Monday, July 2, 2007


I had a great week "doing nothing". Well, I spent less time at my computer than usual, but I am still getting projects completed or delegated and off my desk. So this post is not about my "fresh start", but the FRESH START Trial done at Duke University's Cancer Center, which evaluated tailored versus generic advice to cancer survivors for improving diet and lifestyle behaviors after a cancer diagnosis.

This study (funded by NCI, AICR, and The Komen Foundation) mailed cancer survivors either generalized information about ways to improve eating and increase exercise OR they were mailed information that was tailored to improving an individual's current specific dietary or lifestyle behaviors during a 10 month time period. Then these same people were followed for one year and called to check on what they were eating and how much they were exercising.

After 10 months of mailings and one additional year of follow-up, the study found that both arms significantly improved their lifestyle behaviors (P < .05), which is good. However, the important point is that significantly greater gains occurred in the FRESH START intervention group versus the control group. For example, when comparing the intervention group to the control group, 34% versus 18% practiced two or more goal behaviors (P < .0001); the intervention group increased exercise minutes per week by 59.3 minutes versus +39.2 minutes (P = .02); the intervention group increased consumption of F&V per day by +1.1 serving versus only +0.6 servings in the control group (P = .01); the intervention group decreased total fat intake by –4.4% versus –2.1% (P < .0001), saturated fat by –1.3% versus –0.3% (P < .0001), and BMI by –0.3 versus gaining +0.1 kg/m2 (P = .004).

Why is this study important? Because cancer survivors have other health problems, too, and are also at higher risk of developing other chronic (but preventable) and costly health problems such as diabetes, heart disease, and osteoporosis, besides secondary tumors, all of which can lead to early death or significant decrease in quality of life. All of the information given to encourage diet and lifestyle changes can lead to decreasing risk for developing these other chronic diseases and other cancers.

I have been advocating for the past 10+ years that cancer survivors would benefit by having individualization of diet and lifestyle information, rather than people being told to simply "eat right and exercise". I didn't know what that well-intended but much too general advice really meant for me!! I needed a consult for myself with a dietitian who had experience with oncology at that time, and I had to first push my doctor for a referral (I didn't take "No" for an answer), and then look outside my own cancer center at that time to find one.

My advice? Don't wait for this study to be expanded or repeated or for the materials and method used to be fine-tuned and/or made available for use at your cancer center. If you are a cancer survivor, ask for a referral (and insist if you have to!!) to a Registered Dietitian (RD) who has experience with oncology patients. I repeat, don't wait. You can reduce your risk of developing additional health problems plus optimize both the quality and quantity of life by improving diet and exercise habits now. It is not too late!

If your cancer center does not have an RD (or has one who is too, too, too busy because there is only one RD for hundreds if not thousands of patients), you can be an advocate yourself at your own cancer center for hiring RDs to provide nutritional care for all the cancer patients who need it. You can even use this article to show the administrator how individualized nutrition and lifestyle information is beneficial for cancer survivors.

Here is the full citation for the article just published.

Journal of Clinical Oncology, Vol 25, No 19 (July 1), 2007: pp. 2709-2718
© 2007 American Society of Clinical Oncology.

Main Outcomes of the FRESH START Trial: A Sequentially Tailored, Diet and Exercise Mailed Print Intervention Among Breast and Prostate Cancer Survivors

Wendy Demark-Wahnefried, Elizabeth C. Clipp, Isaac M. Lipkus, David Lobach, Denise Clutter Snyder, Richard Sloane, Bercedis Peterson, Jennifer M. Macri, Cheryl L. Rock, Colleen M. McBride, William E. Kraus

Signing off to have lunch outside (72 degrees, clear and sunny, Michigan at its best!)
Diana Dyer, MS, RD

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