Abstract
Objective
This study aimed to systematically identify and synthesize evidence on the feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors.
Methods
A total of 14 electronic databases and three trial registries were searched. Experimental studies that examined the feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors and published in English or Chinese peer-reviewed journals or protocols were considered eligible. The methodological quality of the included studies was evaluated using the revised Cochrane risk-of-bias assessment tool. Data were extracted and synthesized narratively.
Results
Six studies, with a sample size ranging from 50 to 3088, were included. The studies had a high overall risk of bias. Six studies reported feasibility data, and the average eligibility, recruitment, and retention rates at post-intervention were 60.7%, 66.7%, and 90.7%, respectively. Only one study measured the acceptability and reported that 66.6% of participants were satisfied with the intervention. Five out of the six studies that measured fruit and vegetable consumption reported statistically significant positive intervention effects. Two studies reported inconsistent intervention effects on wholegrain consumption. Only one study measured the consumption of processed meat, sugar, and alcohol, which had statistically nonsignificant intervention effect.
Conclusions
Behavior change interventions for improving multiple dietary behaviors might be feasible and effective to increase fruit and/or vegetable consumption among cancer survivors. Further research is needed to examine the acceptability and effects of the intervention for modifying other dietary behavior.
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References
Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR et al (2019) (2019) Cancer treatment and survivorship statistics. CA Cancer J Clin 69(5):363–385
Ferlay J, Ervik M, Lam F et al (2020) Global cancer observatory: cancer today. International Agency for Research on Cancer. https://gco.iarc.fr/. Accessed May 24, 2021
Donin N, Filson C, Drakaki A, Tan HJ, Castillo A et al (2016) Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer 122(19):3075–3086
Zaorsky NG, Churilla TM, Egleston BL, Fisher SG, Ridge JA et al (2017) Causes of death among cancer patients. Ann Oncol 28(2):400–407
Grosso G, Bella F, Godos J, Sciacca S, Del Rio D et al (2017) Possible role of diet in cancer: systematic review and multiple meta-analyses of dietary patterns, lifestyle factors, and cancer risk. Nutr Rev 75(6):405–419
Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):243–274
World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and cancer: a global perspective. Continuous Update Project Expert Report 2018. https://www.wcrf.org/dietandcancer. Accessed May 24, 2021
Schwedhelm C, Boeing H, Hoffmann G, Aleksandrova K, Schwingshackl L (2016) Effect of diet on mortality and cancer recurrence among cancer survivors: a systematic review and meta-analysis of cohort studies. Nutr Rev 74(12):737–748
Tollosa DN, Tavener M, Hure A, James EL (2019) Adherence to multiple health behaviours in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 13(3):327–343
Cho D, Park CL (2018) Barriers to physical activity and healthy diet among breast cancer survivors: a multilevel perspective. Eur J Cancer Care 27(1):e12772
Lee MK, Park SY, Choi GS (2019) Facilitators and barriers to adoption of a healthy diet in survivors of colorectal cancer. J Nurs Scholarsh 51(5):509–517
Ryu SW, Son YG, Lee MK (2020) Motivators and barriers to adoption of a healthy diet by survivors of stomach cancer: a cross-sectional study. Eur J Oncol Nurs 44:101703
Goode AD, Lawler SP, Brakenridge CL, Reeves MM, Eakin EG (2015) Telephone, print, and web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv 9(4):660–682
Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K (2019) Health behaviors and lifestyle interventions in African American breast cancer survivors: a review. Front Oncol 9:3
Sweeney-Magee M, Moustaqim-Barrette A, Gotay C, Dummer T (2020) A systematic mixed studies review of health behaviour change interventions in colorectal cancer survivors. J Adv Nurs 76(8):1936–1948
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol 134:178–189
Marijn Stok F, Renner B, Allan J, Boeing H, Ensenauer R et al (2018) Dietary behavior: an interdisciplinary conceptual analysis and taxonomy. Front Psychol 9:1689
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F et al (2016) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36(1):11–48
Ligibel J (2012) Lifestyle factors in cancer survivorship. J Clin Oncol 30(30):3697–3704
MacDonald DE, Cassin SE (2015) Nondieting psychological interventions for individuals who are overweight or obese: a systematic review of the evidence. Psychopathol Rev 4(3):290–318
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T et al (2021) Cochrane handbook for systematic reviews of interventions version 6.2 (updated February 2021). Cochrane. http: www.training.cochrane.org/handbook. Accessed May 24, 2021
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R et al (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348:g1687
Michie S, Richardson M, Johnston M, Abraham C, Francis J et al (2013) The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 46(1):81–95
Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898
