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

RENEWeb：通过网络加强癌症幸存者的饮食和体重控制 肥胖率在普通人群中很高。然而，癌症幸存者的发病率更高 因为有13种不同的癌症，肥胖被证明是一个危险因素；另外，体重增加是一种常见的 一些癌症治疗的副作用。鉴于大量证据表明肥胖是一个不良的预后因素 这也与合并症增加、功能衰退和更高的医疗费用有关，美国人说 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还强调了在服务不足的人群中的特殊需求--这一需求也是长期以来由 国家癌症研究所(NCI)。具体地说，NCI指出了在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，因为几乎所有关于癌症的研究 NCI和ASCO都敦促在乳腺癌幸存者中进行生存研究 其他类型癌症的幸存者。拟议的研究直接解决了ASCO和 美国国家情报局。我们将改编之前的名为Renew的干预措施，该干预措施已被证明在增加体重方面取得了成功 丧失并显著改善结直肠癌老年幸存者的生活方式行为和功能状态， 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，由 通过基于网络的平台提供更广泛的服务。为期6个月的RENEWeb干预将是 在选择的7种与肥胖和体力活动相关的癌症中，对326名幸存者进行了测试，其中相当大一部分人 将是年龄较大的、农村的和少数民族。使用双臂随机对照设计，幸存者将被均匀和 随机分配给RENEWeb或等待名单上的控制臂。主要目标将是确定 手臂之间的体重减轻差异。次要目标将是评估干预措施对 其他临床结果(即瘦体重、身体功能和表现)、生活质量、饮食和 体力活动行为，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 这推动了干预的成功，并检查了那些受益最大的人和 评估成本效益。所有这些努力最终都是为了改善健康和 确定有效的干预措施，这些干预措施具有广泛的必要覆盖面，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.