research is required to determine the optimal weight loss intervention and assess the impact of weight loss on survival outcomes. Long-term follow-up in weight loss intervention studies is required to determine if weight changes are sustained beyond the intervention periods.
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Affiliation(s)
- Hassan Shaikh
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Li Xin Ma
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Nutrition and Food Hygiene Department, Hebei University, Baoding, China
| | - Sim Yee Cindy Tan
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Nutrition and Dietetics Department, Concord Repatriation General Hospital, Concord, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sam J Egger
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, Australia
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Cancer, Cardiovascular Disease, and Body Weight: a Complex Relationship. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burse NR, Bhuiyan N, Mama SK, Schmitz KH. Physical activity barriers and resources among black women with a history of breast and endometrial cancer: a systematic review. J Cancer Surviv 2020; 14:556-577. [PMID: 32240461 PMCID: PMC8258672 DOI: 10.1007/s11764-020-00873-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/04/2020] [Indexed: 12/31/2022]
Abstract
Physical inactivity is a significant public health problem among black women. However, there is limited evidence regarding barriers to physical activity and the availability of opportunities to engage in physical activity, specifically for posttreatment black women with a history of cancer. PURPOSE The purpose of this paper was to systematically review, summarize, and synthesize findings on physical activity-related research including barriers, facilitators, and resources for physical activity among posttreatment black women with a history of breast and endometrial cancer. METHODS We developed a comprehensive search strategy and conducted searches in the following databases: PsycINFO, Web of Science, Cochrane, PubMed, and Sociological Abstracts. Summary measures were described qualitatively (e.g., themes) and quantitatively (e.g., frequencies). RESULTS This review identified 35 eligible articles describing 12 intervention and 23 observational studies. We described intervention preferences (e.g., resistance activities), beliefs about physical activity, and benefits of physical activity for quality of life (e.g., improvements in social wellbeing) in black cancer survivors. In addition, very few studies identified barriers to physical activity (n = 7) and focused on increasing physical activity (n = 12) among black women with a history of cancer. The most common reported barriers among the target population were fatigue, lack of social support, weather, illness/health issues, cost, time constraints, living too far away, and inability/unwillingness to obtain physician clearance, whereas the most common facilitators were faith, other health concerns, and social support. CONCLUSIONS/IMPLICATIONS Future studies should target barriers, facilitators, and culturally adapted strategies for physical activity at all levels of influence to develop multi-level interventions to engage and improve physical activity among black women with a history of breast and endometrial cancer. PROTOCOL REGISTRATION NUMBER CRD42018110008.
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Affiliation(s)
- Natasha R Burse
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Kwarteng JL, Beyer KMM, Banerjee A, Stolley MR. Facilitators of behavior change and weight loss in an intervention for African American Breast Cancer Survivors. Cancer Causes Control 2020; 31:737-747. [PMID: 32415529 PMCID: PMC11196002 DOI: 10.1007/s10552-020-01315-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to examine facilitators of behavior change and weight loss among African-American women who participated in the Moving Forward Efficacy trial. METHODS Linear mixed models were used to examine the role of self-efficacy, social support, and perceived access to healthy eating, exercise, and neighborhood safety on weight, physical activity, and diet. We also examined the mediation of self-efficacy, social support, and perceived access to healthy eating, exercise, and neighborhood safety on weight loss, physical activity, and diet using the Freedman Schatzkin statistic. RESULTS We found no evidence to suggest mediation, but some direct associations of self-efficacy, certain types of social support and perceived access to exercise on weight loss, and behavior change. CONCLUSION We determined that self-efficacy, social support, and perceived access to exercise played a role in weight loss, increased MVPA, and better diet. The role of self-efficacy and perceived access to exercise were more consistent than social support.
