Skip to main content

Advertisement

Log in

A randomised controlled trial to evaluate the efficacy of a 6-month dietary and physical activity intervention for patients receiving androgen deprivation therapy for prostate cancer

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Treatment of prostate cancer with androgen deprivation therapy (ADT) is associated with an increased fat mass, decreased lean mass, increased fatigue and a reduction in quality of life (QoL). The aim of this study was to evaluate the efficacy of a 6-month dietary and physical activity intervention for prostate cancer patients receiving ADT, to help minimise these side effects.

Methods

Patients (n = 94) were recruited to this study if they were planned to receive ADT for prostate cancer for at least 6 months. Men randomised to the intervention arm received a dietary and exercise intervention, commensurate with UK healthy eating and physical activity recommendations. The primary outcome of interest was body composition; secondary outcomes included fatigue, QoL, functional capacity, stress and dietary change.

Results

The intervention group had a significant (p < 0.001) reduction in weight, body mass index and percentage fat mass compared to the control group at 6 months; the between-group differences were −3.3 kg (95 % confidence interval (95 % CI) −4.5, −2.1), −1.1 kg/m2 (95 % CI −1.5, −0.7) and −2.1 % (95 % CI −2.8, −1.4), respectively, after adjustment for baseline values. The intervention resulted in improvements in functional capacity (p < 0.001) and dietary intakes but did not significantly impact fatigue, QoL or stress scores at endpoint.

Conclusions

A 6-month diet and physical activity intervention can minimise the adverse body composition changes associated with ADT.

Implications for Cancer Survivors

This study shows that a pragmatic lifestyle intervention is feasible and can have a positive impact on health behaviours and other key outcomes in men with prostate cancer receiving ADT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hussain S, Gunell D, Donovan J, McPhail S, Hamdy F, Neal D, et al. Secular trends in prostate cancer mortality, morbidity, incidence and treatment: England and Wales, 1975–2004. BJU Int. 2008;101:547–55.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Demers RY, Tiwari A, Wei J, Weiss LK, Severson RK, Montie J. Trends in the utilisation of androgen deprivation therapy for patients with prostate carcinoma suggest an effect on mortality. Cancer. 2001;92:2309–17.

    Article  CAS  PubMed  Google Scholar 

  3. National Institute for Health and Care Excellence (NICE). Prostate cancer—diagnosis and treatment. London: 2014

  4. Loblaw DA, Virgo KS, Nam R, Somerfield MR, Ben-Josef E, Mendelson DS, et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2007 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2007;25:1596–605.

    Article  CAS  PubMed  Google Scholar 

  5. Alibhai SMH, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: a systematic literature review. Crit Rev Oncol Hematol. 2006;60:201–15.

    Article  PubMed  Google Scholar 

  6. Haseen F, Murray LJ, Cardwell CR, O’Sullivan JM, Cantwell MM. The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis. J Cancer Surviv. 2010;4:128–39.

    Article  PubMed  Google Scholar 

  7. Smith MR, Finkelstein JS, McGovern FJ, Zietman AL, Fallon MA, Schoenfeld DA, et al. Changes in body composition during androgen deprivation therapy for prostate cancer. J Clin Endocrinol Metab. 2002;87:599–603.

    Article  CAS  PubMed  Google Scholar 

  8. Galvao DA, Spry NA, Taffee DR, Newton RU, Stanley J, Shannon T, et al. Changes in muscle, fat and bone mass after 36 weeks of maximal androgen blockade for prostate cancer. BJU Int. 2008;102:44–7.

    Article  PubMed  Google Scholar 

  9. Hamilton EJ, Gianatti E, Strauss BJ, Wentworth J, Lim-Joon D, Bolton D, et al. Increase in visceral and subcutaneous abdominal fat in men with prostate cancer treated with ADT. Clin Endocrinol. 2011;74:377–83.

    Article  CAS  Google Scholar 

  10. Stone P, Hardy J, Huddart R, A’Hern R, Richards M. Fatigue in patients with prostate cancer receiving hormone therapy. EJC. 2000;36:1134–41.

    Article  CAS  Google Scholar 

  11. Herr HW, O’Sullivan M. Quality of life of asymptomatic men with nonmetastatic prostate cancer on androgen deprivation therapy. J Urol. 2000;163:1743–6.

    Article  CAS  PubMed  Google Scholar 

  12. Green HJ, Pakenham KI, Headley BC, Yaxley J, Nicol DL, Mactaggart PN, et al. Quality of life compared during pharmacological treatments and clinical monitoring for non-localised prostate cancer: a randomised controlled trial. BJU Int. 2004;93:975–9.

    Article  CAS  PubMed  Google Scholar 

  13. Alibhai SMH, Breunis H, Timilshina N, Johnston C, Tomlinson G, Tannock I, et al. Impact of androgen-deprivation therapy on physical function and quality of life in men with nonmetastatic prostate cancer. J Clin Oncol. 2010;28:5038–45.

    Article  CAS  PubMed  Google Scholar 

  14. Keating NL, O’Malley AJ, Freedland SJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of veterans with prostate cancer. JNCI. 2010;102:39–46.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Taylor LG, Canfield SE, Du XL. Review of major adverse effects of androgen-deprivation therapy in men with prostate cancer. Cancer. 2009;115:2388–99.

    Article  PubMed  Google Scholar 

  16. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.

    Article  CAS  PubMed  Google Scholar 

  18. Keto CJ, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, et al. Obesity is associated with castration-resistant disease and metastasis in men treated with androgen deprivation therapy after radical prostatectomy: results from the SEARCH database. BJU Int. 2012;110:492–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol. 2003;21:1653–9.

