-
1.
Using the TIDieR checklist to describe development and integration of a web-based intervention promoting healthy eating and regular exercise among older cancer survivors.
Rogers, LQ, Pekmezi, D, Schoenberger-Godwin, YM, Fontaine, KR, Ivankova, NV, Kinsey, AW, Hoenemeyer, T, Martin, MY, Pisu, M, Farrell, D, et al
Digital health. 2023;:20552076231182805
Abstract
OBJECTIVE To facilitate replication and future intervention design of web-based multibehavior lifestyle interventions, we describe the rationale, development, and content of the AiM, Plan, and act on LIFestYles (AMPLIFY) Survivor Health intervention which provides healthy eating and exercise behavior change support for older cancer survivors. The intervention promotes weight loss, improvements in diet quality, and meeting exercise recommendations. METHODS The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a comprehensive description of the AMPLIFY intervention, consistent with CONSORT recommendations. RESULTS A social cognitive theory web-based intervention founded on the core components of efficacious print and in-person interventions was conceptualized and developed through an iterative collaboration involving cancer survivors, web design experts, and a multidisciplinary investigative team. The intervention includes the AMPLIFY website, text and/or email messaging, and a private Facebook group. The website consists of: (1) Sessions (weekly interactive e-learning tutorials); (2) My Progress (logging current behavior, receiving feedback, setting goals); (3) Tools (additional information and resources); (4) Support (social support resources, frequently asked questions); and (5) Home page. Algorithms were used to generate fresh content daily and weekly, tailor information, and personalize goal recommendations. An a priori rubric was used to facilitate intervention delivery as healthy eating only (24 weeks), exercise only (24 weeks), or both behaviors concurrently over 48 weeks. CONCLUSIONS Our TIDieR-guided AMPLIFY description provides pragmatic information helpful for researchers designing multibehavior web-based interventions and enhances potential opportunities to improve such interventions.
-
2.
Results of DUET: A Web-Based Weight Loss Randomized Controlled Feasibility Trial among Cancer Survivors and Their Chosen Partners.
Demark-Wahnefried, W, Oster, RA, Crane, TE, Rogers, LQ, Cole, WW, Kaur, H, Farrell, D, Parrish, KB, Badr, HJ, Wolin, KY, et al
Cancers. 2023;(5)
Abstract
(1) Background: A healthful diet, regular physical activity, and weight management are cornerstones for cancer prevention and control. Yet, adherence is low in cancer survivors and others, calling for innovative solutions. Daughters, dUdes, mothers, and othErs fighting cancer Together (DUET) is a 6-month, online, diet-and-exercise, weight-loss intervention to improve health behaviors and outcomes among cancer survivor-partner dyads. (2) Methods: DUET was tested in 56 dyads (survivors of obesity-related cancers and chosen partners) (n = 112), both with overweight/obesity, sedentary behavior, and suboptimal diets. After baseline assessment, dyads were randomized to DUET intervention or waitlist control arms; data were collected at 3- and 6-months and analyzed using chi-square, t-tests, and mixed linear models (α < 0.05). (3) Results: Retention was 89% and 100% in waitlisted and intervention arms, respectively. Dyad weight loss (primary outcome) averaged -1.1 (waitlist) vs. -2.8 kg (intervention) (p = 0.044/time-by-arm interaction p = 0.033). Caloric intake decreased significantly in DUET survivors versus controls (p = 0.027). Evidence of benefit was observed for physical activity and function, blood glucose, and c-reactive protein. Dyadic terms were significant across outcomes, suggesting that the partner-based approach contributed to intervention-associated improvements. (4) Conclusions: DUET represents a pioneering effort in scalable, multi-behavior weight management interventions to promote cancer prevention and control, calling for studies that are larger in size, scope, and duration.
-
3.
Dietary Barriers Appear to Influence the Effects of a Dyadic Web-Based Lifestyle Intervention on Caloric Intake and Adiposity: A Mediation Analysis of the DUET Trial.