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Affiliation(s)
- J L Kwarteng
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - K M M Beyer
- Division of Epidemiology, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A Banerjee
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M R Stolley
- Division of Hematology and Oncology, Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Ee C, Cave AE, Naidoo D, Bilinski K, Boyages J. Weight before and after a diagnosis of breast cancer or ductal carcinoma in situ: a national Australian survey. BMC Cancer 2020; 20:113. [PMID: 32075592 PMCID: PMC7031941 DOI: 10.1186/s12885-020-6566-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Overweight/obesity are strongly implicated in breast cancer development, and weight gain post-diagnosis is associated with greater morbidity and all-cause mortality. The aim of this study was to describe the prevalence of overweight/obesity and the pattern of weight gain after diagnosis of breast cancer amongst Australian women. METHODS We collected sociodemographic, medical, weight and lifestyle data using an anonymous, self-administered online cross-sectional survey between November 2017 and January 2018 from women with breast cancer living in Australia. The sample consisted mainly of members of the Breast Cancer Network Australia Review and Survey Group. RESULTS From 309 responses we obtained complete pre/post diagnosis weight data in 277 women, and calculated pre/post Body Mass Index (BMI) for 270 women. The proportion of women with overweight/obesity rose from 48.5% at diagnosis to 67.4% at time of survey. Most women were Caucasian with stage I-III breast cancer (n = 254) or ductal carcinoma in situ (DCIS) (n = 33) and mean age was 59.1 years. The majority of women (63.7%) reported they had gained weight after diagnosis with an average increase of 9.07 kg in this group. Of the women who provided complete weight data, half gained 5 kg or more, 17.0% gained > 20 kg, and 60.7% experienced an increase in BMI of >1 kg/m2. Over half of the women rated their concern about weight as high. Of those women who gained weight, more than half reported that this occurred during the first year after diagnosis. Two-thirds (69.1%) of women aged 35-74 years gained, on average, 0.48 kg more weight per year than age-matched controls. CONCLUSIONS Although the findings from this survey should be interpreted cautiously due to a limited response rate and self-report nature, they suggest that women in Australia gain a considerable amount of weight after a diagnosis of breast cancer/DCIS (in excess of age-matched data for weight gain) and report high levels of concern about their weight. Because weight gain after breast cancer may lead to poorer outcomes, efforts to prevent and manage weight gain must be prioritized and accelerated particularly in the first year after diagnosis.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Adele Elizabeth Cave
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Dhevaksha Naidoo
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Kellie Bilinski
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - John Boyages
- ICON Cancer Centre, Sydney Adventist Hospital, Wahroonga, NSW, 2076, Australia
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Burden S, Jones DJ, Sremanakova J, Sowerbutts AM, Lal S, Pilling M, Todd C. Dietary interventions for adult cancer survivors. Cochrane Database Syst Rev 2019; 2019:CD011287. [PMID: 31755089 PMCID: PMC6872979 DOI: 10.1002/14651858.cd011287.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND International dietary recommendations include guidance on healthy eating and weight management for people who have survived cancer; however dietary interventions are not provided routinely for people living beyond cancer. OBJECTIVES To assess the effects of dietary interventions for adult cancer survivors on morbidity and mortality, changes in dietary behaviour, body composition, health-related quality of life, and clinical measurements. SEARCH METHODS We ran searches on 18 September 2019 and searched the Cochrane Central Register of Controlled trials (CENTRAL), in the Cochrane Library; MEDLINE via Ovid; Embase via Ovid; the Allied and Complementary Medicine Database (AMED); the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and the Database of Abstracts of Reviews of Effects (DARE). We searched other resources including reference lists of retrieved articles, other reviews on the topic, the International Trials Registry for ongoing trials, metaRegister, Physicians Data Query, and appropriate websites for ongoing trials. We searched conference abstracts and WorldCat for dissertations. SELECTION CRITERIA We included randomised controlled trials (RCTs) that recruited people following a cancer diagnosis. The intervention was any dietary advice provided by any method including group sessions, telephone instruction, written materials, or a web-based approach. We included comparisons that could be usual care or written information, and outcomes measured included overall survival, morbidities, secondary malignancies, dietary changes, anthropometry, quality of life (QoL), and biochemistry. