Effects of dietary and physical activity interventions on generic and cancer-specific health-related quality of life, anxiety, and depression in colorectal cancer survivors: a randomized controlled trial

Abstract

Purpose To assess the effects of dietary and physical activity (PA) interventions on generic and cancer-specific quality of life (QoL), anxiety, and depression levels among adult Chinese colorectal cancer (CRC) survivors. Methods Two-hundred twenty-three adult CRC survivors within 1 year of completion of primary cancer treatment were randomized to receive dietary, PA or combined intervention, or usual care for a 12 monthduration, under a 2 (diet vs usual care) × 2 (PA vs usual care) factorial design. Generic and cancer-specific QoL was assessed using a Chinese version 12-Item Short Form Health Survey (SF-12) and the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, respectively. Anxiety and depression was assessed using the Hospital Anxiety and Depression Scale at baseline, 6, 12, 18, and 24 months. Linear mixed models were used for examining the intervention effects. Results Participants receiving dietary intervention experienced a significant improvement in the generic measure of QoL (SF-6D utility scores, mean difference 0.042, 95%CI 0.03 to 0.081) at 12 months, the cancer-specific QoL scores (mean difference 3.09, 95%CI 0.13 to 6.04), and levels of depression (P = 0.015) at both 12 and 24 months follow-up. Participants receiving PA intervention only demonstrated a significant improvement in SF-6D utility index (mean difference 0.039, 95%CI 0.002 to 0.077) and physical functioning (mean difference 2.85, 95%CI 1.00 to 4.70) at 6 months. Conclusions Dietary intervention improved the generic and cancer-specific QoL and depression in CRC survivors. Trial registration The study was prospectively registered on 17 October 2012 at ClinicalTrials.gov (NCT01708824). Implications for Cancer Survivors CRC survivors can benefit from dietary interventions in alleviating depression and improving overall health-related QoL.

A literature review of post‐treatment survivorship interventions for colorectal cancer survivors and/or their caregivers

“…The result showed the Healthy Expressions group demonstrated significant improvements in depression symptoms at months two and four when compared with the control group 45 . Further, a four‐arm RCT focused on dietary and PA showed that the dietary intervention group experienced significant improvements in depression levels 57 …”

“…These studies reported on a range of intervention types, according to their different intervention focus, which could be classified into CRC surveillance programme, 31,32 education (colostomy education, 33–37 psychosexual education, 38 psychoeducation, 39,40 healthy lifestyle education 41 ), psychosocial support, 42,43 supportive expression, 44,45 cognitive behavioural stress management (CBSM), 46 supportive care, 47–50 physical activity (PA) and/or dietary, 51–58 and survivorship care plan (SCP) 59,60 interventions. Detailed definitions of the interventions included are described in Table S1.…”

“…The studies that were included reported on various delivery formats, including face‐to‐face (one‐on‐one or in a group), 33–35,39–41,45,46,60 telephone, 36,38,42,48–50,56 web‐based, 58 and multiple combination with the following formats: face‐to‐face, telephone, home visit, home‐based, or web‐based 37,43,44,47,51–55,57,59 . These interventions were delivered by a range of health professionals, for example, nurse, therapist, doctor, oncologist, dietitian, psychologist, social worker, or trained research assistant.…”

“…Eight studies reported on interventions aiming to improve CRC survivors' depression and/or anxiety, including colostomy education, 33 psychoeducation, 40 psychosocial support, 42,43 supportive expression, 44,45 nurse‐led supportive care, 49 and dietary and PA interventions, 57 with six of these studies showing significantly positive effects.…”

“…Two of these were feasibility studies focused on lifestyle combined with PA and diet, delivered by telephone or at home, resulting in improved dietary intake, diet self‐efficacy, PA, and QOL 55,56 . In the other two RCTs, Ho et al 57 . found that dietary intervention improved both generic and cancer‐specific QOL and physical functioning in CRC survivors, and Mayer et al 58 .…”