There are clear diet and physical activity guidelines for cancer survivors: eat a diet high in fruits/vegetables and low in energy-dense foods and engage in 150 minutes of moderate-to-vigorous physical activity each week. However, cancer survivors are provided with few, if any, resources to meet these guidelines and there are limited data supporting how cancer survivors can achieve sustained dietary change. There are even fewer behavioral change resources available to minority cancer survivors. Few studies have examined the separate and synergistic effects of in-person education and e-communication strategies in changing and maintaining health behaviors. Our prior R21 pilot study among Spanish-speaking Latina breast cancer survivors showed that our culturally-based 9-session (24-hours over 12 weeks) Cocinar Para Su Salud! Curriculum increased fruit/vegetable intake up to 12 months, but did not decrease dietary fat (R21CA152903). A pilot study of a shortened 4-session (16-hours over 4 weeks) curriculum was less effective. Therefore, as an extension of our prior work, we will test a modified version of our curriculum that will include new content on decreasing energy density in food, increasing physical activity, and will include a hands-on skills building cooking component in every class. Social cognitive theory and the Trans theoretical model will frame the intervention. We will recruit 200 female Spanish- and English-speaking Latina breast cancer survivors to participate in a 12-month trial. The study will use a 2x2 factorial design. All participants will receive written materials on diet and physical activity recommendations for breast cancer survivors and a pedometer to encourage physical activity. Participants will be randomized to in-person education alone (6 4-hour sessions), e-communication alone (motivational e-newsletters plus an interactive website), in-person education plus e-communication, or control. Randomization will be stratified on preferred language (English vs. Spanish), menopausal status and current use of anti-hormonal therapy. Clinic visits, blood collection and dietary assessment will occur at baseline, 6 and 12 months. Monthly telephone calls will collect brief behavior change data and serve as retention support. The Primary Aim is to determine the separate and synergistic effects of the Cook for Your Life! Intervention among Latina breast cancer survivors assessed via increase in daily servings of fruits/vegetables and decrease in total daily energy density at 12 months. Secondary Aims will 1) examine effects of the intervention on physical activity and weight loss; 2) examine predictors of mediators of dietary change; and 3) examine the effects of the intervention on biomarkers of inflammation and oxidative stress associated with breast cancer recurrence risk. Study results will determine the best delivery method for the intervention in a diverse and underserved population of cancer survivors. If effective, the standardized intervention can be implemented by community groups and medical centers. Study results will be used to design a multi-site trial to test the long- term effects of a behavioral intervention on comorbidities, cancer recurrence and survival.

Public Health Relevance

There are clear diet and physical activity guidelines for cancer survivors: eat a diet high in fruits/vegetables and low in energy-dense foods and engage in 150 minutes of moderate-vigorous physical activity per week. However, cancer survivors, especially minority cancer survivors, are provided with few, if any, resources to meet these guidelines and there are limited data supporting how cancer survivors can achieve sustained dietary change. We propose to conduct a 2x2 factorial randomized controlled trial to test the separate and synergistic effects of an in-person hands-on dietary change curriculum and e-communication strategies (emailed newsletters and an interactive website) on changing dietary behaviors among a diverse population of Latina breast cancer survivors who have completed treatment.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA186080-05
Application #
9672373
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Agurs-Collins, Tanya
Project Start
2015-04-15
Project End
2020-03-31
Budget Start
2019-04-01
Budget End
2020-03-31
Support Year
5
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Columbia University (N.Y.)
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032