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Vasilopoulou M, Asimakopoulou Z, Velissari J, Vicha A, Rizogianni M, Pusa S, Stöven S, Ficarra S, Bianco Α, Jiménez-Pavón D, Ponce Gonzalez Jesus G, Tavares Paula C, Gomes B, Bayer D, Silva S, Nogueira C, Papakonstantinou S, Musa K, Glorioso F, Vantarakis A. Interventions about physical activity and diet and their impact on adolescent and young adult cancer survivors: a Prisma systematic review. Support Care Cancer 2024; 32:342. [PMID: 38739198 PMCID: PMC11090968 DOI: 10.1007/s00520-024-08516-0] [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] [Received: 01/22/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Over the past few decades, the incidence of cancer among adolescents and young adults (AYA) has been increasing. The impact of behaviors, such as physical activity (PA) and nutrition, on disease progression, prognosis, and overall health and quality of life for AYA cancer survivors is of significant importance. This systematic review aims to evaluate the effectiveness of PA and diet interventions for AYA cancer survivors and to critically evaluate existing literature, gaps, and limitations. METHODS A search of literature was conducted in PubMed, Science Direct, Scopus, and Google Scholar following the PRISMA guidelines. Twenty-two studies were included from online databases from 2012 to 2022, 13 of which were randomized controlled trials. RESULTS Most interventions were related to PA, with only four studies including nutrition or Diet interventions. The interventions were generally feasible and acceptable to AYA cancer survivors, and digitally based PA interventions were commonly used. PA interventions mainly comprised aerobic and resistance training and were individualized. Overall, this review found various PA and diet interventions for AYA cancer survivors that were feasible and well-accepted, but gaps in knowledge and design still exist. CONCLUSIONS This systematic review underscores the importance of conducting more research on diet interventions for YCS. PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/#aboutregpage.
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Affiliation(s)
- M Vasilopoulou
- Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - Z Asimakopoulou
- Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - J Velissari
- Department of Public Health, Medical School, University of Patras, Patras, Greece
- Oncology Unit, University General Hospital of Patras, Patras, Greece
| | - A Vicha
- Oncology Unit, University General Hospital of Patras, Patras, Greece
| | - M Rizogianni
- Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - S Pusa
- Department of Nursing, Umeå University, Campus Örnsköldsvik, Box 843, S 891 18, Örnsköldsvik, Sweden
| | - S Stöven
- European CBRNE Center, Umeå University, KBC-Huset, Linnaeus Väg 6, 90187, Umeå, Sweden
| | - S Ficarra
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - Α Bianco
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - D Jiménez-Pavón
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Puerto Real, Spain
- Biomedical Research and Innovation Institute of Cádiz, University of Cádiz, Cádiz, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - G Ponce Gonzalez Jesus
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Puerto Real, Spain
- Biomedical Research and Innovation Institute of Cádiz, University of Cádiz, Cádiz, Spain
| | - C Tavares Paula
- Faculty of Sport Sciences and Physical Education and *CIDAF (Uid/Dtp/042143/2020), University of Coimbra, Coimbra, Portugal
| | - B Gomes
- Faculty of Sport Sciences and Physical Education and *CIDAF (Uid/Dtp/042143/2020), University of Coimbra, Coimbra, Portugal
| | - D Bayer
- Department of Health Consulting, Research and Science, Outdoor Against Cancer, Munich, Germany
| | - S Silva
- Psycho-Oncology Unit, Portuguese Cancer League-Centre Branch, Lisbon, Portugal
| | - C Nogueira
- Innovation & Development Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, Portugal
| | | | - K Musa
- CEIPES ETS, Palermo, Italy
| | - F Glorioso
- Lega Italiana Per La Lotta Contro I Tumori (LILT Palermo), Palermo, Italy
| | - A Vantarakis
- Department of Public Health, Medical School, University of Patras, Patras, Greece.