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Two people independently assessed titles and full-text articles, extracted data, and assessed risk of bias. For analysis, we used a random-effects statistical model for all meta-analyses, and the GRADE approach to rate the certainty of evidence, considering limitations, indirectness, inconsistencies, imprecision, and bias. MAIN RESULTS We included 25 RCTs involving 7259 participants including 977 (13.5%) men and 6282 (86.5%) women. Mean age reported ranged from 52.6 to 71 years, and range of age of included participants was 23 to 85 years. The trials reported 27 comparisons and included participants who had survived breast cancer (17 trials), colorectal cancer (2 trials), gynaecological cancer (1 trial), and cancer at mixed sites (5 trials). For overall survival, dietary intervention and control groups showed little or no difference in risk of mortality (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.77 to 1.23; 1 study; 3107 participants; low-certainty evidence). For secondary malignancies, dietary interventions versus control trials reported little or no difference (risk ratio (RR) 0.99, 95% CI 0.84 to 1.15; 1 study; 3107 participants; low-certainty evidence). Co-morbidities were not measured in any included trials. Subsequent outcomes reported after 12 months found that dietary interventions versus control probably make little or no difference in energy intake at 12 months (mean difference (MD) -59.13 kcal, 95% CI -159.05 to 37.79; 5 studies; 3283 participants; moderate-certainty evidence). Dietary interventions versus control probably led to slight increases in fruit and vegetable servings (MD 0.41 servings, 95% CI 0.10 to 0.71; 5 studies; 834 participants; moderate-certainty evidence); mixed results for fibre intake overall (MD 5.12 g, 95% CI 0.66 to 10.9; 2 studies; 3127 participants; very low-certainty evidence); and likely improvement in Diet Quality Index (MD 3.46, 95% CI 1.54 to 5.38; 747 participants; moderate-certainty evidence). For anthropometry, dietary intervention versus control probably led to a slightly decreased body mass index (BMI) (MD -0.79 kg/m², 95% CI -1.50 to -0.07; 4 studies; 777 participants; moderate-certainty evidence). Dietary interventions versus control probably had little or no effect on waist-to-hip ratio (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; 106 participants; low-certainty evidence). For QoL, there were mixed results; several different quality assessment tools were used and evidence was of low to very low-certainty. No adverse events were reported in any of the included studies. AUTHORS' CONCLUSIONS Evidence demonstrated little effects of dietary interventions on overall mortality and secondary cancers. For comorbidities, no evidence was identified. For nutritional outcomes, there was probably little or no effect on energy intake, although probably a slight increase in fruit and vegetable intake and Diet Quality Index. Results were mixed for fibre. For anthropometry, there was probably a slight decrease in body mass index (BMI) but probably little or no effect on waist-to-hip ratio. For QoL, results were highly varied. Additional high-quality research is needed to examine the effects of dietary interventions for different cancer sites, and to evaluate important outcomes including comorbidities and body composition. Evidence on new technologies used to deliver dietary interventions was limited.
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Affiliation(s)
- Sorrel Burden
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Debra J Jones
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Jana Sremanakova
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Anne Marie Sowerbutts
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Simon Lal
- Salford Royal Foundation TrustIntestinal Failure UnitSalfordUKM6 8HD
| | - Mark Pilling
- University of CambridgeDepartment of Public and Health and Primary CareCambridgeUKCB2 0SR
| | - Chris Todd
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
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Touyz LM, Cohen J, Cohn RJ, Garnett SP, Anazodo A, Gohil P, Grech AM, Ng A, Wakefield CE. Childhood cancer survivors report preferring lifestyle interventions delivered in person rather than online: An adolescent and parent perspective. Pediatr Blood Cancer 2019; 66:e27922. [PMID: 31309668 DOI: 10.1002/pbc.27922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Maintaining a healthy lifestyle can protect adolescent survivors of pediatric cancer against chronic diseases such as obesity and cardiovascular disease. In this study, we examined the attitudes of adolescent survivors of pediatric cancer and their parents toward improving lifestyle behaviors after cancer treatment, including their preferences for intervention delivery and perceived barriers and benefits to healthy eating and exercise. METHODS We recruited adolescent survivors of childhood cancer aged 11-19 years and their parents, from two hospitals. Participants completed a questionnaire via mail or at routine oncology clinic visits. RESULTS Thirty-three adolescents (response rate 39%, mean age 15, 61% male) and 32 parents (representing 30 parent-child dyads) participated. Parents were significantly more interested in having their child participate in a lifestyle intervention than adolescents (41% of adolescents and 72% of parents, P = .012). Both groups preferred that the survivor receive lifestyle support face to face rather than online. Adolescents preferred to involve their friends (39% of adolescents and 19% of parents) whereas parents preferred to involve the family in a lifestyle intervention (15% of adolescents and 47% of parents, P = .006). Adolescents and their parents perceived a dislike of the taste of fruits and vegetables, fatigue, lack of motivation, and fear of injury as barriers to change. They perceived that keeping healthy and having more energy were benefits to participation. Participants indicated that interventions that provide face-to-face personal training and dietary education at a local gym would be well accepted. CONCLUSIONS Adolescents who have had cancer in childhood have a preference for face-to-face contact with health professionals to overcome the barriers to participation in a lifestyle intervention.
