LITTLE FALLS, N.J., May 12 — Implementing a home-based diet and exercise program could slow functional decline in long-term cancer survivors.

A telephone-based intervention significantly halted functional decline compared with no intervention, Miriam C. Morey, Ph.D., of Duke University, and colleagues reported in the May 12 issue of the Journal of the American Medical Association.

“Even with modest change, [patients in the intervention] experienced clinically meaningful improvements in both physical function and other health-related quality-of-life domains,” the researchers said.

• Explain that a telephone-based intervention significantly slowed functional decline in patients who’d been cancer-free for more than five years.
• Note that long-term survival rates for many cancers are increasing, although patients are at risk for accelerated functional decline.

Long-term survival rates for many early-stage cancer patients exceed 90% and are increasing. However, these patients are at risk for accelerated functional decline.

Lifestyle interventions have benefited younger cancer survivors with more recent diagnoses, but Dr. Morey’s group wanted to know whether they’d help long-term, older cancer survivors whose diagnoses are in the distant past.

So, to determine whether a telephone counseling diet and exercise intervention is effective, the researchers randomized 641 overweight (BMI >25 and <40), long-term (> 5 years) cancer survivors ages 65 to 91 to an intervention group or a control group with no intervention.

The Reach out to Enhance Wellness (RENEW) intervention lasted 12 months over a period from July 1, 2005, to May 17, 2007.

The program consisted of a tailored workbook and a series of quarterly newsletters along with 15 sessions of telephone counseling, each 15 to 30 minutes long.

The researchers found that mean function scores declined less rapidly in the intervention group compared with the control group (-2.15 versus -4.84, P=0.03).

“A decline of 6.5 points over a four-year period is associated with a 10% higher mortality risk within a subsequent three-year window,” the researchers said. “A decline of two points is considered too small to be clinically detectable.”

Basic lower extremity function — going up and down stairs, using a step stool — changed negligibly in the intervention group. The control group, on the other hand, showed a decrease in scores (0.34 versus -1.89, P=0.005).

Advanced lower extremity function — walking a mile, running a short distance to catch a bus — followed a similar pattern, the researchers said, but didn’t reach statistical significance.

Also, there was significantly greater weight loss in the intervention group than in the control group (2.06 kg versus 0.92 kg, P<0.001).

And physical activity and dietary behaviors increased significantly in the intervention group (P<0.001). Quality-of-life scores decreased for control patients, but were sustained in the intervention group.

The researchers noted that the study was limited by self-report, and that the intervention, according to their demographics, was most likely delivered to highly motivated patients.

Still, they said the findings suggest that further efforts should be made to promote such programs among older cancer survivors, “not only in those who are well beyond their diagnosis, but also in those who are more newly diagnosed.”

The study was supported by grants from the NIH and from Veterans Affairs Research and Development. The researchers reported no conflicts of interest.

Primary source: Journal of the American Medical Association

Source reference:

Morey MC, et al “Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors” JAMA 2009; 301(18): 1883-91.

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