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Skiba MB, Miller D, Stratton DB, Hall CA, McKenna S, Blair CK, Demark-Wahnefried W. Adaptation and study protocol for harvest for health together Arizona: A mentored community garden intervention for survivors of cancer. Contemp Clin Trials Commun 2024; 39:101290. [PMID: 38595771 PMCID: PMC11002544 DOI: 10.1016/j.conctc.2024.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/16/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Background Current health behavior recommendations for skin cancer prevention, treatment, and survivorship are the same for survivors of other cancers; they include eating a healthy diet, being physically active, maintaining a healthy weight, and minimizing ultraviolet (U.V.) exposure. Few interventions exist to support health behaviors beyond U.V. exposure. We adapted Harvest for Health, a home-based mentored gardening intervention for cancer survivors, for implementation in Arizona as a community-based intervention. Methods Stakeholder-informed adaptations for Harvest for Health Together Arizona (H4H2-AZ) included updating intervention materials to be relevant to the arid desert environment, emphasizing the importance of sun safety in cancer survivorship, and shifting from a home-based to a community-based delivery model. Participants will be enrolled in cohorts aligned with growing seasons (e.g., spring, monsoon, fall) and matched to an individual 30 ft2 community garden plot for two growing seasons (6 months). Original intervention components retained are: 1) Master Gardeners deliver the intervention providing one-to-one mentorship and 2) gardening materials and supplies provided. This pilot six-month single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer as primary outcomes. Secondary outcomes are to explore the effects on cancer preventive health behaviors and health-related quality of life. Discussion This pilot single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer. If successful, the intervention could be widely implemented throughout existing Master Gardener programs and community garden networks for survivors of other cancers. Trial registration ClinicalTrials.gov identifier: NCT05648604. Trial registered on December 13, 2022.
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Affiliation(s)
- Meghan B. Skiba
- Advanced Nursing Practice and Science Division, College of Nursing, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Dylan Miller
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Epidemiology, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Delaney B. Stratton
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Dermatology, Banner University Health, Tucson, AZ, USA
| | - Caitlyn A. Hall
- W.A. Franke Honors College, University of Arizona, Tucson, AZ, USA
- Department of Biosystems Engineering, College of Agricultural and Life Sciences, University of Arizona, Tucson, AZ, USA
| | - Sharon McKenna
- Melanoma Task Force, Arizona Department of Health Services, Phoenix, AZ, USA
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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Krok-Schoen JL, Chaplow ZL, Chase C, Spees C, Rosko A, Naughton MJ, Smith J, Soufi S, Beck M, Focht BC. E-PROOF: E-intervention for protein intake and resistance training to optimize function: A study protocol. PLoS One 2024; 19:e0302727. [PMID: 38718069 PMCID: PMC11078354 DOI: 10.1371/journal.pone.0302727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Accounting for more than 60% of cancer survivors, older (≥65 years) cancer survivors have a 2- to 5-fold risk of physical function impairment, compared to cancer-free peers. One strategy to improve physical function is dietary and resistance training interventions, which improve muscle strength and mass by stimulating muscle protein synthesis. The E-PROOF (E-intervention for Protein Intake and Resistance Training to Optimize Function) study will examine the feasibility, acceptability, and preliminary efficacy of a 12-week randomized controlled trial of an online, tailored nutritional and resistance training education and counseling intervention to improve physical function and associated health outcomes (muscle strength, health-related quality of life (HRQoL), self-efficacy, and weight management). METHODS In this study, 70 older cancer survivors will be randomized to one of two groups: experimental (receiving remote behavioral counseling and evidence-based education and resources), and control (general survivorship education). We will examine the intervention effects on physical function, muscle strength, HRQoL, self-efficacy, weight, and waist circumference during a 12-week period between the experimental and control groups. Three months following the end of the intervention, we will conduct a follow-up assessment to measure physical function, muscle strength, and HRQoL. SIGNIFICANCE AND IMPACT This study is the first synchronous, online protein-focused diet and resistance training intervention among older cancer survivors. This novel study advances science by promoting independent health behaviors among older cancer survivors to improve health outcomes, and provide foundational knowledge to further address this growing problem on a wider scale through online platforms.
