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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): American women have a 1 in 3 lifetime risk of developing cancer; for men the risk is even higher (1 in 2). While cancer is a leading cause of death, survival rates are ever increasing - 62 percent of those diagnosed with cancer will be alive at least 5 years after diagnosis. Yet, a large proportion are left with significant morbidity, either from the cancer or its treatment. This population also is at increased risk for secondary cancers, diabetes, osteoporosis and cardiovascular disease - compounded comorbidities that manifest themselves in accelerated functional decline, especially among older survivors. With >60 percent of cancer survivors being age 65+, there is large public health potential for interventions that stabilize or positively reorient the functional decline trajectory. A multidisciplinary team representing the fields of aging, oncology, exercise, nutrition, nursing, behavioral psychology and biostatistics at Duke Univ. Med. Ctr. is well-postured to test if a distance medicine-based diet and exercise program will improve physical functioning among older cancer survivors who are >5 yrs out from a diagnosis of colorectal, breast or prostate cancer. The proposed study builds upon our preliminary work which shows that functional decline may be attenuated through such intervention. A total of 640 survivors will be recruited and block randomized into: 1) an arm that receives a 1-yr telephonecounseling+ mailed material program that promotes exercise and a healthful portion-controlled diet (<10 percent of kcal from saturated fat, >= 5 svgs/day of vegetables and fruit); and 2) a delayed intervention arm that receives the intervention after a 1-year observation period. Specific aims of this randomized controlled trial are to: 1)Determine the efficacy of the intervention in reorienting the physical function trajectory among elders who are long term survivors of cancer; 2) determine differences between arms with regard to other endpoints (physical activity, diet quality, BMI, depression, etc); 3) identify factors that influence program efficacy (self efficacy, etc); and 4) characterize functional decline over a 2-year period in survivors who receive the initial intervention vs. those who are intervened upon after a 1-year delay. Results of this study will increase our knowledge of the use of distance-medicine to deliver multiple risk factor interventions among older cancer survivors - an ever expanding population in which historically little research has been conducted.