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Rick TJ, Sagaram S, Jewett PI, Lee HY, Sadak KT, Turcotte LM, Vogel RI, Blaes A. A pilot randomized controlled trial of an online intervention for Hodgkin lymphoma survivors to increase knowledge about late effects and recommended screening. J Cancer Surviv 2024:10.1007/s11764-024-01587-2. [PMID: 38642203 DOI: 10.1007/s11764-024-01587-2] [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: 01/31/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Hodgkin lymphoma (HL) survivors who received chest radiotherapy are at risk for breast cancer and cardiovascular disease, but screening adherence is low. We assessed the acceptability/feasibility of a web-based educational intervention and its impact on knowledge of health risks and screening. METHODS HL survivors were randomized to either an interactive online educational intervention or handouts only. Surveys were completed at baseline and 3 months post-intervention. We described the acceptability/feasibility of the intervention and compared knowledge between groups. RESULTS Fifty-two HL survivors participated; 27 in the intervention group and 25 in the control group. Eighteen (66%) intervention participants completed the intervention and reported high acceptability (89-100%). At baseline, adherence to breast cancer screening was low across all participants. Post-intervention, those in the intervention group more often than controls correctly identified breast cancer and echocardiogram screening guidelines (35% vs. 28%, P = 0.02 and 82% vs. 52%, P = 0.04) and reported knowing how to address potential complications from cancer treatments (87% vs. 64%, P = 0.03). We detected no increase in screening behavior post-intervention. CONCLUSION Online education modules for high-risk HL survivors are an acceptable method to improve knowledge of health risks and screening guidelines. Future interventions should focus on improving screening uptake in this population. IMPLICATIONS FOR CANCER SURVIVORS Web-based learning can be useful in increasing cancer survivor knowledge of their unique risks and screening recommendations but does not necessarily change patient behavior. Involvement in a cancer survivorship program can help assess individual barriers and monitor uptake of screening.
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Affiliation(s)
- Tara J Rick
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA.
- University of Minnesota Masonic Cancer Center, Minneapolis, USA.
| | | | - Patricia I Jewett
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, USA
| | - Karim T Sadak
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, USA
| | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, USA
| | - Rachel I Vogel
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, USA
| | - Anne Blaes
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
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3
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Williams VA, Brown NI, Johnson R, Ainsworth MC, Farrell D, Barnes M, Perumean-Chaney S, Fontaine K, Martin MY, Pekmezi D, Demark-Wahnefried W. A Web-based Lifestyle Intervention for Cancer Survivors: Feasibility and Acceptability of SurvivorSHINE. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1773-1781. [PMID: 34061334 PMCID: PMC8633161 DOI: 10.1007/s13187-021-02026-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 05/05/2023]
Abstract
Assess the feasibility, acceptability, and preliminary efficacy of a healthy lifestyle website, SurvivorSHINE ( www.survivorshine.org ), for cancer survivors using a mixed-methods approach. Formative research included a comprehensive literature review and four focus groups on website preferences with diagnosis-diverse cancer survivors (N = 17). Their feedback informed a web adaptation of a telephone counseling and mailed-print lifestyle intervention previously found effective for cancer survivors. The resulting web-based intervention was examined in a 3-week, single-arm trial among 41 cancer survivors. Assessments of physical activity, diet, body weight, and knowledge related to exercise and diet guidelines for cancer survivors occurred at baseline and 3 weeks later, along with exit interviews. Themes from focus groups indicated cancer survivors' desire for easy-to-use, interactive web-based platforms to access credible diet and exercise information. The study sample was recruited within 12 months, and study retention was high (85.4%). Participants showed significant pre- to post-test improvements in diet and exercise knowledge (t = 5.31, p < .0001) and physical activity (t = 2.40, p = .02). Improvements in body weight and some dietary components (red meat, alcohol) were observed, but did not reach statistical significance. Results support the feasibility and acceptability of SurvivorSHINE. The significant increases in healthy lifestyle knowledge and physical activity found in the current study are promising, but a larger, randomized-controlled trial is needed to determine efficacy.
