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Diet and physical activity influence survival in colorectal cancer survivors. Healthful behaviours are also associated with better quality of life, physical function and fatigue. This is a pilot study to examine the feasibility and acceptability of a telephone-based, personally tailored multiple behaviour change intervention.
Eighteen patients who had recently completed treatment for non-metastatic colorectal cancer were recruited. Participants received a 12 week intervention consisting of tailored-printed materials and telephone consultations to increase physical activity (PA) and fruit and vegetable (F&V) intake, and reduce red and processed meat and alcohol consumption. Diet was measured using food frequency questionnaires and change in blood plasma vitamin C, E and beta-caretone were assessed as an objective measure of F&V intake. Physical activity was measured objectively using accelerometers and by self report.
Thirteen participants completed the study (attrition 28%). Significant improvements in PA were observed (+70 minutes a week, p =.006 as measured by accelerometery). Gains were also seen in diet; F&V + 2.6 (2.2) portions a day (p =.001) red meat consumption -207g (315) a week (p =.036), plasma vitamin C +5 umol/L. Clinically meaningful change in quality of life (+8.6) and fatigue (-2.5) are also reported.
This personally tailored, telephone-based intervention is feasible and acceptable, achieved improvements in diet and PA and saw gains in quality of life and fatigue. A large randomised controlled trial is warranted.
The hypotheses for this study were three-fold: 1) that patients who had recently completed treatment for colorectal cancer (CRC) would be interested in an intervention designed to improve lifestyle behaviours including diet and physical activity, 2) that they would complete all parts of the intervention, 3) the intervention would improve participants' lifestyle behaviours.
Studies have found improved survival after CRC among those who are active and who eat a healthful diet. Additionally, cancer and its treatment can result in impaired quality of life (QoL), physical function and fatigue. Adhering to healthful behaviours has also been found to attenuate these after-effects. Consequently the WCRF recommends that all cancer survivors adhere to the population recommendations for cancer prevention; maintain a healthy weight, engage in regular physical activity, eat at least five portions of fruit and vegetables (F&V) a day, limit alcohol, processed and red meat consumption, and not smoke. However research has found that a large number of cancer survivors do not comply with these recommendations. There is therefore a need to establish effective and acceptable interventions for behaviour change in this population.
Patients who had recently completed treatment for CRC were recruited from five London hospitals. In the first instance patients who were within six months of treatment completion were identified by the nursing team and contacted by post. From that point on patients were identified on discharge of curative treatment and the research nurse informed patients about the study. The intervention was 12 weeks in duration. Participants were provided with written materials detailing the benefits of healthful behaviours. Examples of exercises that can be performed at home were also provided, along with information on F&V portion sizes and examples of meat free meals. Participants were also given a workbook to use throughout the study. Participants received bi-weekly telephone consultations with the project lead. During each consultation goals for behaviour change were set, barriers to change discussed, action plans formed, previous goals reviewed and feedback provided, and self-monitoring encourage for the subsequent weeks. Change in physical activity was determined by accelerometrey. Diet was examined using a food frequency questionnaire and vitamin C, E and beta-carotene blood levels were measured to indicate F&V consumption. Quality of life, physical function and fatigue were measured using validated questionnaires.
Fifteen of 57 patients (26%) invited by post responded to say they would like to take part, 13 were eligible. A further five patients were recruited by research nurses on discharge of treatment. Of the 18 participants, 13 completed the study (23% drop-outs), ten of whom completed all telephone consultations and three missed one each (96% compliance). At the end of the study participants were engaging in an average of 168 minutes a week (70 minutes more than previously), F&V consumption increased by 2.6 portions a day with all participants consuming at least 5 portions a day, no participants were exceeding the recommended limits 500g a week of red meat, and only three participants were eating any processed meat. Significant improvements were also seen in QoL, physical function and fatigue.