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Affiliation(s)
- Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Zachary L. Chaplow
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
| | - Cara Chase
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Colleen Spees
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Ashley Rosko
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Michelle J. Naughton
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Jade Smith
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Sam Soufi
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
| | - Mike Beck
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
| | - Brian C. Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America
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Werts SJ, Lavelle SA, Crane TE, Thomson CA. Recruitment and Retention Strategies Used in Dietary Randomized Controlled Interventions with Cancer Survivors: A Systematic Review. Cancers (Basel) 2023; 15:4366. [PMID: 37686640 PMCID: PMC10486591 DOI: 10.3390/cancers15174366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The purpose of this review was to systematically evaluate the quality of reporting of recruitment and retention methods in diet-related intervention trials among cancer survivors. METHODS A systematic search of five databases in Spring 2023 identified dietary intervention randomized controlled trials with a minimum of 50 cancer survivors, an intervention of at least eight weeks, and at least six months of study duration. Outcomes investigated include methodologic description and reporting of recruitment and retention rates. RESULTS Seventeen trials met inclusion criteria. Recruitment methods included cancer registry and clinician referral, hospital records, flyers, and media campaigns, and were reported in 88.2% of studies. Eleven of 17 studies (64.7%) met a priori recruitment goals. Eleven studies identified an a priori retention goal and seven met the goal. Retention goals were met more often for studies of less than one year (71.4%) versus greater than one year (50%), and for studies with remote or hybrid delivery (66.7%) versus only in-person delivery (50%). CONCLUSIONS Recruitment goals and methods are frequently reported; reporting of retention methods and goals is limited. Efforts are needed to improve reporting of retention methods and rates to inform best practices and enhance the rigor of future dietary intervention trials.
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Affiliation(s)
- Samantha J. Werts
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA
| | - Sarah A. Lavelle
- College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA;
| | - Tracy E. Crane
- Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
| | - Cynthia A. Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA
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Yun J, Yao W, Meng T, Mu Z. Effects of horticultural therapy on health in the elderly: A review and meta-analysis. Z Gesundh Wiss 2023:1-27. [PMID: 37361284 PMCID: PMC10240129 DOI: 10.1007/s10389-023-01938-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/07/2023] [Indexed: 06/28/2023]
Abstract
Aim Given the current aging population, the demand on medical facilities, facilities for elderly care, and even their high prevalence, it is crucial to investigate the advantages of older people. The purpose of our study was to systematically review the existing literature on the health effects of horticultural therapy as a treatment option for the elderly. Subject and methods Article searches were conducted through five databases: Web of science, Science Direct, PubMed, EBSCO, and Google Scholar, according to the standard method of systematic evaluation and meta-analysis. Thirty-two published articles were included, and 27 relevant variables were meta-analyzed to assess the benefits of horticultural therapy in terms of physical and psychological functioning in the elderly. Results Results show that horticultural therapy may be helpful in helping seniors lose weight -0.195 (95% CI -0.507,0.117), reduce their waist circumference -0.327 (95% CI -0.637, -0.017), lower their stress -0.339 (95% CI -0.610, -0.069) and cortisol -0.902 (95% CI -0.728, -0.002) levels, improve their physical flexibility 0.302 (95% CI 0.036, 0.569), social interaction 0.370, (95% CI 0.115, 0.624), and daily vegetables and fruit consumption 0.688 (95% CI: 0.287, 1.089). Conclusion Horticultural therapy may be a useful tool for enhancing the physical, mental and social aspects of the elderly. However, there is substantial heterogeneity and wide variation in the quality of the included studies. Further high-quality studies, rigorous controls and adjustments for significant confounding variables, and larger populations are needed in the future to further our understanding of the link between horticultural therapy and elder health. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01938-w.
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Affiliation(s)
- Jiayue Yun
- Department of Landscape Architecture, College of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, Shandong 266000 People’s Republic of China
| | - Wenfei Yao
- Department of Landscape Architecture, College of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, Shandong 266000 People’s Republic of China
| | - Tian Meng
- Department of Landscape Architecture, College of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, Shandong 266000 People’s Republic of China
| | - Zhiyue Mu
- Department of Landscape Architecture, College of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, Shandong 266000 People’s Republic of China
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Smith KS, Tissier A, Bail JR, Novak JR, Morrow CD, Demark-Wahnefried W, Frugé AD. Health-related quality of life is associated with fecal microbial composition in breast cancer survivors. Support Care Cancer 2022; 31:10. [PMID: 36512109 DOI: 10.1007/s00520-022-07496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
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.
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Affiliation(s)
- Kristen S Smith
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA.