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Affiliation(s)
- Victoria A Williams
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
| | - Nashira I Brown
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Roman Johnson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M Cole Ainsworth
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | | | | | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, UAB, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
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YENMİŞ G, BEŞLİ N. In vitro ve in silico analizi ile metforminin meme tümörü hücrelerinde protein profili üzerindeki etkinliği. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1126777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: This study aimed to uncover the varieties in protein profiles of Met in breast tumor (BT) cells by assessment of in vitro and in silico analysis.
Materials and Methods: Here, the cells obtained from mastectomy patients were cultured, the effective Met-dose was determined as 25 mM through cell viability and BrdU tests. Protein identification in the breast tumor cells was implemented by employing LC-MS/MS technology.
Results: The expression of SSR3, THAP3, FTH1, NEFM, ANP32A, ANP32B, KRT7 proteins was significantly decreased whereas the GARS protein increased in the 25 mM Met group compared to the Non-Met (0 mM) control group. In silico analysis, we analyzed the probable interactions of all these proteins with each other and other proteins, to evaluate the analysis of the larger protein network, and which metabolic pathway proteins are involved in.
Conclusion: The stated proteomics analysis in our study proposes a better understanding of the prognosis of breast cancer and future studies to investigate the effect of metformin in this field on proteomic pathways in other sorts of cancer.
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Affiliation(s)
- Güven YENMİŞ
- Department of Medical Biology, Faculty of Medicine, Biruni University, Istanbul, Turkiye
| | - Nail BEŞLİ
- Department of Medical Biology, Faculty of Medicine, University of Health Sciences, Istanbul, Turkiye
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Williams V, Brown N, Moore JX, Farrell D, Perumean-Chaney S, Schleicher E, Fontaine K, Demark-Wahnefried W, Pekmezi D. Web-Based Lifestyle Interventions for Survivors of Cancer: Usability Study. JMIR Form Res 2022; 6:e30974. [PMID: 35188468 PMCID: PMC8902653 DOI: 10.2196/30974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet-based lifestyle programs are increasingly being used to deliver health behavior change interventions to survivors of cancer. However, little is known about website use in this population or its association with healthy lifestyle changes. OBJECTIVE The aim of this study is to describe lifestyle intervention website use (log-ins, time on website, and page views) among survivors of cancer and patterns of use by participant characteristics. In addition, associations were explored between website use and changes in healthy lifestyle knowledge and practice. METHODS A total of 35 survivors of cancer were recruited between August 2017 and 2018 to participate in a 2-week, single-arm pilot test of the SurvivorSHINE lifestyle intervention website. Knowledge and practices related to healthy diet and physical activity behaviors were measured at baseline and follow-up. Website use (eg, time spent on the website, frequency of log-ins, and page views) were collected from the SurvivorSHINE administrative site during the intervention period. Patterns of use were examined by participants' gender and race. Correlations between website use and changes in healthy lifestyle knowledge, physical activity, diet, and weight were explored. Mann-Whitney U tests were used to compare demographic factors on website use. RESULTS Participants logged into the SurvivorSHINE intervention website an average of 3.2 (SD 2) times over the 2-week period and spent a total average of 94 (SD 56) minutes viewing the website during the intervention. Examining website activity, 1905 page views were logged. The User Profile (344 page views) and Home sections (301 page views) were the most frequently visited components. No associations were observed between the frequency of log-ins or the total time on the website, improvements in knowledge related to healthy lifestyles, or changes in body weight or dietary intake. However, the total time on the website was positively correlated with improvements in accelerometer-measured physical activity (r=0.74; P=.02) and self-reported physical activity (r=0.35; P=.04). CONCLUSIONS Survivors of cancer demonstrated clear interest in a diet and exercise intervention website, as evidenced by their frequency of log-ins, page views on numerous features, and total viewing time. Moreover, increased website use was correlated with improvements in physical activity.
