Lifestyle interventions in patients after colorectal cancer treatment

By Pooja Toshniwal PahariaReviewed by Danielle Ellis, B.Sc.Sep 4 2024

The intervention was feasible for 87% of intervention participants, supporting them in healthy lifestyle changes. 

A recent study published in the European Journal of Clinical Nutrition performed a randomized controlled trial (RCT) to test the practicality of the Healthy Eating and Active Lifestyle After Bowel Cancer (HEAL ABC) program as a post-colorectal cancer (CRC) treatment intervention.

Background

Colorectal cancer is expected to increase in cases and deaths despite better treatment. Post-treatment complications and illness recurrence can reduce quality of life. A healthy lifestyle, which includes keeping a healthy weight, healthy food habits, and regular physical activity, is essential to prevent cancer.

One common treatment option for colorectal cancer is surgery, specifically a colectomy, where part or all of the colon containing the cancer is removed.

However, most healthcare institutions lack the resources, training, and staff to implement these suggestions. The Cochrane review revealed poor to moderate evidence that diets changed behavior after treatment. Cohort studies suggest that healthy lifestyle habits may boost cancer survival; however, data from randomized controlled trials is sparse.

About the study

The present RCT investigated whether the ABC intervention was feasible among CRC patients after treatment.

The intervention followed the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF) guidelines and the Health Action Process Approach (HAPA) philosophy. Participants in England had undergone CRC surgery ≥12 weeks before based on one to three WCRF/AICR guidelines.

They were enrolled between January 30 and December 15, 2021. The study excluded individuals with medical issues, those adhering to most WCRF/AICR recommendations, those receiving active treatment, and those completing five years after surgery.

In total, 16 participants received a three-month telephone-based intervention (intervention group), compared to 19 routine care recipients (control group). Researchers used the Motivation Interviewing Technique (MIT) to inform the telephone conversations.

The primary outcomes were enrollment, retention, withdrawal, and completion rates. Researchers assessed the outcomes at study initiation, three months, and six months after the intervention.

Adherence assessment parameters included intervention call engagement, the duration of study completion, and goal achievement. Participants verified their activities in audio-recorded intervention calls and rated their confidence in implementing changes during the study intervention.

The researchers used the 2011 Shanyinde criteria to assess the intervention's feasibility and conducted follow-up interviews to gauge its acceptability.

WCRF/AICR scores indicated adherence to the WCRF and AICR guidelines. The researchers gathered information on anthropometry, nutritional consumption, physical activity, and sociodemographic characteristics. The Global Physical Activity Questionnaire (GPAQ) scores indicated physical activity levels. Three-day food diaries and questionnaires provided dietary and sociodemographic data. Researchers assessed cancer relapse, morbidities, and survival. They used the Nova categorization to determine the intake of ultra-processed foods (UPF). They also computed Diet Quality Index International (DQI-I) scores. They used multiple linear regressions to analyze the data, adjusting for age, gender, location, and stoma existence.

Results

Study recruitment was difficult (31 individuals were ineligible, and 37 declined to participate; recruitment rate: 49%). The team noted three-month retention rates of 97%, which reduced to 89% by six months. All 31 individuals who completed the study attended six phone calls. The rates of data completion exceeded 90%. The mean participant age was 66 years; all participants were British white; 46% had at least a bachelor's degree; 80% had a stoma; 50% were in the year after surgery and treatment; and 43% had chemotherapy after surgery.

The time for study completion, including follow-up, was estimated to be 39 weeks. The mean duration of study completion was 41.0 weeks. Among the intervention recipients, 87% found the program feasible. WCRF/AICR and DQI-I scores improved considerably for intervention users, and their UPF intake was reduced by 10%. Participants set five objectives on average and accomplished four of them, sustaining them for six months. Participants suggested that the intervention be used as a follow-up program to surgery.

Intervention recipients reported higher self-esteem, healthier food shopping habits, and a better understanding of stoma function. They also raised awareness of their habits and identified opportunities for change. Participants found it easy to consume more fruits and vegetables and limit fast food but struggled to increase whole grains and reduce their sugar intake. Most individuals (88%) began with dietary guides, while two chose to boost physical fitness first. The team found one skin cancer, two lung cancers, and one CRC recurrence. However, the survival rate was 100%.

The study found 87% feasibility of the HEAL ABC program despite the coronavirus disease 2019 (COVID-19) pandemic. The intervention promoted healthy lifestyle practices. It increased the mean WCRF/AICR adherence score by 1.2 points after three months, maintained the score after six months, and lowered UPF consumption by 10%. However, additional recruiting tactics are required for fully powered randomized clinical trials to evaluate the intervention's efficacy.