RENEW Research-out to ENhancE Wellness Older Survivors

描述(由申请人提供)： 美国女性一生中有1/3的风险罹患癌症；男性的风险更高(1/2)。虽然癌症是主要的死亡原因，但存活率一直在上升--被诊断为癌症的人中，62%的人在确诊后至少还能活5年。然而，很大一部分人的发病率很高，要么是因为癌症，要么是因为治疗。这一人群患继发性癌症、糖尿病、骨质疏松症和心血管疾病的风险也增加了，这些并发症表现为功能加速下降，特别是在老年幸存者中。由于60%的癌症幸存者年龄在65岁以上，因此有很大的公共卫生潜力进行干预，以稳定或积极地重新定位功能下降的轨迹。一个代表杜克大学老龄化、肿瘤学、运动学、营养学、护理学、行为心理学和生物统计学领域的多学科团队。地中海医院。CTR。已经做好了充分的准备，以测试基于远程药物的饮食和锻炼计划是否会改善被诊断为结直肠癌、乳腺癌或前列腺癌的老年癌症幸存者的身体功能。这项拟议的研究建立在我们的初步工作基础上，该工作表明，通过这种干预可以减轻功能衰退。总共640名幸存者将被招募并随机分成：1)接受为期一年的电话补充+邮寄材料计划，促进锻炼和健康的部分控制饮食(从饱和脂肪中摄取10%的卡路里，=每天5片蔬菜和水果)；以及2)延迟干预组，在一年观察期后接受干预。这项随机对照试验的具体目的是：1)确定在癌症长期幸存者中重新定位身体功能轨迹的干预的有效性；2)确定手臂在其他终点(体力活动、饮食质量、BMI、抑郁等)方面的差异；3)确定影响计划有效性的因素(自我效能等)；以及4)描述接受初始干预的幸存者与延迟1年后接受干预的幸存者在两年时间内功能下降的特征。这项研究的结果将增加我们对使用远程医学在老年癌症幸存者中提供多种危险因素干预的知识-这是一个不断扩大的人口，历史上几乎没有进行过研究。

DESCRIPTION (provided by applicant): American women have a 1 in 3 lifetime risk of developing cancer; for men the risk is even higher (1 in 2). While cancer is a leading cause of death, survival rates are ever increasing - 62 percent of those diagnosed with cancer will be alive at least 5 years after diagnosis. Yet, a large proportion are left with significant morbidity, either from the cancer or its treatment. This population also is at increased risk for secondary cancers, diabetes, osteoporosis and cardiovascular disease - compounded comorbidities that manifest themselves in accelerated functional decline, especially among older survivors. With >60 percent of cancer survivors being age 65+, there is large public health potential for interventions that stabilize or positively reorient the functional decline trajectory. A multidisciplinary team representing the fields of aging, oncology, exercise, nutrition, nursing, behavioral psychology and biostatistics at Duke Univ. Med. Ctr. is well-postured to test if a distance medicine-based diet and exercise program will improve physical functioning among older cancer survivors who are >5 yrs out from a diagnosis of colorectal, breast or prostate cancer. The proposed study builds upon our preliminary work which shows that functional decline may be attenuated through such intervention. A total of 640 survivors will be recruited and block randomized into: 1) an arm that receives a 1-yr telephonecounseling+ mailed material program that promotes exercise and a healthful portion-controlled diet (<10 percent of kcal from saturated fat, >= 5 svgs/day of vegetables and fruit); and 2) a delayed intervention arm that receives the intervention after a 1-year observation period. Specific aims of this randomized controlled trial are to: 1)Determine the efficacy of the intervention in reorienting the physical function trajectory among elders who are long term survivors of cancer; 2) determine differences between arms with regard to other endpoints (physical activity, diet quality, BMI, depression, etc); 3) identify factors that influence program efficacy (self efficacy, etc); and 4) characterize functional decline over a 2-year period in survivors who receive the initial intervention vs. those who are intervened upon after a 1-year delay. Results of this study will increase our knowledge of the use of distance-medicine to deliver multiple risk factor interventions among older cancer survivors - an ever expanding population in which historically little research has been conducted.