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Affiliation(s)
- Victoria Williams
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nashira Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Justin Xavier Moore
- Department of Population Health Sciences, Augusta University, Augusta, GA, United States
| | | | - Suzanne Perumean-Chaney
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erica Schleicher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
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Higuera-Gomez A, Ribot-Rodriguez R, San-Cristobal R, Martín-Hernández R, Mico V, Espinosa-Salinas I, Ramirez de Molina A, Martinez JA. HRQoL and nutritional well-being dissimilarities between two different online collection methods: Value for digital health implementation. Digit Health 2022; 8:20552076221138316. [DOI: 10.1177/20552076221138316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Online health data collection has gained a reputation over the last years to record and process information about health issues for implementing digital health. Objective The research aim was to appraise two online methods (open and rewarded) to collect information about HRQoL and nutritional well-being and to compare the results between both surveyed populations. Methods This cross-sectional study is framed on the NUTRiMDEA project. Online data through two different web-based methods (open survey and rewarded survey) were retrieved to assemble data related to sociodemographic, lifestyle (diet, physical activity and sleep patterns) and general health aspects, as well as HRQoL by an evidence-based form such as the SF-12 questionnaire, the IPAQ survey, and MEDAS-14, participants were adults (>18 years old). Results Overall, 17,332 participants responded to the open survey (OS, n = 11,883) or the rewarded survey (RS, n = 5449). About 65.1% of the participants were female, while the mean age was in the range of 40–70 years. There were significant differences ( p < 0.05) between surveyed populations in sociodemographic, lifestyle (diet and physical activity), health and HRQoL data. Conclusions This investigation implemented an evidence-based online questionnaire that collected demographic, lifestyle factors, phenotypic and health-related aspects as well as compared differential outcomes in HRQoL and nutritional/lifestyle well-being depending on the online mode data collection. Findings demonstrated dissimilarities in most aspects of health, HRQoL, dietary intake and physical activity records between both populations. Overall, OS sample was characterized as a healthier population with superior lifestyle habits than RS participants.
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Affiliation(s)
- Andrea Higuera-Gomez
- Precision Nutrition and Cardiometabolic Health Program, Research Institute on Food and Health Sciences IMDEA Food, UAM + CSIC, Madrid, Spain
| | - Rosa Ribot-Rodriguez
- Precision Nutrition and Cardiometabolic Health Program, Research Institute on Food and Health Sciences IMDEA Food, UAM + CSIC, Madrid, Spain
| | - Rodrigo San-Cristobal
- Precision Nutrition and Cardiometabolic Health Program, Research Institute on Food and Health Sciences IMDEA Food, UAM + CSIC, Madrid, Spain
| | - Roberto Martín-Hernández
- Bioinformatics and Biostatistics Unit, Madrid Institute for Advanced Studies (IMDEA) Food, CEI UAM + CSIC, Madrid, Spain
| | - Victor Mico
- Precision Nutrition and Cardiometabolic Health Program, Research Institute on Food and Health Sciences IMDEA Food, UAM + CSIC, Madrid, Spain
| | - Isabel Espinosa-Salinas
- Nutritional Genomics and Health Unit, Research Institute on Food and Health Sciences IMDEA Food, UAM + CSIC, Madrid, Spain
| | - Ana Ramirez de Molina
- Molecular Oncology Group, Research Institute on Food and Health Sciences IMDEA Food, UAM + CSIC, Madrid, Spain
| | - J Alfredo Martinez
- Precision Nutrition and Cardiometabolic Health Program, Research Institute on Food and Health Sciences IMDEA Food, UAM + CSIC, Madrid, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain
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Hoover JC, Alenazi AM, Alshehri MM, Alqahtani BA, Alothman S, Sarmento C, Yahya A, Rucker JL, Kluding PM. Recruiting and Retaining Patients with Breast Cancer in Exercise Trials: A Meta-analysis. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021. [DOI: 10.1249/tjx.0000000000000149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
This narrative review of web-delivered weight management, diet quality, and physical activity interventions for cancer survivors relies on a systematic search of PubMed, Psych Info, and EBSCOhost which identified 19 unique web-delivered lifestyle interventions for cancer survivors. The sample sizes for these studies ranged from 11–492. Intervention duration ranged from 1–12 months; however, most interventions were 6–12 weeks in length. Ten studies were randomized controlled trials (RCTs), two were two-arm quasi RCTs, and seven employed a single-arm pre/post-test design. Many (N= 15) of the interventions were well-grounded in behavioral theory, which may have led to favorable behavior change. Most studies (15-of-19) targeted and reported increases in physical activity, while only a few targeted and reported improvements in diet quality (36.9% and 15.8%, respectively) and weight management (26.3% and 10.5%, respectively). A notable limitation was that most studies were conducted among populations that were primarily White and female. Future directions for Internet-based lifestyle interventions for cancer survivors include increasing: (a) focus on multiple behavior change, (b) representation of male and minority populations to improve generalizability of findings, (c) extended intervention duration and follow-up to evaluate long-term efficacy of web-based lifestyle interventions, and (d) sample size to allow for adequate statistical power.
