Project 1: RENEWeb: Reaching-out to ENhance diet and Weight Control via the Web in Cancer Survivors

RENEWeb：通过网络在癌症幸存者中加强饮食和体重控制 普通人群的肥胖率很高。然而，癌症幸存者的死亡率更高， 因为有13种不同的癌症，肥胖是一个被证明的风险因素;另外，体重增加是一个常见的 一些癌症治疗的副作用有大量证据表明肥胖是一个预后不良的因素 这也与并发症增加、功能下降和更高的医疗费用有关， 美国临床肿瘤学会（ASCO）发表了一份立场声明，敦促加大力度改善教育 和资源，以及倡导研究，以确定最佳的干预措施和机制， 行动，并增加癌症幸存者获得体重管理资源和服务的机会。 ASCO还强调了服务不足人群的特殊需要-这也是 国家癌症研究所（NCI）。具体来说，NCI指出了解决老年癌症需求方面的差距 居住在农村地区的少数群体幸存者。此外，因为几乎所有的癌症研究 尽管NCI和ASCO都敦促对乳腺癌幸存者进行研究， 其他类型癌症的幸存者。拟议的研究直接解决了ASCO确定的差距， NCI我们将调整以前的干预措施，名为RENEW，这已被证明是成功的，在促进体重 损失和显着改善生活方式行为和功能状态的老年幸存者的结直肠， 乳腺癌和前列腺癌使用计算机定制的邮寄打印和电话咨询干预， 通过一个基于网络的平台更广泛地提供信息。6个月的RENEWeb干预将是 在326名7种肥胖和体力活动相关癌症的幸存者中进行了测试，其中大部分人 将是老年人、农村人和少数民族。使用2组随机对照设计，存活者将均匀分布， 随机分配到RENEWeb或等待列表控制臂。主要目的是确定 体重减轻的臂间差异。第二个目标是评估干预措施的效果， 其它临床结果（即，瘦体重、身体功能和表现）、生活质量、饮食和 身体活动行为，以及炎症和成功衰老的相关生物标志物（即，c反应 蛋白质、白细胞介素-6和-10、干扰素γ和端粒酶）。最后，我们将确定行为机制 这些因素推动了干预的成功，并检查了受益最多的人的特征， 评估成本效益。所有这些努力最终都是为了改善健康， 确定有效的干预措施，这些干预措施具有广泛的必要范围，以帮助最缺乏服务的人 癌症幸存者

RENEWeb: Reaching-out to ENhancE diet and Weight Control via the Web in Cancer Survivors Rates of obesity are high in the general population. Cancer survivors, however have even higher rates because there are 13 distinct cancers for which obesity is a proven risk factor; plus, weight gain is a common side effect with some cancer treatments. Given substantial evidence that obesity is a poor prognostic factor that also associates with increased comorbidity, functional decline, and higher health care costs, the American Society of Clinical Oncology (ASCO) issued a position statement urging intensified efforts to improve education and resources, as well as advocating for research to determine optimal interventions and mechanisms of action, and to increase access to resources and services for weight management among cancer survivors. ASCO also underscored a particular need in underserved populations – a need also long expressed by the National Cancer Institute (NCI). Specifically, the NCI points to gaps in addressing the needs of older cancer survivors from minority groups who reside in rural areas. In addition, because almost all research in cancer survivorship has been conducted in breast cancer survivors, both the NCI and ASCO urge research in survivors of other types of cancer. The proposed study directly addresses the gaps identified by ASCO and NCI. We will adapt a previous intervention entitled RENEW, which had proven success in promoting weight loss and significantly improving the lifestyle behaviors and functional status of older survivors of colorectal, breast, and prostate cancer using computer-tailored mailed print and telephone counseling intervention, by delivering it more broadly through a web-based platform. The 6-month RENEWeb intervention will then be tested in 326 survivors of 7 select obesity and physical activity related cancers, significant proportions of whom will be older, rural, and minority. Using a 2-arm randomized controlled design, survivors will be evenly and randomly assigned to either RENEWeb or a wait-listed control arm. The primary aim will be to determine between-arm differences in weight loss. Secondary aims will be to assess the effects of the intervention on other clinical outcomes (i.e., lean body mass, physical functioning and performance), quality of life, diet and physical activity behaviors, and relevant biomarkers of inflammation and successful aging (i.e., c-reactive protein, interleukin-6 and -10, interferon γ, and telomerase). Finally, we will identify the behavioral mechanisms that drive the success of the intervention, as well as examine the characteristics of those who benefit most and assess cost effectiveness. All of these efforts are ultimately directed toward improving health and ascertaining effective interventions that have the broad reach necessary to help the most underserved cancer survivors.