How diet, exercise can improve mental and physical functioning in older cancer survivors

Researchers from Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and Dana Farber Cancer Institute in Boston have been awarded $7 million in total funding to study how diet and exercise impact mental and physical functioning in older cancer survivors and their caregivers.

The funding is being provided by the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit, Washington, D.C.-based organization that supports research designed to help patients, caregivers and clinicians make better informed healthcare decisions.

Tracy Crane, PhD, RDN, co-lead of Cancer Control and director of Lifestyle Medicine, Prevention and Digital Health at Sylvester and associate professor of medical oncology, will be the study's co-principal investigator along with Christina Dieli-Conwright, PhD, MPH, exercise oncology and population sciences researcher at Dana- Farber and associate professor of medicine at Harvard Medical School.

Their five-year study, expected to begin in spring 2024, will compare the effectiveness of supervised and unsupervised exercise-and-diet interventions in pairs of older cancer patients and their caregivers. The researchers plan to recruit a total of 763 patient-caregiver pairs from each organization's respective service area. Prospective patients must be age 65 or older and have completed treatment for lung, breast, colorectal or prostate cancer within the past year. Caregivers can be any age so long as they provide informal care for the patient.

Participants will be randomly assigned to either the supervised group, which will participate in exercise and nutrition sessions via videoconferencing to promote aerobic and resistance training and to follow a Mediterranean diet pattern, or an unsupervised group whose participants will use wearable devices to track exercise activity and follow the same diet pattern. Both interventions will last six months and participants will be evaluated at six- and 12-month intervals to measure the impact on mental and physical functioning as well as physical activity and diet.

Past research has demonstrated the importance of healthy diet and exercise in improving outcomes, including physical and cognitive function, for older persons as well as cancer survivors. hat remains unknown is the best way to deliver these interventions, especially in a racially and ethnically diverse population of older cancer survivors and their caregivers."

Tracy Crane, PhD, RDN, co-lead of Cancer Control and director of Lifestyle Medicine, Prevention and Digital Health at Sylvester

Crane, whose Sylvester lab examines the impact of diet, exercise and digital health tools on cancer survivorship, added that caregivers play a vital role for cancer survivors and, in some cases, their health also declines during the patient's cancer journey.

"Our study seeks to determine the best way to deliver a lifestyle intervention," she explained. "With advances in digital health, especially wearable devices, it's important to understand how effective this lower-cost method can be versus the gold standard of one-on-one supervised programs."

By 2040, there will be more 26 million cancer survivors, with almost 75% of them over age 65, the researchers noted. Following their diagnosis, older cancer patients often experience declines in mental and physical abilities.

"These health challenges are complicated by the natural aging process and 'accelerated aging' that can occur with cancer treatment," said Dana Farber's Dieli-Conwright. "However, these declines are likely improved by a physically active lifestyle and well-balanced diet."

Crane and Dieli-Conwright's funding award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

"Sylvester continually strives to improve the health and wellness of our cancer patients and their caregivers throughout South Florida and beyond," said Director Stephen D. Nimer, M.D. "We congratulate Dr. Crane and are grateful for the funding she and her collaborator will receive to advance our knowledge and ability to develop 'best practices' for delivering care to this vulnerable patient group."

"This study was selected for our funding for its potential to answer the need for real-world comparative clinical effectiveness research across the aging continuum that could inform evidence-based clinical practice for this important population," said PCORI Executive Director Nakela L. Cook, MD, MPH. "We look forward to following the study's progress and working with Sylvester and Dana-Farber to share the results."

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