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Affiliation(s)
- Lauren M Touyz
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Paayal Gohil
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Allison M Grech
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Anthea Ng
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Helping Patients Eat Better During and Beyond Cancer Treatment: Continued Nutrition Management Throughout Care to Address Diet, Malnutrition, and Obesity in Cancer. ACTA ACUST UNITED AC 2019; 25:320-328. [PMID: 31567459 DOI: 10.1097/ppo.0000000000000405] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer patients and survivors are at risk of poor clinical outcomes due to poor nutritional intake following cancer diagnosis. During cancer treatment, treatment toxicities can affect eating patterns and can lead to malnutrition resulting in loss of lean body mass and excessive weight loss. Following treatment and throughout survivorship, patients are at risk of not meeting national nutrition guidelines for cancer survivors, which can affect recurrence and survival. Obesity, which is highly prevalent in cancer patients and survivors, can affect clinical outcomes during treatment by masking malnutrition and is also a risk factor for cancer recurrence and poorer survival in some cancers. Appropriate and effective nutritional education and guidance by trained clinicians are needed throughout the cancer continuum. This article presents an overview of recommendations and guidelines for nutrition and weight management and provides recent examples of behavioral theory-based targeted lifestyle interventions designed to increase adherence to recommendation by cancer patients and survivors.
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Crowder SL, Douglas KG, Frugé AD, Carroll WR, Spencer SA, Locher JL, Demark-Wahnefried W, Rogers LQ, Arthur AE. Head and neck cancer survivors' preferences for and evaluations of a post-treatment dietary intervention. Nutr J 2019; 18:57. [PMID: 31506077 PMCID: PMC6737706 DOI: 10.1186/s12937-019-0479-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/27/2019] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Dietary preferences vary depending on cancer type. The purpose of this study was to report dietary intervention preferences and a study program evaluation from post-treatment head and neck cancer survivors participating in a dietary intervention. METHODS Between January 2015 and August 2016, 24 head and neck cancer survivors participated in a 12-week randomized clinical dietary intervention trial that promoted weekly consumption of 2.5 cups of cruciferous vegetables and 3.5 cups of green leafy vegetables. At study completion, survivors completed a preferences survey and a study program evaluation to probe interests and improvement aspects for planning future dietary intervention trials. Descriptive statistics (means and frequencies) were generated for multiple choice question responses. Responses to open-ended questions were recorded and grouped based on themes, and verified by quality assurance checks by a second study team member. RESULTS Twenty-three survivors completed the preferences and evaluation surveys (response rate 96%). Overall, most participants reported a preference for one-on-one telephone counseling from a registered dietitian nutritionist before beginning treatment. Ninety-six percent of participants ranked the overall study program as "very good" to "excellent," and all agreed the objectives of the study were clear, the study staff was helpful and easy to contact, and the registered dietitian nutritionist was knowledgeable. CONCLUSIONS Future research and dietary intervention planning for head and neck cancer survivors should focus on strategies to promote one-on-one telephone or other distance-based counseling combined with face-to-face visits, according to survivor preference.
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Affiliation(s)
- Sylvia L Crowder
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA
| | - Katherine G Douglas
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA
| | - Andrew D Frugé
- Department of Nutrition, Dietetics, & Hospitality Management, Auburn University, Auburn, AL, USA
| | - William R Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sharon A Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julie L Locher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Laura Q Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna E Arthur
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA. .,Carle Cancer Center, Carle Foundation Hospital, Urbana, IL, USA.
