Harvest for Health in Older Cancer Survivors

老年癌症幸存者的健康收获

基本信息

批准号：
10197801
负责人：
Wendy Demark-Wahnefried
金额：
$ 41.05万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10197801
关键词：
Accelerometer Activities of Daily Living Adherence Adult Adverse effects Age Age-Years Aging Alabama Back Beds Behavior Biological Markers Biometry Blood Body Weight Body mass index Breast Breast Cancer survivor Cancer Survivor Cancer Survivorship Cardiovascular Diseases Chinese People Chronic Disease Clinical Communities Country County Data Diabetes Mellitus Diet Dietary intake Disease District of Columbia Eating Economics Elderly Enrollment Funding Gait speed Gardenal Gender Goals Harvest Health Health behavior High-Risk Cancer Home Home visitation Impairment Individual Infrastructure Intake Interleukin-6 Intervention Life Life Style Living Arrangement Malignant Neoplasms Measures Mental Health Mentors Morbidity - disease rate Nursing Homes Osteoporosis Outcome Measure Participant Patient Self-Report Physical Function Physical Performance Physical activity Plants Plasma Population Prognosis Proverb Public Health Publishing Quality of life Questionnaires Randomized Randomized Controlled Trials Research Research Personnel Risk Sampling Seasons Second Primary Cancers Second Primary Neoplasms Survivors Telomerase Therapeutic Treatment Efficacy United States Vegetables Waiting Lists Weight Woman alpha-carotene arm base cancer care comorbidity cost design economic cost economic evaluation effective intervention feasibility trial follow-up fruits and vegetables functional decline functional disability health related quality of life improved intervention cost intervention effect mortality novel performance tests prevent programs recruit secondary endpoint societal costs success treatment arm trend two-arm study

项目摘要

Harvest for Health in Older Cancer Survivors There are close to 15 million cancer survivors in the U.S., and the majority are 65 years of age or older. Despite improvements in treatment and 5-year cure rates, cancer survivors are at greater risk for second malignancies, cardiovascular disease, osteoporosis, and functional impairment - downstream effects that result in an annual cost of approximately $130 billion each year. Cancer survivorship has been claimed a national priority, with a call to develop effective interventions that can prevent, delay, or mitigate the adverse effects and comorbidities attendant with cancer and its treatment. Strong evidence exists that a healthful diet and regular physical activity can prevent many chronic diseases and improves physical functioning. But, more research is needed to develop interventions that can produce long-term adherence to healthful lifestyle behaviors. This study builds on strong, R21-supported preliminary data, and relies on the extant infrastructure of the Cooperative Extension Master Gardener Program. A total of 426 older (≥65 yrs.) survivors of a loco-regionally staged cancer with a good prognosis (≥ 80% 5-yr. survival) and with at least one physical function limitation will be recruited throughout Alabama and randomized to 1-of-2 study arms: 1) one that receives a 1-year mentored vegetable gardening intervention that pairs a cancer survivor with a certified Master Gardener; or 2) a wait-list control arm that receives the intervention after a 1-year delay. All participants will be followed for 2 years. This randomized controlled trial aims to: 1) determine the efficacy of the vegetable gardening intervention on fruit and vegetable intake, physical activity AND physical function (assessed by self-report and backed by objective measures: plasma α−carotene, accelerometry, and performance testing); 2) assess effects of the intervention on secondary endpoints, e.g., quality of life, biomarkers of successful aging (interleukin-6 and telomerase); 3) evaluate the durability and repeatability of the intervention; 4) explore participant factors related with program efficacy (e.g., gender, co-morbidity, age); and 5) perform an economic analysis to assess the value of health improvements relative to intervention costs. The proposed home-based, vegetable gardening intervention (using raised beds or Earthboxes® – depending on survivors' living arrangements) is a novel and feasible strategy to improve dietary intake, physical activity, and physical functioning in cancer survivors at high risk for cancer-related morbidity – one that has great clinical and public health significance given the increasing number of cancer survivors and the high economic and societal costs associated with comorbid disease. Moreover, the infrastructure for sustainability and wide-scale dissemination already exists as there are Master Gardener Programs in all 50 United States, and the proposed intervention could easily be implemented in states with 2 or more growing seasons (72% of states, plus the District of Columbia), thus reaching the vast majority of older cancer survivors (roughly 10.8 million) who reside in the temperate zones of this nation.

老年癌症幸存者的健康收获美国有近 1500 万癌症幸存者，其中大多数年龄在 65 岁或以上。尽管治疗方法和 5 年治愈率有所改善，但癌症幸存者面临第二次癌症的风险更大恶性肿瘤、心血管疾病、骨质疏松症和功能障碍——由此产生的下游影响每年癌症幸存者的费用约为 1300 亿美元。优先考虑，呼吁制定有效的干预措施，以预防、延迟或减轻不利影响，强有力的证据表明，健康的饮食和规律的治疗会伴随癌症。但是，更多的研究表明，身体活动可以预防许多慢性疾病并改善身体机能。需要制定可以长期坚持健康生活方式的干预措施。这项研究建立在 R21 支持的强大初步数据的基础上，并依赖于现有的基础设施合作推广园丁大师计划共有 426 名当地地区的老年（≥65 岁）幸存者。具有良好预后（≥ 80% 5 年生存率）且至少存在一项身体功能限制的分期癌症在阿拉巴马州各地招募并随机分配到 2 个研究组中的 1 个：1) 接受 1 年指导的研究组将癌症幸存者与经过认证的园艺大师配对的蔬菜园艺干预措施；或 2) 等候名单；延迟 1 年后接受干预的控制臂将被跟踪 2 年。随机对照试验旨在：1）确定蔬菜园艺干预对水果的功效和蔬菜摄入量、体力活动和身体机能（通过自我报告评估并以目标为支持）措施：血浆 α−胡萝卜素、加速测量和性能测试）；2) 评估干预效果次要终点，例如生活质量、成功衰老的生物标志物（白细胞介素 6 和端粒酶）；评估干预的持久性和可重复性；4）探索与计划相关的参与者因素；功效（例如性别、合并症、年龄）；以及 5) 进行经济分析以评估健康的价值拟议的家庭蔬菜园艺干预措施的相对改善。（使用高架床或 Earthboxes® – 取决于幸存者的生活安排）是一种新颖且可行的方法改善高危癌症幸存者的饮食摄入、体力活动和身体机能的策略与癌症相关的发病率——鉴于日益增加的癌症相关发病率，具有重大的临床和公共卫生意义癌症幸存者的数量以及与共病相关的高昂经济和社会成本。此外，可持续发展和大规模传播的基础设施已经存在，因为有大师美国所有 50 个州都实施了园丁计划，拟议的干预措施可以很容易地在有 2 个或更多生长季节的州（72% 的州，加上哥伦比亚特区），从而覆盖了广大大多数老年癌症幸存者（约 1080 万）居住在该国的温带地区。