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9
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A Randomized Controlled Trial Testing the Effectiveness of Coping with Cancer in the Kitchen, a Nutrition Education Program for Cancer Survivors. Nutrients 2020; 12:nu12103144. [PMID: 33076229 PMCID: PMC7602419 DOI: 10.3390/nu12103144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022] Open
Abstract
Following a diet rich in whole grains, vegetables, fruit, and beans may reduce cancer incidence and mortality. The aim of this study was to investigate the effect of Coping with Cancer in the Kitchen (CCK), an 8 week in-person program offering education, culinary demonstrations and food tasting, and psychosocial group support, compared to receiving CCK printed materials by mail on knowledge, confidence, and skills in implementing a plant-based diet. A total of 54 adult cancer survivors were randomly assigned to intervention (n = 26) and control groups (n = 27) with assessments at baseline, 9, and 15 weeks via self-administered survey. The response rate was 91% at 9 weeks and 58% at 15 weeks. The majority of our study participants were female breast cancer survivors (58%) who had overweight or obesity (65%). Compared with the control, there were significant (p < 0.05) increases in intervention participants’ knowledge about a plant-based diet at weeks 9 and 15, reductions in perceived barriers to eating more fruits and vegetables at week 9, and enhanced confidence and skills in preparing a plant-based diet at week 15. There was a significant reduction in processed meat intake but changes in other food groups and psychosocial measures were modest. Participation in CCK in person increased knowledge, skills, and confidence and reduced barriers to adopting a plant-based diet. Positive trends in intake of plant-based foods and quality of life warrant further investigation in larger-scale studies and diverse populations.
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10
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Chhabria K, Ross KM, Sacco SJ, Leahey TM. The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study. J Med Internet Res 2020; 22:e17967. [PMID: 32720911 PMCID: PMC7420735 DOI: 10.2196/17967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. OBJECTIVE This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. METHODS Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. RESULTS In Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=-0.26; P=.06). CONCLUSIONS The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244.