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Marinari G, Espitalier-Rivière C, Fédou C, Romain AJ, Raynaud de Mauverger E, Brun JF. Activité physique, obésité et cancer du sein : quelles conclusions pratiques ? Sci Sports 2019. [DOI: 10.1016/j.scispo.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Arnotti K, Bamber M. Fruit and Vegetable Consumption in Overweight or Obese Individuals: A Meta-Analysis. West J Nurs Res 2019; 42:306-314. [PMID: 31256714 DOI: 10.1177/0193945919858699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Researchers have shown that fruit and vegetable consumption (FVC) promotes weight loss and prevents weight gain, thereby reducing risks for chronic health conditions. We conducted a meta-analysis to examine the overall effects of FVC interventions on weight loss for those with body-mass index (BMI) >25; we follow-up with moderator analyses to determine if effects varied based on participants, interventions, methods, or source characteristics. Extensive literature searches were conducted, resulting in 16 studies and providing 17 comparisons, across 3,719 participants. The overall summary effect was large (-2.81kg; p<.001). Several moderators were significant for increased weight loss: low socio-economic status (-4.99kg; p<.001), higher baseline BMI (slope=-0.29; p=.047), longer interventions (slope=0.012; p<.001), and recruitment setting [health care/programs (-3.7kg; p<.001); work/academic settings (-5.2kg: p<.001)]. Future researchers should investigate varying intervention lengths and examine specific needs of subgroups-higher versus lower socio-economic status, and overweight versus obese.
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Affiliation(s)
| | - Mandy Bamber
- Associate Professor, Florida State University, Tallahassee, FL, USA
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Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K. Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review. Front Oncol 2019; 9:3. [PMID: 30723698 PMCID: PMC6349825 DOI: 10.3389/fonc.2019.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors. Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review. Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range -1.9 to -3.6%), sedentary behavior (-18%), and dietary fat intake (range -13 to -33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%). Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.
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Affiliation(s)
- Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas, Dallas, TX, United States
| | - Lorraine T Dean
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, MD, United States
| | - Georgiana Logan
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - Kristen Allen-Watts
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
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Abstract
This review evaluates evidence on dietary interventions for cancer survivors giving an overview of people's views and preferences for service attributes and provides a narrative review. After cancer, people often want to change their diet and there is a plethora of evidence why dietary optimisation would be beneficial. However, cancer survivors have different preferences about attributes of services including: place, person and communication mode. Randomised control trials have been reviewed to provide a narrative summary of evidence of dietary interventions. Most studies were on survivors of breast cancer, with a few on colorectal, prostate and gynaecological survivors. Telephone interventions were the most frequently reported means of providing advice and dietitians were most likely to communicate advice. Dietary assessment methods used were FFQ, food diaries and 24-h recalls. Dietary interventions were shown to increase intake of fruit and vegetables, dietary fibre, and improve diet quality in some studies but with contradictory findings in others. Telephone advice increased fruit and vegetable intake primarily in women with breast cancer and at some time points in people after colorectal cancer, but findings were inconsistent. Findings from mail interventions were contradictory, although diet quality improved in some studies. Web-based and group sessions had limited benefits. There is some evidence that dietary interventions improve diet quality and some aspects of nutritional intake in cancer survivors. However, due to contradictory findings between studies and cancer sites, short term follow-up and surrogate endpoints it is difficult to decipher the evidence base.
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Dieli-Conwright CM, Sweeney FC, Courneya KS, Tripathy D, Sami N, Lee K, Buchanan TA, Spicer D, Bernstein L, Mortimer JE, Demark-Wahnefried W. Hispanic ethnicity as a moderator of the effects of aerobic and resistance exercise in survivors of breast cancer. Cancer 2018; 125:910-920. [PMID: 30500981 PMCID: PMC7164690 DOI: 10.1002/cncr.31879] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/21/2018] [Accepted: 10/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Metabolic syndrome (MSY) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic women compared with non-Hispanic women. Although exercise mitigates MSY in BCS, to the best of the authors' knowledge, few studies to date have focused on minorities. This secondary analysis examined ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on MSY, sarcopenic obesity, and serum biomarkers in BCS. METHODS A total of 100 eligible BCS were randomized to exercise (50 BCS) or usual care (50 BCS). The exercise intervention promoted moderate to vigorous aerobic and resistance exercise 3 times a week for 16 weeks. MSY z scores, sarcopenic obesity, and serum biomarkers were measured at baseline, after the intervention, and at the 28-week follow-up (exercise group only). Linear mixed models adjusted for baseline values of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. RESULTS The study sample was 57% Hispanic BCS (HBCS) and 43% non-Hispanic BCS (NHBCS). HBCS were younger, of greater adiposity, and had been diagnosed with more advanced cancers compared with NHBCS (P<.001). Ethnicity was found to moderate the mean differences in exercise training on triglycerides (-36.4 mg/dL; 95% confidence interval [95% CI],-64.1 to -18.8 mg/dL), glucose (-8.6 mg/dL; 95% CI, -19.1 to -3.0 mg/dL), and C-reactive protein (-3.3 mg/L; 95% CI, -7.3 to -0.9 mg/L). CONCLUSIONS HBCS appear to have poorer metabolic profiles and therefore may derive relatively larger metabolic changes from exercise compared with NHBCS. Clinical exercise interventions may attenuate existing health disparities across diverse groups of BCS.