| | - Abby Tissier
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA
| | - Jennifer R Bail
- College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA
| | - Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, AL, USA
| | - Casey D Morrow
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Andrew D Frugé
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA
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Bikomeye JC, Balza JS, Kwarteng JL, Beyer AM, Beyer KMM. The impact of greenspace or nature-based interventions on cardiovascular health or cancer-related outcomes: A systematic review of experimental studies. PLoS One 2022; 17:e0276517. [PMID: 36417344 PMCID: PMC9683573 DOI: 10.1371/journal.pone.0276517] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
SIGNIFICANCE Globally, cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. While having different etiologies, CVD and cancer are linked by multiple shared risk factors, the presence of which exacerbate adverse outcomes for individuals with either disease. For both pathologies, factors such as poverty, lack of physical activity (PA), poor dietary intake, and climate change increase risk of adverse outcomes. Prior research has shown that greenspaces and other nature-based interventions (NBIs) contribute to improved health outcomes and climate change resilience. OBJECTIVE To summarize evidence on the impact of greenspaces or NBIs on cardiovascular health and/or cancer-related outcomes and identify knowledge gaps to inform future research. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Peer Review of Electronic Search Strategies (PRESS) guidelines, we searched five databases: Web of Science, Scopus, Medline, PsycINFO and GreenFile. Two blinded reviewers used Rayyan AI and a predefined criteria for article inclusion and exclusion. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). This review is registered with PROSPERO, ID # CRD42021231619. RESULTS & DISCUSSION Of 2565 articles retrieved, 31 articles met the inclusion criteria, and overall had a low risk of bias. 26 articles studied cardiovascular related outcomes and 5 studied cancer-related outcomes. Interventions were coded into 4 categories: forest bathing, green exercise, gardening, and nature viewing. Outcomes included blood pressure (BP), cancer-related quality of life (QoL) and (more infrequently) biomarkers of CVD risk. Descriptions of findings are presented as well as visual presentations of trends across the findings using RAW graphs. Overall studies included have a low risk of bias; and alluvial chart trends indicated that NBIs may have beneficial effects on CVD and cancer-related outcomes. CONCLUSIONS & IMPLICATIONS (1) Clinical implication: Healthcare providers should consider the promotion of nature-based programs to improve health outcomes. (2) Policy implication: There is a need for investment in equitable greenspaces to improve health outcomes and build climate resilient neighborhoods. (3) Research or academic implication: Research partnerships with community-based organizations for a comprehensive study of benefits associated with NBIs should be encouraged to reduce health disparities and ensure intergenerational health equity. There is a need for investigation of the mechanisms by which NBIs impact CVD and exploration of the role of CVD biological markers of inflammation among cancer survivors.
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Affiliation(s)
- Jean C. Bikomeye
- Division of Epidemiology & Social Sciences, PhD Program in Public and Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Joanna S. Balza
- Division of Epidemiology & Social Sciences, PhD Program in Public and Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jamila L. Kwarteng
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Andreas M. Beyer
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
- Division of Cardiology, Department of Medicine, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Kirsten M. M. Beyer
- Division of Epidemiology & Social Sciences, PhD Program in Public and Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America
- MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
- * E-mail:
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Briggs R, Morris PG, Rees K. The effectiveness of group-based gardening interventions for improving wellbeing and reducing symptoms of mental ill-health in adults: a systematic review and meta-analysis. J Ment Health 2022:1-18. [PMID: 36151719 DOI: 10.1080/09638237.2022.2118687] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is increasing interest in the association between nature, health and wellbeing. Gardening is a popular way in which interaction with nature occurs and numerous gardening projects aim to facilitate wellbeing among participants. More research is needed to determine their effectiveness. AIM To systematically evaluate the effectiveness of group-based gardening interventions for increasing wellbeing and reducing symptoms of mental ill-health in adults. METHODS A systematic review of Randomised Controlled Trials was conducted following the protocol submitted to PROSPERO (CRD42020162187). Studies reporting quantitative validated health and wellbeing outcomes of the community residing, adult populations (18+) were eligible for inclusion. RESULTS 24 studies met inclusion criteria: 20 completed and four ongoing trials. Meta-analyses suggest these interventions may increase wellbeing and may reduce symptoms of depression, however, there was uncertainty in the pooled effects due to heterogeneity and unclear risk of bias for many studies. There were mixed results for other outcomes. RESEARCH LIMITATIONS/IMPLICATIONS Heterogeneity and small sample sizes limited the results. Poor reporting precluded meta-analysis for some studies. Initial findings for wellbeing and depression are promising and should be corroborated in further studies. The research area is active, and the results of the ongoing trials identified will add to the evidence base.
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Affiliation(s)
- Rebecca Briggs
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland.,Warwick Medical School, The University of Warwick, Coventry, England
| | - Paul Graham Morris
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland
| | - Karen Rees
- Warwick Medical School, Health Sciences, The University of Warwick, Coventry, England
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Bail JR, Blair CK, Smith KP, Oster RA, Kaur H, Locher JL, Frugé AD, Rocque G, Pisu M, Cohen HJ, Demark-Wahnefried W. 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. J Acad Nutr Diet 2022; 122:1629-1643. [PMID: 35533876 PMCID: PMC10656755 DOI: 10.1016/j.jand.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- Jennifer R Bail
- College of Nursing, University of Alabama in Huntsville, Huntsville, AL; Department of Nutrition Sciences, University of Alabama, Birmingham, AL
| | - Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Kerry P Smith
- Alabama Cooperative Extension System, Auburn University, Auburn, AL
| | - Robert A Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, AL
| | - Harleen Kaur
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL
| | - Julie L Locher
- Division of Geriatrics, Department of Medicine, University of Alabama, Birmingham, AL
| | - Andrew D Frugé
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL; Department of Nutrition, Dietetics & Hospitality Management, Auburn University, Auburn, AL
| | | | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, AL
| | - Harvey Jay Cohen
- Department of Medicine, Duke University Medical Center, Durham, NC
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Sharma H, Pankratz VS, Demark-Wahnefried W, Pestak CR, Blair CK. Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors. Healthcare (Basel) 2022; 10:1421. [PMID: 36011078 PMCID: PMC9407773 DOI: 10.3390/healthcare10081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To examine potential factors associated with maintaining or improving self-reported physical function (PF) among older cancer survivors participating in a gardening intervention impacted by the Coronavirus 2019 (COVID-19) pandemic. Methods: Thirty cancer survivors completed a home-based gardening intervention to encourage a healthier diet and a more active lifestyle. Device-based measures of physical activity (PA) and surveys to evaluate quality of life (QOL; PROMIS-57 questionnaire) were administered at baseline, mid-intervention (6 months), and post-intervention (9 months). Results: Depression, fatigue, and sleeplessness at baseline were significantly associated with worse average PF scores across follow-up (2.3 to 4.9 points lower for every decrease of 5 points in the QOL score; p-values < 0.02). Worsening of these QOL domains during the intervention was also associated with an additional decrease of 2.1 to 2.9 points in PF over follow-up (p values < 0.01). Better social participation and PA at baseline were significantly associated with better average PF scores during the intervention (2.8 to 5.2 points higher for every 5-point increase in social participation or 30 min more of PA; p values < 0.05). Every 5-point increase in pain at baseline, or increases in pain during the intervention, was associated with decreases of 4.9 and 3.0 points, respectively, in PF. Conclusions: Worse QOL scores before and during the intervention were significantly associated with worse PF over follow-up. Encouraging social participation and PA through interventions such as home-based gardening may improve long-term health among older cancer survivors.