    Article  PubMed  Google Scholar 

  20. Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28:340–7.

    Article  PubMed  Google Scholar 

  21. Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, Norris S, et al. Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Support Care Cancer. 2010;18:591–9.

    Article  PubMed  Google Scholar 

  22. Department of Health UK. Chief Medical Officer’s report: evidence on the impact of physical activity and its relationship with health. London: HSMO; 2004.

    Google Scholar 

  23. Haskell WL, Lee I-M, Pate RR, Powell R, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sport Exerc. 2007;39:1423–34.

    Article  Google Scholar 

  24. Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, Hartman TJ, et al. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomised controlled trial. JAMA. 2009;301:1883–91.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Bourke L, Gilbert S, Hooper R, Steed LA, Joshi M, Jim WF, et al. Lifestyle changes for improving disease specific quality of life in sedentary men on long term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial. Eur Urol. 2013;65:865–72.

    Article  PubMed  Google Scholar 

  26. Haseen F, Murray LJ, O’Neill RF, O’Sullivan MJ, Cantwell MM. A randomised controlled trial to evaluate the efficacy of a 6 month dietary and physical activity intervention for prostate cancer patients receiving androgen deprivation therapy. Trials. 2010;11:86.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Durnin J, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr. 1974;32:77–97.

    Article  CAS  PubMed  Google Scholar 

  28. McCance & Widdowson’s ‘The composition of foods’. 5th edition B Holland, A A Welch, I D Unwin, D H Buss, AA Paul and DAT Southgate. The Royal Society of Chemistry, 1991.

  29. Food Standards Agency: Eat well, be well. [http://www.food.gov.uk/].

  30. Blackburn G. Effect of degree of weight loss on health benefits. Obes Res. 1995;3:211–6.

    Article  Google Scholar 

  31. Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Cella D, Eton DT, Lai J, Peterman AH, Merkel DE. Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anaemia and fatigue scales. J Pain Symptom Manag. 2002;24:547–61.

    Article  Google Scholar 

  33. Cella D, Nichol MB, Eton D, Nelson JB, Mulani P. Estimating clinically meaningful changes in the Functional Assessment of Cancer Therapy-Prostate. Results from a clinical trial of patients with metastatic hormone refractory prostate cancer. Value Health. 2009;12:124–9.

    Article  PubMed  Google Scholar 

  34. Lachin JM. Statistical considerations in the intent-to-treat principle. Control Clin Trials. 2000;21:167–89.

    Article  CAS  PubMed  Google Scholar 

  35. Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, et al. Improving the quality of reporting of randomized controlled trials—the CONSORT statement. JAMA. 1996;276:637–9.

    Article  CAS  PubMed  Google Scholar 

  36. Galvão DA, Nosaka K, Taffe DR, Spry N, Kristjanson LJ, Mcguigan MR, et al. Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sport Exerc. 2006;38:2045–52.

    Article  Google Scholar 

  37. Carmack-Taylor CL, Demoor C, Smith MA, Dunn AL, Basen-Enquist K, Nielsen I, et al. Active for life after cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients. Psycho-Oncology. 2006;15:847–62.

    Article  PubMed  Google Scholar 

  38. Braga-Basaria M, Dobs AS, Muller DC, Carducci MA, John M, Egan J, et al. Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy. J Clin Oncol. 2006;24:3979–83.

    Article  PubMed  Google Scholar 

  39. Isomma B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683–9.

    Article  Google Scholar 

  40. Nobes JP, Langley SEM, Klopper T, Russell-Jones D, Laing RW. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy. BJU Int. 2012;109:1495–502.

    Article  CAS  PubMed  Google Scholar 

  41. Jensen GL, Friedmann JM. Obesity is associated with functional decline in community-dwelling rural older persons. J Am Geriatr Soc. 2002;50:918–23.

    Article  PubMed  Google Scholar 

  42. Culos-Reed SN, Robinson JL, Lau H, O’Connor K, Keats MR. Benefits of a physical activity intervention for men with prostate cancer. J Sport Exerc Psychol. 2007;29:118–27.

    PubMed  Google Scholar 

  43. Bourke L, Doll H, Crank H, Daly A, Rosario D, Saxton JM. Lifestyle intervention in men with advanced prostate cancer receiving androgen suppression therapy: a feasibility study. Cancer Epidemiol Biomarkers. 2011;20:647–57.

    Article  Google Scholar 

  44. Stone P, Hardy J, Broadley J, Kurowska A, A’Hern R. Fatigue in advanced cancer: a prospective controlled cross-sectional study. Brit J Cancer. 1999;79:1479–86.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W, et al. Stages of change and decisional balance for 12 problem behaviours. Health Psychol. 1994;13:39–46.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Salary costs for this project were covered by the Department of Employment and Learning and the Centre of Excellence for Public Health, Queen’s University Belfast. The authors would like to acknowledge the contribution of the administrative and clinical staff at the Northern Ireland Cancer Centre, particularly nurses Barbara Harvey and Wendy McPhee. Special thanks also to the prostate cancer patients who gave so generously of their time.

Conflict of interest

Roisin F O’Neill, Farhana Haseen, Liam J Murray, Joe M O’Sullivan and Marie M Cantwell declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roisin F. O’Neill.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

O’Neill, R.F., Haseen, F., Murray, L.J. et al. A randomised controlled trial to evaluate the efficacy of a 6-month dietary and physical activity intervention for patients receiving androgen deprivation therapy for prostate cancer. J Cancer Surviv 9, 431–440 (2015). https://doi.org/10.1007/s11764-014-0417-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-014-0417-8

Keywords

Navigation