Kaur, H, Pavela, G, Pekmezi, DW, Rogers, LQ, Cole, WW, Parrish, KB, Sayer, RD, Wyatt, HR, Demark-Wahnefried, W
Nutrients. 2023;(23)
Abstract
Mechanisms that explain behavior change within web-based lifestyle interventions are not well-studied. This secondary analysis explores whether the effects of the DUET web-based lifestyle intervention on diet, physical activity, and/or adiposity are mediated through changes in self-efficacy, social support, and perceived barriers (key constructs of social cognitive theory). Data on mediators, diet quality, caloric intake, moderate-to-vigorous physical activity (MVPA), weight, and waist circumference (WC) were analyzed from 112 cancer survivors and their partners enrolled in the DUET intervention. Mediation analyses were performed using Mplus to execute regression analyses and determine associations. Mediation analyses supported an effect of the intervention on caloric intake (-3.52, 95% CI [-8.08 to -0.84]), weight (-1.60, CI [-3.84 to -0.47]), and WC (-0.83, CI [-1.77 to -0.18]), interpreting these negative associations as intervention induced reductions in dietary barriers. Higher social support was significantly and positively associated with, but not a mediator for, improvements in self-reported and accelerometry-measured MVPA (b = 0.69, CI [0.19, 1.24]) and (b = 0.55, CI [0.15, 1.00]), respectively. Self-efficacy did not appear to mediate the intervention's effects. Findings suggest that the effects of the DUET intervention on diet and adiposity stem from reducing perceived barriers to a healthful, low-calorie diet.
-
4.
Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19.
Bail, JR, Blair, CK, Smith, KP, Oster, RA, Kaur, H, Locher, JL, Frugé, AD, Rocque, G, Pisu, M, Cohen, HJ, et al
Journal of the Academy of Nutrition and Dietetics. 2022;(9):1629-1643
-
-
Free full text
-
Abstract
BACKGROUND Accelerated functional decline is a concern among older cancer survivors that threatens independence and quality of life. Pilot studies suggest that vegetable gardening interventions ameliorate functional decline through improved diet and physical activity. OBJECTIVE The aim of this article was to describe the rationale, recruitment challenges, and enrollment for the Harvest for Health randomized controlled trial (RCT), which will test the impact of a home-based, vegetable gardening intervention on vegetable and fruit consumption, physical activity, and physical functioning among older cancer survivors. Modifications made to the intervention and assessments to assure safety and continuity of the RCT throughout the COVID-19 pandemic also are reported. DESIGN Harvest for Health is a 2-year, 2-arm, single-blinded, wait-list controlled RCT with cross-over. PARTICIPANTS/SETTING Medicare-eligible survivors of cancers with ≥60% 5-year survival were recruited across Alabama from October 1, 2016 to February 8, 2021. INTERVENTION Participants were randomly assigned to a wait-list control or a 1-year home-based gardening intervention and individually mentored by extension-certified master gardeners to cultivate spring, summer, and fall vegetable gardens. MAIN OUTCOME MEASURES Although the RCT's primary end point was a composite measure of vegetable and fruit consumption, physical activity, and physical functioning, this article focuses on recruitment and modifications made to the intervention and assessments during COVID-19. STATISTICAL ANALYSES PERFORMED χ2 and t tests (α < .05) were used to compare enrolled vs unenrolled populations. RESULTS Older cancer survivors (n = 9,708) were contacted via mail and telephone; 1,460 indicated interest (15% response rate), 473 were screened eligible and consented, and 381 completed baseline assessments and were randomized. Enrollees did not differ from nonrespondents/refusals by race and ethnicity, or rural-urban status, but comprised significantly higher numbers of comparatively younger survivors, those who were female, and survivors of breast cancer (P < .001). Although COVID-19 delayed trial completion, protocol modifications overcame this barrier and study completion is anticipated by June 2022. CONCLUSIONS This RCT will provide evidence on the effects of a mentored vegetable gardening program among older cancer survivors. If efficacious, Harvest for Health represents a novel, multifaceted approach to improve lifestyle behaviors and health outcomes among cancer survivors-one with capacity for sustainability and widespread dissemination.
-
5.
Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline.