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Affiliation(s)
- Harsh Sharma
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
| | - Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Claire R. Pestak
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
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Cases MG, Blair CK, Hendricks PS, Smith K, Snyder S, Demark-Wahnefried W. Sustainability capacity of a vegetable gardening intervention for cancer survivors. BMC Public Health 2022; 22:1238. [PMID: 35733142 PMCID: PMC9215023 DOI: 10.1186/s12889-022-13644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/14/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Health behavior interventions, especially those that promote improved diet and physical activity, are increasingly directed toward cancer survivors given their burgeoning numbers and high risk for comorbidity and functional decline. However, for health behavior interventions to achieve maximal public health impact, sustainability at both the individual and organizational levels is crucial. The current study aimed to assess the individual and organizational sustainability of the Harvest for Health mentored vegetable gardening intervention among cancer survivors. METHODS Telephone surveys were conducted among 100 cancer survivors (mean age 63 years; primarily breast cancer) completing one-of-two Harvest for Health feasibility trials. Surveys ascertained whether participants continued gardening, and if so, whether they had expanded their gardens. Additionally, surveys were emailed to 23 stakeholders (Cooperative Extension county agents, cancer support group leaders, and healthcare representatives) who were asked to rate the intervention's ability to generate sustained service and produce benefits over time using the eight-domain Program Sustainability Assessment Tool (PSAT). RESULTS The survey among cancer survivors (91.9% response rate) indicated that 85.7% continued gardening throughout the 12 months following intervention completion; 47.3% expanded their gardens beyond the space of the original intervention. Moreover, 5.5% of cancer survivors enrolled in the certification program to become Extension Master Gardeners. The survey among stakeholders generated a similar response rate (i.e., 91.3%) and favorable scores. Of the possible maximum of 7 points on the PSAT, the gardening intervention's "Overall Capacity for Sustainability" scored 5.7 (81.4% of the maximum score), with subscales for "Funding Stability" scoring the lowest though still favorably (5.0) and "Program Evaluation" scoring the highest (6.3). CONCLUSIONS Data support the sustainability capacity of the Harvest for Health vegetable gardening intervention for cancer survivors. Indeed, few interventions have proven as durable in terms of individual sustainability. Furthermore, Harvest for Health's overall organizational score of 5.7 on the PSAT is considered strong when compared to a previous review of over 250 programs, where the mean overall organizational PSAT score was 4.84. Thus, solutions for long-term funding are currently being explored to support this strong, holistic program that is directed toward this vulnerable and growing population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02150148.
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Affiliation(s)
- Mallory G Cases
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Cindy K Blair
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM, 87131, USA.