Befort CA, Bennett L, Christifano D, Klemp JR, Krebill H (2015) Effective recruitment of rural breast cancer survivors into a lifestyle intervention. Psycho-Oncol 24(4):487–490
Blok AC, Blonquist TM, Nayak MM, Somayaji D, Crouter SE et al (2018) Feasibility and acceptability of “healthy directions” a lifestyle intervention for adults with lung cancer. Psycho-Oncol 27(1):250–257
Grimmett C, Simon A, Lawson V, Wardle J (2015) Diet and physical activity intervention in colorectal cancer survivors: a feasibility study. Eur J Oncol Nurs 19(1):1–6
Lawler S, Maher G, Brennan M, Goode A, Reeves MM et al (2017) Get healthy after breast cancer—examining the feasibility, acceptability and outcomes of referring breast cancer survivors to a general population telephone-delivered program targeting physical activity, healthy diet and weight loss. Support Care Cancer 25(6):1953–1962
Cartmel B, Bowen D, Ross D, Johnson E, Mayne ST (2005) A randomized trial of an intervention to increase fruit and vegetable intake in curatively treated patients with early-stage head and neck cancer. Cancer Epidemiol Biomarkers Prev 14(12):2848–2854
Greenlee H, Ogden Gaffney A, Aycinena AC, Koch P, Contento I et al (2016) Long-term diet and biomarker changes after a short-term intervention among Hispanic breast cancer survivors: the inverted exclamation markCocinar Para Su Salud! Randomized controlled trial. Cancer Epidemiol Biomarkers Prev 25(11):1491–1502
Pierce JP, Newman VA, Natarajan L, Flatt SW, Al-Delaimy WK et al (2007) Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern. J Nutr 137(10):2291–2296
Van Blarigan EL, Kenfield SA, Chan JM, Van Loon K, Paciorek A et al (2020) Feasibility and acceptability of a web-based dietary intervention with text messages for colorectal cancer: a randomized pilot trial cancer. Cancer Epidemiol Biomarkers Prev 29(4):752–760
Del Valle MO, Martín-Payo R, Cuesta-Briand B, Lana A (2018) Impact of two nurse-led interventions targeting diet among breast cancer survivors: results from a randomized controlled trial. Eur J Cancer Care 27(4):e12854
Arends J, Theobald S, Schmid J, Bartsch H (2014) Nutritional training increases long-term fruit and vegetable consumption in women with early breast cancer—a randomized controlled trial. Metab Nutr Oncol 02(01):e1–e7
Boutron I, Tubach F, Giraudeau B, Ravaud P (2004) Blinding was judged more difficult to achieve and maintain in nonpharmacologic than pharmacologic trials. J Clin Epidemiol 57(6):543–550
Freedland KE, Mohr DC, Davidson KW, Schwartz JE (2011) Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions. Psychosom Med 73(4):323–335
Boushey CJ, Spoden M, Zhu FM, Delp EJ, Kerr DA (2017) New mobile methods for dietary assessment: review of image-assisted and image-based dietary assessment methods. Proc Nutr Soc 76(3):283–294
Ho DKN, Tseng SH, Wu MC, Shih CK, Atika AP et al (2020) Validity of image-based dietary assessment methods: a systematic review and meta-analysis. Clin Nutr 39(10):2945–2959
Gemming L, Utter J, Ni Mhurchu C (2015) Image-assisted dietary assessment: a systematic review of the evidence. J Acad Nutr Diet 115(1):64–77
Carey RN, Connell LE, Johnston M, Rothman AJ, de Bruin M et al (2019) Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med 53(8):693–707
Toomey E, Hardeman W, Hankonen N, Byrne M, McSharry J et al (2020) Focusing on fidelity: narrative review and recommendations for improving intervention fidelity within trials of health behaviour change interventions. Health Psychol Behav Med 8(1):132–151
Bell K (2012) Remaking the self: trauma, teachable moments, and the biopolitics of cancer survivorship. Cult Med Psychiatry 36(4):584–600
Bluethmann SM, Basen-Engquist K, Vernon SW, Cox M, Gabriel KP et al (2015) Grasping the ‘teachable moment’: time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors. Psycho-Oncol 24(10):1250–1257
Frazelle ML, Friend PJ (2016) Optimizing the teachable moment for health promotion for cancer survivors and their families. J Adv Pract Oncol 7(4):422
Vijayvergia N, Denlinger CS (2015) Lifestyle factors in cancer survivorship: where we are and where we are headed. J Pers Med 5(3):243–263
Sekhon M, Cartwright M, Francis JJ (2017) Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res 17(1):88
Fang X, Wei J, He X, An P, Wang H et al (2015) Landscape of dietary factors associated with risk of gastric cancer: a systematic review and dose-response meta-analysis of prospective cohort studies. Eur J Cancer 51(18):2820–2832
Ferro A, Rosato V, Rota M, Costa AR, Morais S et al (2020) Meat intake and risk of gastric cancer in the stomach cancer pooling (StoP) project. Int J Cancer 147(1):45–55
Weng KG, Yuan YL (2017) Soy food intake and risk of gastric cancer: a dose-response metaanalysis of prospective studies. Medicine 96(33):e7802
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All authors contributed to the conception and design of the systematic review. GT and CH performed study selection, data extraction, quality appraisal, and data analysis; GT drafted the manuscript, and all authors revised the manuscript critically. All authors read and approved the manuscript for submission.
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Gan, T., Cheng, HL. & Tse, M.M.Y. Feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors: a systematic review. Support Care Cancer 30, 2877–2889 (2022). https://doi.org/10.1007/s00520-021-06582-2
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DOI: https://doi.org/10.1007/s00520-021-06582-2