Abstract

ObjectiveKnowledge about determinants of participation in lifestyle interventions in cancer patients undergoing chemotherapy, particularly with palliative intent, remains poor. The objective of the present study was to identify determinants of participating in a 12 month individualized, comprehensive lifestyle intervention, focusing on diet, physical activity, mental stress and smoking cessation, in cancer patients receiving chemotherapy with curative or palliative intent. The secondary objective was to identify participation determinants 4 months into the study.MethodsNewly diagnosed cancer patients starting chemotherapy at the cancer center in Kristiansand/Norway (during a 16 month inclusion period) were screened. Demographic and medical data (age, sex, body mass index, education level, marital status, smoking status, Eastern Cooperative Oncology Group performance status (ECOG), diagnosis, tumor stage and treatment intention) was analyzed for screened patients.Results100 of 161 invited patients participated. There were more females (69 vs. 48%; P = 0.004), breast cancer patients (46 vs. 25%; P = 0.007), non-smokers (87 vs. 74%; P = 0.041), younger (mean age 60 vs. 67 yrs; P < 0.001) and fitter (82 vs. 64% with EGOC 0; P = 0.036) participants vs. non-participants included. In multivariate logistic regression analyses, age (Odds Ratio 0.94, 95% Confidence Interval 0.91, 0.97) and smoking (0.42, 0.18, 0.99) were negatively associated with participation. After 4 months, 63 participants were still participating. Cancer type, smoking and age increased the probability of dropping out. Multivariate logistic regression revealed that age was the only significant determinant of 4 month participation (0.95, 0.91, 0.99). Patients aged >70 years were less likely to participate at baseline and 4 months.ConclusionIndividualized lifestyle interventions in cancer patients undergoing chemotherapy appear to facilitate a high participation rate that declines with increasing age; both during the enrollment process and completing the intervention. Neither oncologic nor socioeconomic variables deterred participation.

Highlights

  • The age distribution of the Western population is right shifting, and as a consequence, both the incidence and prevalence of cancer are continuously rising [1]

  • Individualized lifestyle interventions in cancer patients undergoing chemotherapy appear to facilitate a high participation rate that declines with increasing age; both during the enrollment process and completing the intervention

  • 197 curative and palliative cancer patients starting chemotherapy were screened for participation in the I CAN study, of which 36 were excluded

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Summary

Introduction

The age distribution of the Western population is right shifting, and as a consequence, both the incidence and prevalence of cancer are continuously rising [1]. Preclinical and a few clinical studies indicate that detrimental tumor metabolism and inflammation may be targeted via different lifestyle measures [9] These measures include changes in the patients diet [10], physical activity level [11], mental stress [12] and cigarette smoking [13]. The majority of lifestyle interventions to date have been conducted in a selected population of the healthiest, fittest, most educated patients undergoing curative chemotherapy, with inclusion of only a minority of the target population [16,18,19,20,21,22,23] This selection bias may be due to a commonly applied one size fits all-approach, which does not consider the patients’ preferences, abilities or perceived barriers to behavior change [14,24]. Identification of participation determinants should include a description of the patients, as well as tumor and treatment characteristics [16]

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