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
| | - Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kerry Smith
- Alabama Cooperative Extension System, Auburn University, Auburn, AL, USA
| | - Scott Snyder
- School of Education, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, School of Health Professions, UAB, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
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Kaur H, Fernández JR, Locher JL, Demark-Wahnefried W. Rural and Urban Differences in Vegetable and Fruit Consumption Among Older Cancer Survivors in the Deep South: An Exploratory Cross-Sectional Study. J Acad Nutr Diet 2022; 122:1717-1724.e4. [PMID: 35017097 PMCID: PMC9271124 DOI: 10.1016/j.jand.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/21/2021] [Accepted: 01/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Cancer survivors, especially those who are older, experience increased comorbidity and risk for secondary cancers. A varied dietary pattern, rich in vegetables and fruit (V&F) is recommended to improve health. However, V&F intake may differ by rural versus urban status. OBJECTIVE To assess differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and explore whether differences exist by sex, race, and cancer type. DESIGN This was a cross-sectional secondary analysis. PARTICIPANTS/SETTING Screening data from the Harvest for Health trial were obtained from October 2016 to November 2019 on 731 Medicare-eligible cancer survivors across Alabama. MAIN OUTCOME MEASURES V&F consumption was measured by 2-items from the Eating at America's Table NCI Dietary Screener. Rural and urban residence was coded at the zip-code level using the USDA's Rural-Urban Commuting Area (RUCA) coding schema using five different classifications (A-E). Sex, race and cancer-type were dichotomized as male/female, Non-Hispanic White (NHW)/Non-Hispanic Black (NHB) and gastro-intestinal/other cancers, respectively. STATISTICAL ANALYSES Kruskal Wallis rank sum and post-hoc tests were performed to detect differences in V&F consumption (α<0.05). RESULTS The study sample was largely female (66.2%), NHW (78.1%), of mean age 70 years and reported an average V&F intake of 1.47 cups/day. V&F consumption of cancer survivors living in isolated, small, rural towns was roughly half that consumed by survivors living elsewhere; thus, statistically significant rural-urban differences were found in models that accounted specifically for this subgroup, i.e., RUCA categorizations A and E.V&F consumption also was significantly lower in NHB (1.32 ± 0.98 cups/day) than NHW survivors (1.51 ± 1.10 cups/day) (p=0.0456); however, no statistically significant differences were detected by sex and cancer type. CONCLUSION Analyses that address the variability within "rural" designated areas are important in future studies. Moreover, a greater understanding is needed of factors that adversely affect V&F consumption of those most vulnerable, i.e., older NHB cancer survivors as well as those living in isolated, small, rural towns to best target future interventions.
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Affiliation(s)
- Harleen Kaur
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 604A Birmingham, AL 35294-3360.
| | - José R Fernández
- Professor and Vice Chair for Education, Department of Nutrition Sciences, UAB, 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 522 Birmingham, AL 35294-3360
| | - Julie L Locher
- Professor Emerita, Department of Medicine, UAB, CH19-Room 218F; Birmingham, Alabama 35294-2041
| | - Wendy Demark-Wahnefried
- Associate Director for Cancer Prevention and Control for the O'Neal Comprehensive Cancer Center at UAB, Professor and Webb Endowed Chair of Nutrition Sciences, American Cancer Society Clinical Research Professor, Department of Nutrition Sciences, UAB, 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 650 Birmingham, AL 35294-3360
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12
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Ashley Verzwyvelt L, McNamara A, Xu X, Stubbins R. Effects of virtual reality v. biophilic environments on pain and distress in oncology patients: a case-crossover pilot study. Sci Rep 2021; 11:20196. [PMID: 34642416 DOI: 10.1038/s41598-021-99763-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
This pilot study aimed to determine if a biophilic Green Therapy or Virtual Reality environment can decrease an oncology patient’s pain and distress while receiving chemotherapy. A case-crossover pilot study was conducted in a comprehensive cancer infusion center. 33 participants with breast, gynecologic, gastrointestinal, pancreatic and prostate cancers were all included in three rooms in a random order at different cycles: control room, Green Therapy room, and Virtual Reality room to receive chemotherapy, respectively. Participants’ pain, distress, heart rate, blood pressure, and saliva cortisol were measured before and after infusion in each room. No statistical significance differences were shown in the changes of heart rate, systolic, or diastolic blood pressure, saliva cortisol, pain, or distress before and after infusion between the control, Green Therapy, and Virtual Reality rooms. However, more patients reported the experience as “fun” and “enjoyable” when they were in Green Therapy or Virtual reality room as compared to in the control room. Additionally, since participating in the study, 14 patients reported spending at least 30 min or more outside in nature. In this study, we found that patients’ heart rate, blood pressure, and self-reported distress levels were reduced after each biophilic intervention although results are not statistically significant. The study also suggested that biophilic interventions are safe and feasible and may complement the standard of care for oncology patients.
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Alexander GK, Bashore L, Brooks V. Improving Food Literacy and Access Among Young Adult Cancer Survivors: A Cross-Sectional Descriptive Study. Cancer Nurs 2021. [PMID: 34507337 DOI: 10.1097/NCC.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The links between nutrition and chronic disease are well established, but consumption of fruits and vegetables is low among young adult childhood cancer survivors (YACS) worldwide. Ensuring equitable access to fresh produce is a significant, persistent public health challenge. OBJECTIVE The purposes of this report are to describe patterns of access to fresh produce, daily intake of fruits/vegetables, and nutrition education preferences among a sample of YACS and to highlight early development of a mentored gardening intervention. METHODS A cross-sectional descriptive study design was used to assess dietary intake, access to fruits/vegetables, and preferences for nutrition education among 124 YACS through a comprehensive cancer survivorship program in a large pediatric cancer center. RESULTS Most participants (71.8%) live more than 10 minutes' walking distance from a supermarket, and 88.7% do not meet the recommended daily intake of 5 or more servings of fruit and vegetables. A total of 91% of participants express that nutrition is important, and 81.5% desire dietary improvement. Most (78.2%) are likely to use either their computer or cell phone for nutrition content. To establish healthy nutrition habits, many seek the support of a nutritionist (63.7%) or another survivor (41.9%). CONCLUSIONS Study findings underscore the need for advocacy to support equitable access to fresh produce and technology-enhanced nutrition education among YACS. IMPLICATIONS FOR PRACTICE To improve access to fresh produce and food literacy among YACS, providers can collaborate with community stakeholders to build capacity for sustainable, technology-enhanced, and mentored gardening interventions at the individual, family, and community level.