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Affiliation(s)
- Karishma Chhabria
- The Center for Health Care Data, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Shane J Sacco
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Tricia M Leahey
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
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Skiba MB, McElfresh JJ, Howe CL, Crane TE, Kopp LM, Jacobs ET, Thomson CA. Dietary Interventions for Adult Survivors of Adolescent and Young Adult Cancers: A Systematic Review and Narrative Synthesis. J Adolesc Young Adult Oncol 2020; 9:315-327. [DOI: 10.1089/jayao.2019.0105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Meghan B. Skiba
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer J. McElfresh
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Carol L. Howe
- University of Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Tracy E. Crane
- Department of Biobehavioral Sciences, College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Lisa M. Kopp
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Lopez C, McGarragle K, Pritlove C, Jones JM, Alibhai SMH, Lenton E, Santa Mina D. Variability and limitations in home-based exercise program descriptions in oncology: a scoping review. Support Care Cancer 2020; 28:4005-4017. [PMID: 32296982 DOI: 10.1007/s00520-020-05453-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The literature reflects considerable heterogeneity in what constitutes home-based exercise interventions. The variability for where and what "home-based" exercise can represent challenges interpretation of findings and appropriate advocacy, referral, or development of these models of care. Therefore, the objective of this review was to provide a comprehensive summary of how home-based exercise is defined and reported in the literature and summarize the range of supportive elements utilized in home-based exercise trials. METHODS We followed methodology for scoping reviews. Relevant research databases were searched from inception to March 2019. Two reviewers independently screened articles to determine eligibility and extracted terminology used to describe home-based exercise and intervention details for intervention delivery. RESULTS Of the 9432 records identified, 229 articles met inclusion criteria. Across the literature, exercise interventions were described as home-based if they were completed at-home, outdoors in the neighbourhood, and in community facilities; or in self-selected environments; or if they were unsupervised. Supportive elements for home-based models ranged with respect to the amount of supervision and resources utilized, including the provision of print materials, exercise equipment, telephone support, home visits, and technology. CONCLUSIONS This review provides a comprehensive summary of strategies previously utilized to deliver home-based exercise interventions in oncology, along with the various definitions of the home-based environment for exercise reported by researchers. Specific recommendations to improve the prescription and reporting of home-based exercise interventions are provided in order to facilitate the delivery, evaluation, and translation of findings into clinical practice.
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Affiliation(s)
- Christian Lopez
- Faculty of Kinesiology and Physical Education, The University of Toronto, 55 Harbord St., Toronto, Ontario, M5S 2W6, Canada
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kaitlin McGarragle
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Cheryl Pritlove
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Jennifer M Jones
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Erica Lenton
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, The University of Toronto, 55 Harbord St., Toronto, Ontario, M5S 2W6, Canada.
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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13
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Ayyoubzadeh SM, R. Niakan Kalhori S, Shirkhoda M, Mohammadzadeh N, Esmaeili M. Supporting colorectal cancer survivors using eHealth: a systematic review and framework suggestion. Support Care Cancer 2020; 28:3543-3555. [DOI: 10.1007/s00520-020-05372-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/20/2020] [Indexed: 01/01/2023]
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14
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A Systematic Review of Electronic Health (eHealth) interventions to improve physical activity in patients with breast cancer. Breast Cancer 2019; 27:25-46. [DOI: 10.1007/s12282-019-00982-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
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15
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Nero H, Ranstam J, Kiadaliri AA, Dahlberg LE. Evaluation of a digital platform for osteoarthritis treatment: study protocol for a randomised clinical study. BMJ Open 2018; 8:e022925. [PMID: 30413507 PMCID: PMC6231565 DOI: 10.1136/bmjopen-2018-022925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Despite favourable results from structured face-to-face treatment of osteoarthritis (OA) in Sweden through the Better management of patients with OsteoArthritis (BOA) initiative, only around 20% of people with knee or hip OA receive the primary treatment recommended by international guidelines (ie, information, exercise, weight management). In 2014, a digital treatment programme named Joint Academy was introduced in Sweden, based on the same concept as the face-to-face BOA programme. In line with BOA, Joint Academy follows national and international guidelines and best practice for OA treatment. Results from observational studies suggest that this digital treatment is a valuable alternative to the traditional treatment approach and can positively impact patients' function and pain. However, conclusions from such studies commonly suggest that more rigorous testing is necessary to ascertain the benefits of digital treatment delivery for people with OA. METHODS AND ANALYSIS A randomised clinical trial will be performed, comparing regular face-to-face care according to BOA with the digital version, Joint Academy. A total of 270 participants with clinically diagnosed knee OA will be recruited at primary care centres and randomised to either standard treatment (BOA) for 3 months, or the experimental group (digital intervention programme). Both groups will receive educational sessions and exercises yet with a difference in programme deliverance. The objective of the trial is to evaluate the effectiveness of the online treatment programme, in comparison with BOA. The two treatment groups will be compared with respect to the number of repetitions of the 30 s chair stand test at 3, 6 and 12 months, using a mixed model repeated measures analysis of variance. ETHICS AND DISSEMINATION Ethical approval has been attained from the Regional Board of Ethics in Lund, Sweden (Dnr 2017/719). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03328741.