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Affiliation(s)
- Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California.,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Frank C Sweeney
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathalie Sami
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, City of Hope, Duarte, California
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
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Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJC, Rosario DJ, Thaha MA, Bourke L. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 2018; 9:CD010192. [PMID: 30229557 PMCID: PMC6513653 DOI: 10.1002/14651858.cd010192.pub3] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in the Cochrane Library 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. OBJECTIVES To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? SEARCH METHODS We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. SELECTION CRITERIA We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. DATA COLLECTION AND ANALYSIS In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. MAIN RESULTS We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week).Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). AUTHORS' CONCLUSIONS Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population.
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Affiliation(s)
- Rebecca R Turner
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Liz Steed
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public HealthBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Helen Quirk
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Rosa U Greasley
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - John M Saxton
- Northumbria UniversityDepartment of Sport, Exercise, and RehabilitationNewcastle‐upon‐TyneUKNE1 8ST
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
| | - Derek J Rosario
- University of SheffieldDepartment of OncologyBeech Hill RoadRoyal Hallamshire HospitalSheffieldUKS010 2RX
| | - Mohamed A Thaha
- Barts & The London School of Medicine & Dentistry, Queen Mary University LondonAcademic Surgical Unit, National Centre for Bowel Research & Surgical Innovation, Centre for Digestive Diseases, Blizard Institute1st Floor, Abernethy Building, 2 Newark StreetThe Royal London Hospital, WhitechapelLondonEnglandUKE1 2AT
| | - Liam Bourke
- Sheffield Hallam UniversityHealth and Wellbeing Research InstituteSheffieldUKS10 2BP
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Sturgeon KM, Foo W, Heroux M, Schmitz K. Change in Inflammatory Biomarkers and Adipose Tissue in BRCA1/2+ Breast Cancer Survivors Following a Yearlong Lifestyle Modification Program. Cancer Prev Res (Phila) 2018; 11:545-550. [PMID: 29925515 DOI: 10.1158/1940-6207.capr-18-0098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/16/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022]
Abstract
Breast cancer survivors who carry a genetic mutation for one of the BRCA genes often undergo surgically induced menopause a decade or more before the usual age of natural menopause. These women are at elevated risk for multiple negative health outcomes, including metabolic diseases, heart disease, and cancer recurrence. Effects of a 12-month commercially available web-based lifestyle program (Precision Nutrition) were tested on body composition and markers of inflammation in a randomized controlled trial. Participants (N = 35) were BRCA1/2+, breast cancer survivors, and had completed surgically induced menopause at age <45 years. Dual-energy X-ray absorptiometry was used to quantify body composition. Fasting blood samples were used to assay insulin, IL1β, IL6, IL8, and TNFα. At baseline, we observed relationships between insulin, TNFα, and IL6, and between biomarkers and adiposity. Insulin and subcutaneous adipose tissue levels significantly decreased following the intervention compared with the change in the control group. Compared with baseline, TNFα and total adipose tissue levels decreased significantly in the intervention group. The percent change in insulin levels was moderately correlated with the percent change in subcutaneous adipose tissue (r = 0.33). Change in adiposity was not related to change in TNFα or IL6. Women in the intervention group decreased levels of subcutaneous, but not visceral, adipose tissue. The change in subcutaneous adipose tissue was the main driver of change in insulin levels for the women in the intervention group. However, the change in body composition achieved by the Precision Nutrition program was not sufficient to alter biomarker levels of inflammation. Cancer Prev Res; 11(9); 545-50. ©2018 AACR.
