Lifestyle Intervention Yields Lasting Effects in Elderly Cancer Survivors

An intervention aimed at improving diet and exercise among elderly cancer survivors worked well and had durable effects in a new study of more than 600 people.

Cancer survivors are at high risk for a number of diseases and conditions, some of which can be prevented with good diet and exercise; changing lifestyle behaviors, though, has proven difficult. The Reach Out to Enhance Wellness trial (RENEW) involved a home-based intervention consisting of a personally tailored workbook, quarterly newsletters, and telephone counseling with automated prompts. Participants were encouraged to engage in 15 minutes of strength training every other day and 30 minutes of endurance exercise every day, and specific food serving recommendations were given.

The study included 641 participants, all of whom were over the age of 65 and were at least 5 years from diagnosis of colorectal, breast, or prostate cancers. All patients were considered sedentary, and all were overweight or obese. Of the 641 original participants, 558 (87.1%) completed at least 1 year of follow-up, and 488 (76.1%) completed 2 years. The study used a crossover design where participants received the intervention either immediately or after a 1-year delay.

The immediate intervention patients saw improvements in diet quality, physical activity, and body mass index (BMI) from baseline to year 1, after which values stabilized with no change from year 1 to year 2. In contrast, the patients in the delayed intervention group saw no improvement in the first year of the study, but then saw significant improvements from year 1 to year 2.

From baseline to the year 2 follow-up, BMI improved from 29.1 to 28.2 in the immediate intervention group (P < .001) and from 29.1 to 28.3 in the delayed group (P < .001). Participants exercised a mean of 33.3 minutes per week at baseline in the immediate group, and for 100.9 minutes per week at 2 years (P < .001); in the delayed group, the mean rose from 37.5 minutes per week to 114.8 minutes per week (P < .001).

The authors noted that though the response to the intervention was durable in the immediate group, the rate of functional decline did speed up after the intervention was completed.

“I think a lot of our success comes from delivering the intervention using home-based approaches and building up people’s self-efficacy so that they rely on themselves,” said study lead author Wendy Demark-Wahnefried, PhD, RD, of the University of Alabama at Birmingham Comprehensive Cancer Center. “Thus when we end our intervention, people are left with the skills and coping strategies that they have honed over the course of the intervention year, rather than getting discontinued from a program that they have come to rely on.”

Dr. Demark-Wahnefried added that a cost-benefit analysis of the RENEW intervention would have been useful but was not conducted. “These interventions are relatively inexpensive to deliver, and if we can capitalize on the teachable moment of cancer to create lasting improvements in health behavior, it could save lots of money in the long run.”

She said that tailoring the intervention to other languages, types of cancer survivors, and cultures is a priority in the future.