Harvest for Health in Older Cancer Survivors

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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.