Context Five-year survival rates for early stage colorectal, breast, and prostate cancer currently exceed 90% and are increasing. Cancer survivors are at greater risk for second malignancies, other comorbidities, and accelerated functional decline. Lifestyle interventions may provide benefit, but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status.Objective To determine whether a telephone counseling and mailed print materialbased diet and exercise intervention is effective in reorienting functional decline in older, overweight cancer survivors.Design, Setting, and Participants Randomized controlled trial of 641 overweight (body mass index Ն25 and Ͻ40), long-term (Ն5 years) survivors (aged 65-91 years) of colorectal, breast, and prostate cancer, who were randomly assigned to an intervention group (n=319) or delayed intervention (control) group (n=322) in Canada, the United Kingdom, and 21 US states. Individuals were recruited for the Reach out to

Mailed material interventions, especially those that are tailored, are effective in promoting healthful lifestyle changes among cancer survivors. Further study is needed to determine sustainability, cost to benefit, and generalizability to other cancer populations.

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Purpose-Declines in physical functioning (PF) among elderly cancer patients threaten quality of life and the ability to maintain independence. Adherence to healthy lifestyle behaviors may prevent functional decline. Patients and Methods-Project Leading the Way in Exercise and Diet (LEAD), an intervention development study of the Pepper Older Americans Independence Center, aimed to determine whether breast and prostate cancer survivors (age 65+ years) assigned to a 6-month home-based diet and exercise intervention experienced improvements in PF when compared with an attention control arm receiving general health information. An accrual target was set at 420, and PF (Short Form-36 subscale), physical activity (Community Healthy Activities Models Program for Seniors), and diet quality (index from 3-day recalls) were assessed at baseline and at 6 and 12 months (6 months after intervention). Results-This developmental project did not achieve its accrual target (N = 182); however, PF change scores were in the direction and of the magnitude projected. Baseline to 6-month change scores in the intervention versus the control arms were as follows: PF, +3.1 v −0.5 (P = .23); physical activity energy expenditure, +111 kcal/wk v −400 kcal/wk (P = .13); and diet quality index, +2.2 v −2.9 (P = .003), respectively. Differences between arms diminished during the postintervention period.Conclusion-These findings suggest that home-based diet and exercise interventions hold promise in improving lifestyle behaviors among older cancer survivors, changes that trend toward improved PF. Future studies should incorporate larger sample sizes and interventions that sustain long-term effects and also take into account secular trends; these efforts will require adequate planning and resources to overcome the numerous barriers to intervening in this difficult to reach yet vulnerable population.

In the world today, there are roughly 25 million cancer survivors. Although the increasing numbers of survivors testifies to the success of early detection and treatment, there is a downside. Cancer survivors are at increased risk for second cancers, other forms of comorbidity (e.g., cardiovascular disease, diabetes, osteoporosis), and functional decline. Lifestyle factors, such as a healthy diet, regular exercise, and smoking cessation may prevent these conditions and improve survivors' quality of life. Data also are accumulating to suggest that healthful lifestyle practices and successful weight management may prevent progressive or recurrent disease. Previous surveys conducted among both adult and pediatric cancer survivors indicate that most survivors have high levels of interest in diet and exercise interventions. Additionally, survivors who smoke report high levels of interest in interventions aimed at smoking cessation. Many factors, such as intervention timing and duration and channels of delivery, must be carefully considered in developing interventions that best meet the needs of this vulnerable population. Total transparency also is necessary in reporting the results of trials to ensure the inclusion of information regarding proportional accrual, attrition, and study sample sociodemographic characteristics to move toward the development of interventions most likely to gain broad-scale acceptance and adherence. Home-based interventions that rely on telephone counseling, mailed materials, or computer-assisted approaches offer promising means of reaching the geographically dispersed population of cancer survivors. More research is necessary to develop interventions that can reach and effectively promote long-term behavior change in this ever-increasing population.

Background-Older cancer survivors are at increased risk for secondary cancers, cardiovascular disease, obesity, and functional decline and, thus, may benefit from health-related interventions. However, little is known regarding older cancer survivors' health behaviors and their associations with quality of life outcomes, especially during the long-term post-treatment period. Methods: A total of 753 older (age ≥ 65 years), long-term (≥ 5 years post-diagnosis) breast, prostate, and colorectal cancer survivors completed two baseline telephone interviews to assess eligibility for a diet and exercise intervention trial. Interviews assessed exercise, diet, weight status, and quality of life. Results-Older cancer survivors reported a median of 10 minutes of moderate-to-vigorous exercise per week, and only 7% had Healthy Eating Index scores above 80 (indicative of healthful eating habits relative to national guidelines). Despite their suboptimal health behaviors, survivors reported mental and physical quality of life that exceeded age-related norms. Greater exercise and better diet quality were associated with better physical quality of life outcomes (e.g., better vitality and physical functioning; ps ≤ .05), whereas greater body mass index was associated with reduced physical quality of life (ps < .001). Conclusions-Results indicate a high prevalence of suboptimal health behaviors among older, long-term breast, prostate, and colorectal cancer survivors who are interested in lifestyle modification. In addition, findings point to the potential negative impact of obesity and positive impact of physical activity and a healthy diet on physical quality of life in this population.

Background: Prostate cancer affects one of six men during their lifetime. Dietary factors are postulated to influence the development and progression of prostate cancer. Low-fat diets and flaxseed supplementation may offer potentially protective strategies. Methods: We undertook a multisite, randomized controlled trial to test the effects of low-fat and/or flaxseedsupplemented diets on the biology of the prostate and other biomarkers. Prostate cancer patients (n = 161) scheduled at least 21 days before prostatectomy were randomly assigned to one of the following arms: (a) control (usual diet), (b) flaxseed-supplemented diet (30 g/d), (c) low-fat diet (<20% total energy), or (d) flaxseed-supplemented, low-fat diet. Blood was drawn at baseline and before surgery and analyzed for prostate-specific antigen, sex hormone-binding globulin, testosterone, insulin-like growth factor-I and binding protein-3, C-reactive protein, and total and

A B S T R A C T PurposeDiet and exercise interventions have been tested in cancer survivors as a means to reduce late effects and comorbidity, but few have assessed adherence and health outcomes long term. 2 ), and over age 65 years. The trial tested a diet-exercise intervention delivered via mailed print materials and telephone counseling. RENEW used a wait-list control, cross-over design (ie, participants received the year-long intervention immediately or after a 1-year delay), which allowed the opportunity to assess program efficacy (previously reported primary outcome), durability, and reproducibility (reported herein). Measures included diet quality (DQ), PA, BMI, and physical function (PF). Methods ResultsNo significant relapse was observed in the immediate-intervention arm for DQ, PA, and BMI; however, rates of functional decline increased when the intervention ceased. From year 1 to year 2, significant improvements were observed in the delayed-intervention arm; mean change scores in behaviors and BMI and PF slopes were as follows: DQ score, 5.2 (95% CI, 3.4 to 7.0); PA, 45.8 min/wk (95% CI, 26.9 to 64.6 min/wk); BMI, Ϫ0.56 (95% CI, Ϫ0.75 to Ϫ0.36); and Short Form-36 PF, Ϫ1.02 versus Ϫ5.52 (P Ͻ .001 for all measures). Overall, both arms experienced significant improvements in DQ, PA, and BMI from baseline to 2-year follow-up (P Ͻ .001). ConclusionOlder cancer survivors respond favorably to lifestyle interventions and make durable changes in DQ and PA that contribute to sustained weight loss. These changes positively reorient functional decline trajectories during intervention delivery.