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Blair CK, Adsul P, Guest DD, Sussman AL, Cook LS, Harding EM, Rodman J, Duff D, Burgess E, Quezada K, Brown-Glaberman U, King TV, Baca E, Dayao Z, Pankratz VS, Davis S, Demark-Wahnefried W. Southwest Harvest for Health: An Adapted Mentored Vegetable Gardening Intervention for Cancer Survivors. Nutrients 2021; 13:2319. [PMID: 34371829 PMCID: PMC8308636 DOI: 10.3390/nu13072319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/22/2023] Open
Abstract
Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with Master Gardeners from the Cooperative Extension System. Initially developed and tested in Alabama, the program was adapted for the different climate, growing conditions, and population in New Mexico. This paper chronicles the feasibility, acceptability, and preliminary efficacy of "Southwest Harvest for Health". During the nine-month single-arm trial, 30 cancer survivor-Master Gardener dyads worked together to establish and maintain three seasonal gardens. Primary outcomes were accrual, retention, and satisfaction. Secondary outcomes were vegetable and fruit (V and F) intake, physical activity, and quality of life. Recruitment was diverse and robust, with 30 survivors of various cancers, aged 50-83, roughly one-third minority, and two-thirds females enrolled in just 60 days. Despite challenges due to the COVID-19 pandemic, retention to the nine-month study was 100%, 93% reported "good-to-excellent" satisfaction, and 87% "would do it again." A median increase of 1.2 servings of V and F/day was documented. The adapted home-based vegetable gardening program was feasible, well-received, and resulted in increased V and F consumption among adult cancer survivors. Future studies are needed to evaluate the effectiveness of this program and to inform strategies to increase the successful implementation and further dissemination of this intervention.
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Affiliation(s)
- Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Dolores D. Guest
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Andrew L. Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Linda S. Cook
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Elizabeth M. Harding
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT 05405, USA;
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Dorothy Duff
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM 87107, USA;
| | - Ellen Burgess
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Karen Quezada
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Ursa Brown-Glaberman
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Towela V. King
- School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (T.V.K.); (E.B.)
| | - Erika Baca
- School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (T.V.K.); (E.B.)
| | - Zoneddy Dayao
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Vernon Shane Pankratz
- Department of Internal Medicine, University of New Mexico, MSC07-4025, Albuquerque, NM 87131, USA; (P.A.); (D.D.G.); (L.S.C.); (U.B.-G.); (Z.D.); (V.S.P.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA; (A.L.S.); (J.R.); (E.B.); (K.Q.)
| | - Sally Davis
- Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USA;
- University of New Mexico Prevention Research Center, Albuquerque, NM 87131, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL 35294, USA
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15
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Blair CK, Harding EM, Adsul P, Moran S, Guest D, Clough K, Sussman AL, Duff D, Cook LS, Rodman J, Dayao Z, Brown-Glaberman U, King TV, Pankratz VS, Servin E, Davis S, Demark-Wahnefried W. Southwest Harvest for Health: Adapting a mentored vegetable gardening intervention for cancer survivors in the southwest. Contemp Clin Trials Commun 2021; 21:100741. [PMID: 33659763 PMCID: PMC7896154 DOI: 10.1016/j.conctc.2021.100741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/26/2020] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
Few diet and physical activity evidence-based interventions have been routinely used in community settings to achieve population health outcomes. Adapting interventions to fit the implementation context is important to achieve the desired results. Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with certified Master Gardeners from the Cooperative Extension Service with the ultimate goal of increasing vegetable consumption and physical activity, and improving physical functioning and health-related quality-of-life. Harvest for Health has potential for widespread dissemination since Master Gardener Programs exist throughout the United States. However, state- and population-specific adaptations may be needed to improve intervention adoption by other Master Gardener Programs. Our primary objective was to adapt this evidence-informed intervention that was initially incepted in Alabama, for the drastically different climate and growing conditions of New Mexico using a recommended adaptation framework. Our secondary objective was to develop a study protocol to support a pilot test of the adapted intervention, Southwest Harvest for Health. The adaptation phase is a critical first step towards widespread dissemination, implementation, and scale-out of an evidence-based intervention. This paper describes the adaptation process and outcomes, and the resulting protocol for the ongoing pilot study that is currently following 30 cancer survivors and their paired Extension Master Gardener mentors.
