A Randomized Pilot Trial of Dietary Modification for the Chemoprevention of Noninvasive Bladder Cancer: The Dietary Intervention in Bladder Cancer Study

Abstract

Epidemiological data suggest robust associations of high vegetable intake with decreased risks of bladder cancer incidence and mortality, but translational prevention studies have yet to be performed. We designed and tested a novel intervention to increase vegetable intake in patients with non-invasive bladder cancer. We randomized 48 patients aged 50 to 80 years with biopsy-proven non-invasive (Ta, T1, or carcinoma in situ) urothelial cell carcinoma to telephone- and Skype-based dietary counseling or a control condition that provided print materials only. The intervention behavioral goals promoted 7 daily vegetable servings, with at least 2 of these as cruciferous vegetables. Outcome variables were self-reported diet and plasma carotenoid and 24-hour urinary isothiocyanate (ITC) concentrations. We used 2-sample t-tests to assess between-group differences at 6-month follow-up. After 6 months, intervention patients had higher daily intakes of vegetable juice (p=0.02), total vegetables (p=0.02), and cruciferous vegetables (p=0.07); lower daily intakes of energy (p=0.007), (p=0.002) and energy from fat (p=0.06); and higher plasma alpha-carotene concentrations (p=0.03). Self-reported cruciferous vegetable intake correlated with urinary ITC concentrations at baseline (p<0.001) and at 6 months (p=0.03). Although urinary ITC concentrations increased in the intervention group and decreased in the control group, these changes did not attain between-group significance (p=0.32). In patients with non-invasive bladder cancer, our novel intervention induced diet changes associated with protective effects against bladder cancer. These data demonstrate the feasibility of implementing therapeutic dietary modifications to prevent recurrent and progressive bladder cancer.

Impact of the Method of Delivering Electronic Health Behavior Change Interventions in Survivors of Cancer on Engagement, Health Behaviors, and Health Outcomes: Systematic Review and Meta-Analysis

“…There were a range of different cancer types targeted during the study interventions: 7 unspecified cancer types [ 45 , 49 , 50 , 52 , 55 - 57 , 60 ]; 6 breast cancer [ 33 , 35 , 42 , 51 , 54 , 61 ]; 2 colon or colorectal [ 36 , 43 ]; 2 breast, prostate, or colorectal [ 44 , 59 ]; 2 melanoma [ 41 , 53 ]; and 1 each of breast/colon or rectal [ 37 ], colorectal or prostate [ 58 ], prostate [ 46 ], and urothelial cell carcinoma [ 47 ]. The majority of studies focused on posttreatment (also reported as survivors) with 17 studies [ 33 , 36 , 37 , 41 , 43 - 45 , 49 - 56 , 59 , 61 ], 6 studies included patients during active cancer treatment (2 used survivors and active cancer treatment) [ 35 , 42 , 47 , 57 , 58 , 60 ], and 1 study included patients undergoing surveillance for their cancer [ 46 ]. Of the 24 studies included in this review, 19 provided data on a measure of physical activity behavior change [ 33 , 35 - 37 , 42 - 45 , 48 - 50 , 54 - 57 , 59 ] and 9 studies provided data on a measure of dietary behavior change [ 33 , 36 , 42 , 44 - 47 , 54 , 56 ]; 2...…”

“…The majority of studies focused on posttreatment (also reported as survivors) with 17 studies [ 33 , 36 , 37 , 41 , 43 - 45 , 49 - 56 , 59 , 61 ], 6 studies included patients during active cancer treatment (2 used survivors and active cancer treatment) [ 35 , 42 , 47 , 57 , 58 , 60 ], and 1 study included patients undergoing surveillance for their cancer [ 46 ]. Of the 24 studies included in this review, 19 provided data on a measure of physical activity behavior change [ 33 , 35 - 37 , 42 - 45 , 48 - 50 , 54 - 57 , 59 ] and 9 studies provided data on a measure of dietary behavior change [ 33 , 36 , 42 , 44 - 47 , 54 , 56 ]; 2 studies provided data on skin self-examination during melanoma-related interventions [ 41 , 53 ]; 2 studies provided data on smoking cessation [ 52 , 56 ], whereas another study provided information on alcohol intake [ 36 ]. Interventions delivered via synchronous modes included telephone, Skype, and videoconferencing, whereas those delivered via asynchronous modes used combinations of custom or existing websites and mobile apps, with short messaging and email.…”

“…A total of 9 studies included in this review provided data on diet as a behavior change outcome; 6 studies were included in this meta-analysis [ 36 , 42 , 44 , 45 , 47 , 54 ] and a further 3 could not be included as the data were presented in a format incompatible with meta-analysis [ 33 , 46 , 56 ]. There was a finding that diet interventions delivered via eHealth can improve behavior change compared with control (SMD 0.44; 95% CI 0.18 to 0.70; Figure 5 ).…”

Bladder cancer: the importance of modifiable risk factors

“…Результаты продолжающегося изучения данных выживших больных РМП могут послужить основой для будущих исследований в этой области. Пилотное исследование показало, что телефонное или Skype-консультирование по вопросам питания способно увеличить общее потребление овощей пациентами с РМП, что указывает на целесообразность применения программ питания в катамнезе среди пациентов с РМП [65]. Наконец, хотя первичная профилактическая борьба с курением и пропаганда здорового образа жизни осуществляются на государственном уровне, имеющиеся данные свидетельствуют о потенциально высоких возможностях вторичной профилактики путем выдачи урологом рекомендаций пациентам по отказу от курения как компоненту лечения РМП, имеющему прямое влияние на результаты лечения.…”

Evaluation of 2‐Thiothiazolidine‐4‐Carboxylic Acid, a Common Metabolite of Isothiocyanates, as a Potential Biomarker of Cruciferous Vegetable Intake

“…Several dozen types of vegetables make up the cruciferous vegetable family and they have been evaluated as disease preventative and therapeutic agents in both observational studies and in randomized clinical trials . The underlying biological mechanism of these disease‐mitigating effects is governed by the enzymatic conversion of glucosinolates to isothiocyanates by the plant enzyme myrosinase.…”