Ligibel, JA, Bohlke, K, May, AM, Clinton, SK, Demark-Wahnefried, W, Gilchrist, SC, Irwin, ML, Late, M, Mansfield, S, Marshall, TF, et al
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2022;(22):2491-2507
Abstract
PURPOSE To provide guidance on exercise, diet, and weight management during active cancer treatment in adults. METHODS A systematic review of the literature identified systematic reviews and randomized controlled trials evaluating the impact of aerobic and resistance exercise, specific diets and foods, and intentional weight loss and avoidance of weight gain in adults during cancer treatment, on quality of life, treatment toxicity, and cancer control. PubMed and the Cochrane Library were searched from January 2000 to May 2021. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 52 systematic reviews (42 for exercise, nine for diet, and one for weight management), and an additional 23 randomized controlled trials. The most commonly studied types of cancer were breast, prostate, lung, and colorectal. Exercise during cancer treatment led to improvements in cardiorespiratory fitness, strength, fatigue, and other patient-reported outcomes. Preoperative exercise in patients with lung cancer led to a reduction in postoperative length of hospital stay and complications. Neutropenic diets did not decrease risk of infection during cancer treatment. RECOMMENDATIONS Oncology providers should recommend regular aerobic and resistance exercise during active treatment with curative intent and may recommend preoperative exercise for patients undergoing surgery for lung cancer. Neutropenic diets are not recommended to prevent infection in patients with cancer during active treatment. Evidence for other dietary and weight loss interventions during cancer treatment was very limited. The guideline discusses special considerations, such as exercise in individuals with advanced cancer, and highlights the critical need for more research in this area, particularly regarding diet and weight loss interventions during cancer treatment.Additional information is available at www.asco.org/supportive-care-guidelines.
-
6.
Adapting MultiPLe behavior Interventions that eFfectively Improve (AMPLIFI) cancer survivor health: program project protocols for remote lifestyle intervention and assessment in 3 inter-related randomized controlled trials among survivors of obesity-related cancers.
Pekmezi, D, Fontaine, K, Rogers, LQ, Pisu, M, Martin, MY, Schoenberger-Godwin, YM, Oster, RA, Kenzik, K, Ivankova, NV, Demark-Wahnefried, W
BMC cancer. 2022;(1):471
Abstract
BACKGROUND Scalable, multiple behavior change interventions are needed to address poor diet, inactivity, and excess adiposity among the rising number of cancer survivors. Efficacy-tested diet (RENEW) and exercise (BEAT Cancer) programs were adapted for web delivery among middle-aged and older cancer survivors for the AMPLIFI study, a National Cancer Institute-funded, multi-site, program project. METHODS Throughout the continental U.S., survivors of several obesity-related cancers are being recruited for three interconnected randomized controlled trials (RCTs). Projects 1 and 2 test 6-month diet or exercise interventions versus a wait-list control condition. Upon completion of the 6-month study period, the intervention participants receive the next behavior change sequence (i.e., diet receives exercise, exercise receives diet) and the wait-list control arm initiates a 12-month combined diet and exercise intervention. Project 3 tests the efficacy of the sequential versus simultaneous interventions. Assessments occur at baseline and semi-annually for up to 2-years and include: body mass index, health behaviors (diet quality, accelerometry-assessed physical activity/sleep), waist circumference, D3 creatine-assessed muscle mass, physical performance, potential mediators/moderators of treatment efficacy, biomarkers of inflammation and metabolic regulation, health care utilization, cost, and overall health. Four shared resources support AMPLIFI RCTs: 1) Administrative; 2) Adaptation, Dissemination and Implementation; 3) Recruitment and Retention; and 4) Assessment and Analysis. DISCUSSION Representing a new generation of RCTs, AMPLIFI will exclusively use remote technologies to recruit, intervene and assess the efficacy of the newly-adapted, web-based diet and exercise interventions and determine whether sequential or combined delivery works best for at-risk (older, rural, racial minority) cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov , NCT04000880 . Registered 27 June 2019.
-
7.
A comparison of two mail-based strategies to recruit older cancer survivors into a randomized controlled trial of a lifestyle intervention.