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Affiliation(s)
- Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Sara Moran
- Extension Plant Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Dolores Guest
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Kathy Clough
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM, USA
| | - Andrew L. Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Dorothy Duff
- Albuquerque Area Extension Master Gardener Program, NMSU Cooperative Extension Service, Albuquerque, NM, USA
| | - Linda S. Cook
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Zoneddy Dayao
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Ursa Brown-Glaberman
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Towela V. King
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - V. Shane Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Eduardo Servin
- Extension Plant Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Sally Davis
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Prevention Research Center, Albuquerque, NM, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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Forbes CC, Swan F, Greenley SL, Lind M, Johnson MJ. Physical activity and nutrition interventions for older adults with cancer: a systematic review. J Cancer Surviv 2020; 14:689-711. [PMID: 32328828 PMCID: PMC7473955 DOI: 10.1007/s11764-020-00883-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022]
Abstract
Purpose The aim of this review was to summarize the current literature for the effectiveness of activity and nutritional based interventions on health-related quality of life (HRQoL) in older adults living with and beyond cancer (LWBC). Methods We conducted systematic structured searches of CINAHL, Embase, Medline, Cochrane CENTRAL databases, and bibliographic review. Two independent researchers selected against inclusion criteria: (1) lifestyle nutrition and/or activity intervention for people with any cancer diagnosis, (2) measured HRQoL, (3) all participants over 60 years of age and (4) randomized controlled trials. Results Searches identified 5179 titles; 114 articles had full text review, with 14 studies (participant n = 1660) included. Three had nutrition and activity components, one, nutrition only and ten, activity only. Duration ranged from 7 days to 1 year. Interventions varied from intensive daily prehabilitation to home-based gardening interventions. Studies investigated various HRQoL outcomes including fatigue, general and cancer-specific quality of life (QoL), distress, depression, global side-effect burden and physical functioning. Eight studies reported significant intervention improvements in one or more QoL measure. Seven studies reported using a psychosocial/theoretical framework. There is a gap in tailored nutrition advice. Conclusions Among the few studies that targeted older adults with cancer, most were activity-based programmes with half reporting improvements in QoL. Future research should focus on or include tailored nutrition components and consider appropriate behaviour change techniques to maximize potential QoL improvement. Implications for Cancer Survivors More research is needed to address the research gap regarding older adults as current recommendations are derived from younger populations. Electronic supplementary material The online version of this article (10.1007/s11764-020-00883-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cynthia C Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK. .,University of Hull, Allam Medical Building 3rd Floor, Cottingham Road, Kingston-Upon-Hull, East Yorkshire, HU6 7RX, UK.
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Sarah L Greenley
- Academy of Primary Care, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Michael Lind
- Cancer Research Group, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bail JR, Frugé AD, Cases MG, De Los Santos JF, Locher JL, Smith KP, Cantor AB, Cohen HJ, Demark-Wahnefried W. A home-based mentored vegetable gardening intervention demonstrates feasibility and improvements in physical activity and performance among breast cancer survivors. Cancer 2018; 124:3427-3435. [PMID: 29932460 PMCID: PMC6108896 DOI: 10.1002/cncr.31559] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/05/2018] [Accepted: 05/01/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The current study assessed the feasibility of a mentored home-based vegetable gardening intervention and examined changes in health-related outcomes among breast cancer survivors (BCS). METHODS BCS were randomized to either a year-long vegetable gardening intervention to begin immediately or a wait-list control. Master Gardeners mentored participants in planning, planting, and maintaining 3 seasonal gardens over the course of 1 year. Participant accrual, retention, and satisfaction rates of ≥80% served as feasibility (primary outcome) benchmarks. Secondary outcomes (ie, vegetable consumption, physical activity, performance and function, anthropometrics, biomarkers, and health-related quality of life) were collected at baseline and post-intervention (1-year follow-up) using subjective and objective measures. RESULTS The trial surpassed all feasibility benchmarks at 82% of targeted accrual, 95% retention, and 100% satisfaction (ie, experience ratings of "good to excellent" and willingness to "do it again"). Compared with the controls, intervention participants reported significantly greater improvements in moderate physical activity (+14 vs -17 minutes/week) and demonstrated improvements in the 2-Minute Step Test (+22 vs + 10 steps), and Arm Curl (+2.7 vs + 0.1 repetitions) (P values < .05). A trend toward improved vegetable consumption was observed (+0.9 vs + 0.2 servings/day; P = .06). Approximately 86% of participants were continuing to garden at the 2-year follow-up. CONCLUSIONS The results of the current study suggest that a mentored, home-based vegetable gardening intervention is feasible and offers an integrative and durable approach with which to improve health behaviors and outcomes among BCS. Harvest for Health led to the establishment of a group of trained Master Gardeners and gave rise to local and global community-based programs. Larger studies are needed to confirm the results presented herein and to define applicability across broader populations of survivors.