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Affiliation(s)
- Håkan Nero
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Joint Academy, Malmö, Sweden
| | - Jonas Ranstam
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Leif E Dahlberg
- Joint Academy, Malmö, Sweden
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
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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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17
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Preclinical randomized controlled trial of bilateral discectomy versus bilateral discopexy in Black Merino sheep temporomandibular joint: TEMPOJIMS – Phase 1- histologic, imaging and body weight results. J Craniomaxillofac Surg 2018; 46:688-696. [DOI: 10.1016/j.jcms.2018.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/27/2017] [Accepted: 01/22/2018] [Indexed: 12/18/2022] Open
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18
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Haggerty AF, Hagemann A, Barnett M, Thornquist M, Neuhouser ML, Horowitz N, Colditz GA, Sarwer DB, Ko EM, Allison KC. A Randomized, Controlled, Multicenter Study of Technology-Based Weight Loss Interventions among Endometrial Cancer Survivors. Obesity (Silver Spring) 2017; 25 Suppl 2:S102-S108. [PMID: 29086522 PMCID: PMC6743497 DOI: 10.1002/oby.22021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to test the efficacy of technology-based weight loss interventions for endometrial cancer (EC) survivors with obesity. METHODS EC survivors with obesity (n = 196) from three medical centers completed assessments for knowledge of obesity as a risk for EC and interest in weight management. Forty-one women were randomized to a 6-month intervention: telemedicine with Wi-Fi scales, text messaging (texting), or enhanced usual care (EUC). Changes in anthropometrics and psychosocial measures were analyzed. RESULTS One-third of survey participants lacked awareness that obesity increased the risk of EC, and 40% misclassified their body mass. There were no significant differences in weight loss across interventions (mean = -4.4 kg, SD = 6.5 kg). Telemedicine showed improvements in physical health and cancer-related body image (Ps = 0.04) compared to texting and in sexual functioning compared to EUC (P = 0.03). Total physical activity was increased in EUC compared with telemedicine (P = 0.01), and vigorous physical activity was increased in EUC compared with both interventions (P = 0.01-0.03); walking significantly increased in texting compared with telemedicine (P = 0.02). CONCLUSIONS Technology-based lifestyle interventions in EC survivors with obesity were accessible and resulted in weight loss and improved quality of life. EUC also produced weight loss, demonstrating a potential for beginning weight management with information on specific diet and exercise goals.
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Affiliation(s)
- Ashley F. Haggerty
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Hagemann
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Barnett
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mark Thornquist
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Neil Horowitz
- Dana Farber Cancer Institute, Harvard University, Cambridge, Massachusetts, USA
| | - Graham A. Colditz
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David B. Sarwer
- College of Public Health and Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA
| | - Emily M. Ko
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly C. Allison
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Al-Zaidan L, El Ruz RA, Malki AM. Screening Novel Molecular Targets of Metformin in Breast Cancer by Proteomic Approach. Front Public Health 2017; 5:277. [PMID: 29085821 PMCID: PMC5650619 DOI: 10.3389/fpubh.2017.00277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/27/2017] [Indexed: 01/09/2023] Open
Abstract
Metformin is a commonly prescribed antihyperglycemic drug, and has been investigated in vivo and in vitro for its effect to improve the comorbidity of diabetes and various types of cancers. Several studies investigated the therapeutic mechanisms of metformin on cancer cells, but the exact mechanism of metformin’s effect on the proteomic pathways of cancer cells is yet to be further investigated. The main objective of our research line is to discover safe and alternative therapeutic options for breast cancer, we aimed in this study to design a novel “bottom up proteomics workflow” in which proteins were first broken into peptides to reveal their identity, then the proteomes were precisely evaluated using spectrometry analysis. In our study, metformin suppressed cell proliferation and induced apoptosis in human breast carcinoma cell line MCF-7 with minimal toxicity to normal breast epithelial cells MCF-10. Metformin induced apoptosis by arresting cells in G1 phase