RENEWeb: Reaching-out to ENhancE diet and Weight Control via the Web in Cancer Survivors Rates of obesity are high in the general population. Cancer survivors, however have even higher rates because there are 13 distinct cancers for which obesity is a proven risk factor; plus, weight gain is a common side effect with some cancer treatments. Given substantial evidence that obesity is a poor prognostic factor that also associates with increased comorbidity, functional decline, and higher health care costs, the American Society of Clinical Oncology (ASCO) issued a position statement urging intensified efforts to improve education and resources, as well as advocating for research to determine optimal interventions and mechanisms of action, and to increase access to resources and services for weight management among cancer survivors. ASCO also underscored a particular need in underserved populations ? a need also long expressed by the National Cancer Institute (NCI). Specifically, the NCI points to gaps in addressing the needs of older cancer survivors from minority groups who reside in rural areas. In addition, because almost all research in cancer survivorship has been conducted in breast cancer survivors, both the NCI and ASCO urge research in survivors of other types of cancer. The proposed study directly addresses the gaps identified by ASCO and NCI. We will adapt a previous intervention entitled RENEW, which had proven success in promoting weight loss and significantly improving the lifestyle behaviors and functional status of older survivors of colorectal, breast, and prostate cancer using computer-tailored mailed print and telephone counseling intervention, by delivering it more broadly through a web-based platform. The 6-month RENEWeb intervention will then be tested in 326 survivors of 7 select obesity and physical activity related cancers, significant proportions of whom will be older, rural, and minority. Using a 2-arm randomized controlled design, survivors will be evenly and randomly assigned to either RENEWeb or a wait-listed control arm. The primary aim will be to determine between-arm differences in weight loss. Secondary aims will be to assess the effects of the intervention on other clinical outcomes (i.e., lean body mass, physical functioning and performance), quality of life, diet and physical activity behaviors, and relevant biomarkers of inflammation and successful aging (i.e., c-reactive protein, interleukin-6 and -10, interferon ?, and telomerase). Finally, we will identify the behavioral mechanisms that drive the success of the intervention, as well as examine the characteristics of those who benefit most and assess cost effectiveness. All of these efforts are ultimately directed toward improving health and ascertaining effective interventions that have the broad reach necessary to help the most underserved cancer survivors.
More than half of cancer survivors have suboptimal diets and one-third are classified as obese, putting them at risk for second cancers, cardiovascular disease, diabetes, and functional decline ? conditions which are prevalent in this patient population and associated with high health care costs. Diet and weight control interventions can improve health and quality of life in this vulnerable and growing sector. We will adapt a diet/weight management intervention that was previously delivered via computer-tailored mailed print and telephone counseling and shown effective in promoting durable weight loss and improving the diet and health outcomes among cancer survivors to a more scalable Web-based platform (plus email) and test its impact on weight status, diet quality, physical function, health, and health care costs ? focusing on rural, older and minority cancer survivors who are the most in need and the most underserved.