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Affiliation(s)
- Jennifer R Bail
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew D Frugé
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
| | - Mallory G Cases
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | | | - Julie L Locher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kerry P Smith
- Alabama Cooperative Extension System, Auburn University, Auburn, Alabama
| | - Alan B Cantor
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harvey J Cohen
- Deparment of Medicine, Duke University, Durham, North Carolina
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Demark-Wahnefried W, Cases MG, Cantor AB, Frugé AD, Smith KP, Locher J, Cohen HJ, Tsuruta Y, Daniel M, Kala R, De Los Santos JF. Pilot Randomized Controlled Trial of a Home Vegetable Gardening Intervention among Older Cancer Survivors Shows Feasibility, Satisfaction, and Promise in Improving Vegetable and Fruit Consumption, Reassurance of Worth, and the Trajectory of Central Adiposity. J Acad Nutr Diet 2018; 118:689-704. [PMID: 29305129 DOI: 10.1016/j.jand.2017.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Holistic approaches are sought to improve lifestyle behaviors and health of cancer survivors long term. OBJECTIVE Our aim was to explore whether a home-based vegetable gardening intervention is feasible and whether it improves diet and other health-related outcomes among older cancer survivors. DESIGN We conducted a feasibility trial in which cancer survivors were randomized to receive a year-long gardening intervention immediately or to a wait-list control arm. Home visits at baseline and 1 year assessed physical performance, anthropometric indices, behavioral and psychosocial outcomes, and biomarkers. PARTICIPANTS/SETTING Participants included 46 older (aged 60+ years) survivors of locoregionally staged cancers across Alabama from 2014 to 2016. Forty-two completed 1-year follow-up. INTERVENTION Cooperative extension master gardeners delivered guidance to establish three seasonal vegetable gardens at survivors' homes. Plants, seeds, and gardening supplies were provided. OUTCOMES Primary outcomes were feasibility targets of 80% accrual and retention, and an absence of serious adverse events; other outcomes were secondary and explored potential benefits. STATISTICAL ANALYSES Baseline to follow-up changes were assessed within and between arms using paired t, McNemar's, and χ2 tests. RESULTS This trial proved to be safe and demonstrated 91.3% retention; 70% of intervention participants rated their experience as "excellent," and 85% would "do it again." Data suggest significantly increased reassurance of worth (+0.49 vs -0.45) and attenuated increases in waist circumference (+2.30 cm vs +7.96 cm) in the gardening vs control arms (P=0.02). Vegetable and fruit consumption increased by approximately 1 serving/day within the gardening arm from baseline to follow-up (mean [standard error]=1.34 [1.2] to 2.25 [1.9] servings/day; P=0.02)] compared to controls (1.22 [1.1] to 1.12 [0.7]; P=0.77; between-arm P=0.06). CONCLUSIONS The home vegetable gardening intervention among older cancer survivors was feasible and suggested improvements in vegetable and fruit consumption and reassurance of worth; data also suggest attenuated increases in waist circumference. Continued study of vegetable gardening interventions is warranted to improve health, health behaviors, and well-being of older cancer survivors.
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Frugé AD, Cases MG, Howell CR, Tsuruta Y, Smith-Johnston K, Moellering DR, Demark-Wahnefried W. Fingernail and toenail clippings as a non-invasive measure of chronic cortisol levels in adult cancer survivors. Cancer Causes Control 2017; 29:185-191. [PMID: 29170880 DOI: 10.1007/s10552-017-0989-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/21/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer survivors are at greater risk of comorbidities and functional decline due to physiological and psychological stress which can be measured by salivary cortisol. If saliva is used, multiple samples must be collected to accurately quantify long-term stress; however, fingernail (FN) and toenail (TN) clippings offer an opportunity to measure retrospective cortisol levels in a non-invasive manner. METHODS Three sets of FN and TN clippings were collected at 12-month intervals in conjunction with saliva samples from cancer survivors (n = 109) participating in two clinical trials. FN and TN samples were stored at room temperature (RT); a subset underwent additional processing and freezing before analysis. Cortisol levels were determined via enzyme immunoassay, and correlation coefficients were generated to determine overall correspondence of the individual measures. RESULTS Matched RT and frozen samples were highly correlated for TN (r = 0.950, p = 5.44 × 10-37) and FN (r = 0.784, p = 1.05 × 10-10). Correlations between RT FN and TN were statistically significant (r = 0.621, p = 3.61 × 10- 17), as were frozen FN and TN (r = 0.310, p = 0.0283). RT, but not frozen TN and FN correlated with salivary cortisol (r = 0.580, p = 1.65 × 10- 16 and r = 0.287, p = 0.00042 for TN and FN, respectively). CONCLUSIONS FN and TN cortisol levels correlate with salivary cortisol in adult cancer survivors and may offer a less invasive and convenient means for measuring chronic cortisol levels.
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Affiliation(s)
- Andrew D Frugé
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA.
| | | | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yuko Tsuruta
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
| | - Kelley Smith-Johnston
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
| | - Douglas R Moellering
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
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