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Affiliation(s)
- Kathleen M Sturgeon
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Wayne Foo
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | | | - Kathryn Schmitz
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
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Amireault S, Fong AJ, Sabiston CM. Promoting Healthy Eating and Physical Activity Behaviors: A Systematic Review of Multiple Health Behavior Change Interventions Among Cancer Survivors. Am J Lifestyle Med 2018; 12:184-199. [PMID: 30202391 PMCID: PMC6124968 DOI: 10.1177/1559827616661490] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/17/2016] [Accepted: 07/07/2016] [Indexed: 12/31/2022] Open
Abstract
Multiple health behavior change (MHBC) interventions have great potential for enhancing health and well-being following cancer diagnosis and treatment. However, the characteristics and effects of MHBC interventions remain elusive for cancer survivors. The main purpose of this study was to evaluate the effectiveness of MHBC interventions on healthy eating and physical activity behaviors among cancer survivors. A secondary aim was to examine the effect of using a simultaneous and sequential design approach to MHBC (ie, changing both behaviors at the same time or one after the other). Randomized controlled trials reporting the impact of a MHBC intervention on both healthy eating and physical activity behaviors among cancer survivors were retrieved from MEDLINE, Cochrane Library, and PsycINFO. A total of 27 MHBC interventions were identified; most (92.6%) were designed to promote simultaneous change in both behaviors and assessed end-of-treatment effect among breast cancer survivors. MHBC interventions led by nurses or multidisciplinary teams showed the most compelling evidence for small to moderate improvement in both behaviors, with interventions that lasted ≥17 weeks more likely to improve both behaviors. This study identifies research priorities and provides preliminary evidence for clinical decision making and advancements in MHBC intervention design and delivery for clinical oncology.
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Affiliation(s)
- Steve Amireault
- Steve Amireault, PhD, Department of Health and Kinesiology, Purdue University, 800 West Stadium Avenue, Lambert Fieldhouse, Office 311A, West Lafayette, IN 47907; e-mail:
| | - Angela J. Fong
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana (SA)
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada (AJF, CMS)
| | - Catherine M. Sabiston
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana (SA)
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada (AJF, CMS)
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Demark-Wahnefried W, Schmitz KH, Alfano CM, Bail JR, Goodwin PJ, Thomson CA, Bradley DW, Courneya KS, Befort CA, Denlinger CS, Ligibel JA, Dietz WH, Stolley MR, Irwin ML, Bamman MM, Apovian CM, Pinto BM, Wolin KY, Ballard RM, Dannenberg AJ, Eakin EG, Longjohn MM, Raffa SD, Adams-Campbell LL, Buzaglo JS, Nass SJ, Massetti GM, Balogh EP, Kraft ES, Parekh AK, Sanghavi DM, Morris GS, Basen-Engquist K. Weight management and physical activity throughout the cancer care continuum. CA Cancer J Clin 2018; 68:64-89. [PMID: 29165798 PMCID: PMC5766382 DOI: 10.3322/caac.21441] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
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Affiliation(s)
| | - Kathryn H Schmitz
- Professor of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Catherine M Alfano
- Vice President, Survivorship, American Cancer Society, Inc., Washington, DC
| | - Jennifer R Bail
- Post-Doctoral Fellow, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Pamela J Goodwin
- Professor of Medicine, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute at the University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Thomson
- Professor of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Don W Bradley
- Associate Consulting Professor, Community and Family Medicine, Duke School of Medicine, Durham, NC
| | - Kerry S Courneya
- Professor of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christie A Befort
- Associate Professor of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Crystal S Denlinger
- Associate Professor of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - William H Dietz
- Chair, Redstone Global Center for Prevention and Wellness, George Washington University, Washington, DC
| | | | - Melinda L Irwin
- Professor of Epidemiology, Yale School of Public Health, New Haven, CT
| | - Marcas M Bamman
- Professor of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Rachel M Ballard
- Director, Prevention Research Coordination, Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
| | | | - Elizabeth G Eakin
- Professor and Director, Cancer Prevention Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Matt M Longjohn
- Vice President and National Health Officer, YMCA of the USA, Chicago, IL
| | - Susan D Raffa
- National Program Director for Weight Management, Veterans Health Administration, Durham, NC
| | | | - Joanne S Buzaglo
- Senior Vice President, Research and Training Institute, Cancer Support Community, Philadelphia, PA
| | - Sharyl J Nass
- Director, National Cancer Policy Forum and Board on Health Care Services, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Greta M Massetti
- Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin P Balogh
- Senior Program Officer, National Cancer Policy Forum, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | | | - Anand K Parekh
- Chief Medical Advisor, Bipartisan Policy Center, Washington, DC
| | - Darshak M Sanghavi
- Chief Medical Officer, Senior Vice President, Translation, Optum Labs, Cambridge, MA
| | | | - Karen Basen-Engquist
- Professor of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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