Warnock, AC, Kaur, H, Buckman, JR, Hoenemeyer, T, Demark-Wahnefried, W
Journal of cancer survivorship : research and practice. 2022;(5):998-1003
-
-
Free full text
-
Abstract
PURPOSE To compare response rates to business letter versus greeting card invitations used to recruit older cancer survivors to a randomized controlled clinical trial of a lifestyle intervention METHODS Capitalizing upon recruitment efforts for a lifestyle intervention trial among older cancer survivors, we explored response rates to study invitations formatted as greeting cards versus standard business letters. Survivors were identified from cancer registries and medical records and randomly assigned with strata defined by gender and racial/ethnicity to one-of-the-two invitations. Both groups received telephone follow-up. RESULTS Contact was verified among 708 survivors with an average age of 72 years with most being non-Hispanic White (NHW), urban dwelling, and female. Survivors assigned to the business letter (n = 360) as compared to the greeting card (n = 348) were significantly more likely to express interest in participation (OR 1.73, 95% CI 1.11-2.70). With the exception of racial/ethnic minorities (OR 0.73; 95% CI 0.26-2.11), all other subgroups favored the business letter with significance observed in females (OR 1.66, 95% CI 1.00-2.74), NHWs (OR 2.12; 95% CI 1.29-3.49), and rural dwellers (OR 3.61; 95% CI 1.49-8.76). Moreover, the business letter costs were substantially lower than the card. CONCLUSION Clinical trial recruitment is significantly more effective if solicitations are formatted as standard business letters as compared to greeting cards, though this may not generalize to racial/ethnic minorities where more research is warranted. IMPLICATIONS FOR CANCER SURVIVORS These study findings are not only valuable to researchers but also have the potential to improve recruitment and engagement of older cancer survivors in clinical trials. CLINICAL TRIAL REGISTRATION Harvest for Health for in Older Cancer Survivors, ClinicalTrials.gov Identifier: NCT02985411.
-
8.
Health-related quality of life is associated with fecal microbial composition in breast cancer survivors.
Smith, KS, Tissier, A, Bail, JR, Novak, JR, Morrow, CD, Demark-Wahnefried, W, Frugé, AD
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2022;(1):10
Abstract
PURPOSE To investigate relationships between body size, gut microbiome, and health-related quality of life (QOL) in breast cancer survivors (BCS) in a clinical trial. METHODS A cross-sectional substudy was conducted using baseline data from 70 BCS participating in a randomized controlled trial of a lifestyle intervention. Measures included anthropometrics, QOL (Short Form Health-related QOL Survey-36 [SF-36]), and 16S rRNA gene sequencing of fecal microbes. Participants were categorized by body mass index (BMI) into without obesity (≤ 29.9 kg/m2; n = 38) and with obesity (≥ 30.0 kg/m2; n = 32) groups. Differences in bacterial taxa between groups were assessed using Kruskal-Wallis one-way analysis of variance. Spearman and partial correlations explored associations between taxa and SF-36 subscales. Mediation analysis explored the relationship between BMI and SF-36 mental health summary score with alpha diversity as a mediator. RESULTS Most BCS (72.9%) were non-Hispanic White with average age of 61.6 (± 8.7) years. No differences were observed for SF-36 subscales between groups. Physical functioning, vitality, and mental health subscales were negatively associated with Ruminococcus (ρ = - 0.304, p = 0.036; ρ = - 0.361, p = 0.012; ρ = - 0.495, p < 0.001) and Dorea (ρ = - 0.378, p = 0.028; ρ = - 0.33, p = 0.022; ρ = - 0.388, p = 0.006) abundance controlling for BMI. BCS without obesity had a significantly higher relative abundance of Ruminococcus (p = 0.003), Streptococcus (p = 0.049), Roseburia (p = 0.035), and Dorea (p = 0.003). CONCLUSIONS Fecal microbial composition differed between BCS with and without obesity, with associations between QOL and several microbial taxa. Several of these genera, previously identified as potentially beneficial, may also influence QOL in BCS. These results support further studies to determine the role of individual microbiota in QOL and obesity in cancer survivors.
-
9.
Correction: Pekmezi et al. Rationale and Methods for a Randomized Controlled Trial of a Dyadic, Web-Based, Weight Loss Intervention among Cancer Survivors and Partners: The DUET Study. Nutrients 2021, 13, 3472.
Pekmezi, DW, Crane, TE, Oster, RA, Rogers, LQ, Hoenemeyer, T, Farrell, D, Cole, WW, Wolin, K, Badr, H, Demark-Wahnefried, W
Nutrients. 2022;(15)
Abstract
The authors would like to correct errors in their prior publication [...].
-
10.
Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis.
Aune, D, Markozannes, G, Abar, L, Balducci, K, Cariolou, M, Nanu, N, Vieira, R, Anifowoshe, YO, Greenwood, DC, Clinton, SK, et al
JNCI cancer spectrum. 2022;(6)
Abstract
BACKGROUND Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project. METHODS PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence. RESULTS A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions. CONCLUSION PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.