as evaluated by flow cytometric analysis. Moreover, The G1 phase arrest for the MCF-7 has been confirmed by increased expression levels of p21 and reduction in cyclin D1 level. Additionally, metformin increased the expression levels of p53, Bax, Bad while it reduced expression levels of Akt, Bcl-2, and Mdm2. The study employed a serviceable strategy that investigates metformin-dependent changes in the proteome using a literature-derived network. The protein extracts of the treated and untreated cell lines were analyzed employing proteomic approaches; the findings conveyed a proposed mechanism of the effectual tactics of metformin on breast cancer cells. Metformin proposed an antibreast cancer effect through the examination of the proteomic pathways upon the MCF-7 and MCF-10A exposure to the drug. Our findings proposed prolific proteomic changes that revealed the therapeutic mechanisms of metformin on breast cancer cells upon their exposure. In conclusion, the reported proteomic pathways lead to increase the understanding of breast cancer prognosis and permit future studies to examine the effect of metformin on the proteomic pathways against other types of cancers. Finally, it suggests the possibility to develop further therapeutic generations of metformin with increased anticancer effect through targeting specific proteomes.
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Affiliation(s)
- Lobna Al-Zaidan
- Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Rasha Abu El Ruz
- Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Ahmed M Malki
- Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, Qatar
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Lynch SM, Stricker CT, Brown JC, Berardi JM, Vaughn D, Domchek S, Filseth S, Branas A, Weiss-Trainor E, Schmitz KH, Sarwer DB. Evaluation of a web-based weight loss intervention in overweight cancer survivors aged 50 years and younger. Obes Sci Pract 2017; 3:83-94. [PMID: 28392934 PMCID: PMC5358075 DOI: 10.1002/osp4.98] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 01/29/2023] Open
Abstract
Purpose Half of adult cancer survivors under age 50 years are obese. Excess body weight is associated with cancer recurrence, and effective weight loss interventions for younger cancer survivors are needed. Commercially available, online weight loss programmes are readily accessible, but few have been studied in this population. This study employed a single‐arm, pre‐post intervention (baseline‐6 month/baseline‐12 month comparisons) to preliminarily explore feasibility, efficacy and safety of an online, commercially available weight loss programme in breast (n = 30) and testicular (n = 16) cancer survivors under age 50 years. Methods The intervention included three daily components: exercise, nutritional/behavioural modification strategies and health lessons. Intention‐to‐treat and completers analyses were conducted. Feasibility was measured by participation (number of participants enrolled/number screened), retention (number of participants attending 6/12 month study visit/number of enrolled) and self‐reported adherence rates (average of mean percent adherence to each of the three intervention components). Efficacy was assessed by changes in initial weight (percent weight loss). Safety was assessed by adverse events. Results The mean participation rate was 42%. The retention rate was 59% at 6 and 49% at 12 months. The adherence rate for all participants (completers/dropouts/lost‐to‐follow‐up) was 50.1% at 6 and 44% at 12 months. Completers reported adherence rates of 68% at 12 months. Study participants lost 5.3% body weight at 12 months; completers lost 9%. Only three unexpected adverse events (unrelated to the intervention) were reported. Conclusion Clinically significant weight loss was observed, although retention rates were low. Findings generally support preliminary feasibility, efficacy and safety of this online weight loss programme, and future randomized control trials should be explored.
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Affiliation(s)
- S M Lynch
- Cancer Prevention and Control Fox Chase Cancer Center Philadelphia PA USA; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia PA USA
| | - C T Stricker
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - J C Brown
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia PA USA
| | | | - D Vaughn
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - S Domchek
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - S Filseth
- Recruitment, Outreach, and Assessment Resource(ROAR), Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - A Branas
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | | | - K H Schmitz
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia PA USA
| | - D B Sarwer
- Center for Obesity Research and Education, College of Public Health Temple University Philadelphia PA USA
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