Harvest for Health in Older Cancer Survivors

老年癌症幸存者为健康而收获 美国有近1500万癌症幸存者，其中大多数年龄在65岁或以上。 尽管在治疗和5年治愈率方面有所改善，癌症幸存者患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 每年的成本约为1300亿美元。癌症幸存者已被宣布为全国癌症幸存者 优先事项，呼吁制定有效的干预措施，以预防、推迟或减轻不利影响和 癌症合并疾病及其治疗。有强有力的证据表明，健康的饮食和规律的饮食 体育锻炼可以预防许多慢性病，改善身体机能。但是，更多的研究是 需要制定能够产生长期坚持健康生活方式行为的干预措施。 这项研究建立在强大的、R21支持的初步数据基础上，并依赖于 合作推广园艺大师计划。共有426名老年人(≥65岁)疯人病的幸存者-地区 分期为癌症，预后良好(≥80%，5年。生存)，并且至少有一个身体功能限制将 在整个阿拉巴马州招募，并随机分配到2人中的1人进行研究：1)接受为期1年的指导 蔬菜园艺干预，将癌症幸存者与认证的园艺大师配对；或2)等待名单 延迟一年后接受干预的控制臂。所有参与者将被跟踪2年。这 随机对照试验的目的是：1)确定蔬菜园艺干预对水果的效果 以及蔬菜摄入量、体力活动和身体机能(通过自我报告进行评估，并由目标支持 测量：血浆α−胡萝卜素、加速度计和运动测试)；2)评估干预效果 次级终点，例如生活质量、成功老龄化的生物标志物(白细胞介素6和端粒酶)；3) 评估干预的持久性和可重复性；4)探索与项目相关的参与者因素 功效(例如，性别、合并症、年龄)；和5)进行经济分析，以评估健康的价值 相对于干预成本的改善。拟议的居家蔬菜园艺干预措施 (根据幸存者的生活安排，使用加高的床或地球箱)是一种新颖和可行的方法 改善癌症高危幸存者饮食摄入量、体力活动和身体功能的策略 与癌症相关的发病率-由于不断增加的癌症发病率，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的经济和社会成本。 此外，可持续发展和大范围传播的基础设施已经存在，因为有大师 所有50个美国的园丁计划，拟议的干预措施可以很容易地在 有两个或两个以上生长季的州(72%的州，加上哥伦比亚特区)，因此覆盖了广大的 大多数老年癌症幸存者(约1080万)居住在这个国家的温带地区。

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.