Algemeen: Aangepast voedingspatroon en meer beweging onder telefonische en schriftelijke begeleiding verbetert significant kwaliteit van leven en functioneren van oudere overlevenden van borstkanker en prostaatkanker met overgewicht en slechte levensstijl

14 augustus 2009: Bron: 1: JAMA. 2009 May 13;301(18):1883-91

Aangepast voedingspatroon en meer beweging onder telefonische en schriftelijke begeleiding verbetert significant kwaliteit van leven en functioneren van oudere overlevenden van borstkanker en prostaatkanker met overgewicht en slechte levensstijl. Aldus de uitkomsten van een gerandomiseerde studie bij 641 voormalige kankerpatienten met overgewicht waarvan deelnemers aan de studiegroep een jaar lang werden begeleid. De resultaten waren na 1 jaar significant beter in alle onderzochte punten. Zowel in gewichtsafname als in verandering van voedingspatroon, levenstijl als in functioneren.

1: JAMA. 2009 May 13;301(18):1883-91.

Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial.

Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, Hartman TJ, Miller P, Mitchell DC, Demark-Wahnefried W.

Duke University Older Americans Independence Center, and Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27705, USA. morey@geri.duke.edu

CONTEXT: Five-year survival rates for early stage colorectal, breast, and prostate cancer currently exceed 90% and are increasing. Cancer survivors are at greater risk for second malignancies, other comorbidities, and accelerated functional decline. Lifestyle interventions may provide benefit, but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status.

OBJECTIVE: To determine whether a telephone counseling and mailed print material-based diet and exercise intervention is effective in reorienting functional decline in older, overweight cancer survivors.

DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 641 overweight (body mass index > or = 25 and < 40), long-term (> or = 5 years) survivors (aged 65-91 years) of colorectal, breast, and prostate cancer, who were randomly assigned to an intervention group (n = 319) or delayed intervention (control) group (n = 322) in Canada, the United Kingdom, and 21 US states. Individuals were recruited for the Reach out to Enhance Wellness (RENEW) trial from July 1, 2005, through May 17, 2007.

INTERVENTION: A 12-month, home-based tailored program of telephone counseling and mailed materials promoting exercise, improved diet quality, and modest weight loss. The control group was wait-listed for 12 months.

MAIN OUTCOME MEASURES: Change in self-reported physical function on the Short-Form 36 physical function subscale (score range, 0-100; a high score indicates better functioning) from baseline to 12 months was the primary end point. Secondary outcomes included changes in function on the basic and advanced lower extremity function subscales of the Late Life Function and Disability Index (score range, 0-100), physical activity, body mass index, and overall health-related quality of life.

RESULTS: The mean baseline Short-Form 36 physical function score was 75.7. At the 12-month follow-up, the mean function scores declined less rapidly in the intervention group (-2.15; 95% confidence interval , -0.36 to -3.93) compared with the control group (-4.84; 95% CI, -3.04 to -6.63) (P = .03). The mean baseline basic lower extremity function score was 78.2. The mean changes in basic lower extremity function were 0.34 (95% CI, -0.84 to 1.52) in the intervention group compared with -1.89 (95% CI, -0.70 to -3.09) in the control group (P = .005). Physical activity, dietary behaviors, and overall quality of life increased significantly in the intervention group compared with the control group, and weight loss also was greater (2.06 kg [95% CI, 1.69 to 2.43 kg] vs 0.92 kg [95% CI, 0.51 to 1.33 kg], respectively; P < .001).

CONCLUSION: Among older, long-term survivors of colorectal, breast, and prostate cancer, a diet and exercise intervention reduced the rate of self-reported functional decline compared with no intervention.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00303875.

PMID: 19436015 [PubMed - indexed for MEDLINE]

1: Psychooncology. 2009 Apr;18(4):429-39.

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Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW): design, methods and recruitment challenges of a home-based exercise and diet intervention to improve physical function among long-term survivors of breast, prostate, and colorectal cancer.

Snyder DC, Morey MC, Sloane R, Stull V, Cohen HJ, Peterson B, Pieper C, Hartman TJ, Miller PE, Mitchell DC, Demark-Wahnefried W.

Duke University School of Nursing, Durham, NC 27710, USA. denise.snyder@duke.edu

OBJECTIVE: Cure rates for cancer are increasing, especially for breast, prostate, and colorectal cancer. Despite positive trends in survivorship, a cancer diagnosis can trigger accelerated functional decline that can threaten independence, reduce quality-of-life and increase healthcare costs, especially among the elderly who comprise the majority of survivors. Lifestyle interventions may hold promise in reorienting functional decline in older cancer survivors, but few studies have been conducted.

METHODS: We describe the design and methods of a randomized controlled trial, RENEW (Reach out to ENhancE Wellness), that tests whether a home-based multi-behavior intervention focused on exercise, and including a low saturated fat, plant-based diet, would improve physical functioning among 641 older, long-term (>or=5 years post-diagnosis) survivors of breast, prostate, or colorectal cancer. Challenges to recruitment are examined.

RESULTS: Twenty thousand and fifteen cases were approached, and screened using a two-step screening process to assure eligibility. This population of long-term, elderly cancer survivors had lower rates of response (approximately 11%) and higher rates of ineligibility (approximately 70%) than our previous intervention studies conducted on adults with newly diagnosed cancer. Significantly higher response rates were noted among survivors who were White, younger, and more proximal to diagnosis and breast cancer survivors (p-values<0.001).

CONCLUSION: Older cancer survivors represent a vulnerable population for whom lifestyle interventions may hold promise. RENEW may provide guidance in allocating limited resources in order to maximize recruitment efforts aimed at this needy, but hard-to-reach population. (c) 2008 John Wiley & Sons, Ltd.

PMID: 19117329 [PubMed - indexed for MEDLINE]

begeleiding, leefstijl, sporten, beweging, preventie van kanker, dieet, Voedingspatrtoon