A Randomized Trial of an Intervention to Increase Fruit and Vegetable Intake in Curatively Treated Patients with Early-Stage Head and Neck Cancer

Abstract

The leading cause of death in patients who have had curatively treated early-stage head and neck cancer is a second primary cancer of the upper aerodigestive tract (lung, esophagus, larynx, pharynx, and oral cavity cancers). Low fruit and vegetable intake has been associated with increased risk of primary head and neck cancer and the available data suggest that increasing intake following diagnosis may reduce the risk of a second primary cancer. The goal of this study was to develop and test an easily administered intervention to increase fruit and vegetable intake in these patients following diagnosis and treatment. The 6-month intervention was based on the Stage of Change model. Seventy-five early-stage head and neck cancer patients were randomized to either the intervention group or to the ''blinded'' control group, with diet change data available on 65 patients. Fruit and vegetable intake, assessed using a food frequency questionnaire, and plasma carotenoid concentrations were measured at baseline and at the end of the study period. The change in self-reported intake of fruit and vegetables (servings per day) over the study period was significantly greater (P = 0.009) in the intervention group (n = 35; +2.1) compared with the control group (n = 30; +0.5). Total plasma carotenoids, a biomarker of fruit and vegetable intake, increased by 70 nmol/L in the intervention group as compared with a reduction of 42 nmol/L in the control group, a relative difference of 12% (nonsignificant). An intervention that can be delivered in a physician's office resulted in a significant increase in intake of fruit and vegetables in earlystage head and neck cancer patients. (Cancer Epidemiol Biomarkers Prev 2005;14(12):2848 -54)

Plasma Carotenoids and Biomarkers of Oxidative Stress in Patients with prior Head and Neck Cancer

“…The study has been described in detail elsewhere 44. Briefly, the study goal was to increase fruit and vegetable consumption in patients with early-stage, curatively treated head and neck cancer.…”

A behavioural approach in the development of work-related interventions for cancer survivors: an exploratory review

“…Most studies were directed at breast cancer survivors, but colorectal and prostate cancer survivors were also studied. Of the 34 studies, 14 were aimed at increasing exercise or physical activity (Basen‐Engquist et al., ; Bennett, Lyons, Winters‐Stone, Nail, & Scherer, ; Courneya et al., ; Fillion et al., ; Hatchett, Hallam, & Ford, ; Jones, Courneya, Fairey, & Mackey, ; Jones et al., ; Matthews et al., ; Mutrie et al., ; Pinto, Frierson, Rabin, Trunzo, & Marcus, ; Pinto, Papandonatos, Goldstein, Marcus, & Farrell, ; Pinto et al., ; Rogers et al., ; Vallance, Courneya, Plotnikoff, & Mackey, ), six at enhancing diet quality (Cartmel, Bowen, Ross, Johnson, & Mayne, ; Chlebowski et al., ; Djuric et al., ; Hebert et al., ; Pierce et al., , ), and nine at changing both exercise and diet behaviour (Campbell et al., ; Christy et al., ; Demark‐Wahnefried et al., , , ; Harris et al., ; Morey et al., ; Mosher et al., ; Ottenbacher et al., ). Furthermore, four studies were aimed at ceasing smoking (Cox et al., ; Emmons et al., ; Schnoll et al., ; Wakefield, Olver, Whitford, & Rosenfeld, ) and one at reducing both alcohol intake and tobacco use (Duffy et al., ).…”

“…For participants in the preparation stage, the intervention focused on the skills and strategies necessary to change behaviour. The change in self‐reported intake of fruit and vegetables was significantly greater in the intervention group compared to the usual care control group (Cartmel et al., ). Not only studies applying usual care in the control group, but also studies with a non‐tailored intervention for the control group showed their efficacy.…”

“…Of the 18 retrieved studies applying the TTM in the development of an intervention, most of them demonstrated their efficacy in cancer survivors. For example, Cartmel et al (2005) developed and tested an easily administered intervention, based on the TTM, to increase fruit and vegetable intake in early-stage head and neck cancer patients. For participants in the precontemplation and contemplation stage, messages were provided about the usefulness of changing dietary behaviours to convince participants that changing behaviour may be a positive and potentially health promoting achievement.…”

Cancer Chemopreventive and Therapeutic Properties of Fruits and Vegetables Against Head and Neck Malignancies

“…The upper aerodigestive tract is the major area affected with the second primaries of lung cancer, esophageal cancer, pharyngeal, laryngeal, and oral cancers. 12 Thus, a precautionary approach before the advance of invasive cancer or progress of second primary tumors is highly desirable.…”