RENEW Research-out to ENhancE Wellness Older Survivors

描述（由申请人提供）： 美国女性一生中患癌症的风险为1/3;男性的风险甚至更高（1/2）。虽然癌症是死亡的主要原因，但存活率不断增加-62%的癌症患者在诊断后至少存活5年。然而，很大一部分人留下了显著的发病率，无论是癌症还是治疗。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在增加--这些复合性合并症表现为功能加速衰退，特别是在老年幸存者中。由于超过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调整功能衰退轨迹。一个多学科团队代表了杜克大学医学中心的老龄化、肿瘤学、运动、营养、护理、行为心理学和生物统计学领域。很有可能测试基于远程医疗的饮食和锻炼计划是否会改善结直肠癌、乳腺癌或前列腺癌诊断后5年以上的老年癌症幸存者的身体功能。拟议的研究建立在我们的初步工作，这表明，功能下降可能会通过这种干预减弱。总共招募了640名幸存者，并将其随机分为：1）一组接受为期1年的电话咨询+邮寄材料计划，该计划促进运动和健康的部分控制饮食（<10%的饱和脂肪千卡，>= 5 svgs/天的蔬菜和水果）; 2）延迟干预组，在1年观察期后接受干预。这项随机对照试验的具体目的是：1）确定干预措施在癌症长期幸存者中重新定位身体功能轨迹的有效性; 2）确定两组之间在其他终点方面的差异（体力活动，饮食质量，BMI，抑郁症等）; 3）确定影响计划效果的因素（自我效能等）;和4）表征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2年内的功能下降。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风险因素干预的知识-这是一个不断扩大的人口，历史上很少进行研究。

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.