Demark-Wahnefried Wendy, Jones Lee W, Snyder Denise C, Sloane Richard J, Kimmick Gretchen G, Hughes Daniel C, Badr Hoda J, Miller Paige E, Burke Lora E, Lipkus Isaac M
Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas; Duke University School of Nursing, Durham, North Carolina.
Cancer. 2014 Aug 15;120(16):2522-34. doi: 10.1002/cncr.28761. Epub 2014 May 7.
Few studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members. Given the role of obesity in the primary and tertiary prevention of breast cancer, the authors explored the feasibility of a mother-daughter weight loss intervention.
A randomized controlled trial of a mailed weight loss intervention was undertaken among 68 mother-daughter dyads (n = 136), each comprised of a survivor of breast cancer (AJCC stage 0-III) and her adult biological daughter. All women had body mass indices ≥ 25 kg/m(2) and underwent in-person assessments at baseline, 6 months, and 12 months, with accelerometry and exercise capacity performed on a subset of individuals. All women received a personalized workbook and 6 newsletters over a 1-year period that promoted weight loss; exercise; and a nutrient-rich, low-energy density diet. A total of 25 dyads received individually tailored instruction (individual), 25 dyads received team-tailored instruction (TEAM), and 18 dyads received standardized brochures (control).
The trial met its accrual target, experienced 90% retention, and caused no serious adverse events. Significant differences in baseline to 12-month changes were observed between individual versus control mothers for body mass index, weight, and waist circumference (WC); significant differences also were observed in the WC of corresponding daughters (P < .05). Significant differences were found between individual versus control and team versus control dyads for WC (P = .0002 and .018, respectively), minutes per week of physical activity (P = .031 and .036, respectively), and exercise capacity (P = .047 for both).
Significant improvements in lifestyle behaviors and health outcomes are possible with tailored print interventions directed toward survivors of cancer and their family members. For greater impact, more research is needed to expand this work beyond the mother-daughter dyad.
迄今为止，很少有研究将癌症诊断作为一个可用于教育的契机，来促进癌症幸存者及其家庭成员的健康行为改变。鉴于肥胖在乳腺癌一级和三级预防中的作用，作者探讨了母女体重减轻干预措施的可行性。
对68对母女（n = 136）进行了一项邮寄减肥干预的随机对照试验，每对母女由一名乳腺癌幸存者（美国癌症联合委员会分期0 - III期）及其成年亲生女儿组成。所有女性的体重指数均≥25 kg/m²，并在基线、6个月和12个月时接受了面对面评估，部分个体还进行了加速度测量和运动能力测试。所有女性在1年时间内收到了一本个性化工作手册和6份时事通讯，这些资料都旨在促进减肥、运动以及采用营养丰富、低能量密度的饮食。共有25对母女接受了个性化定制指导（个体组），25对母女接受了团队定制指导（团队组），18对母女收到了标准化手册（对照组）。
该试验达到了招募目标，保留率为90%，且未发生严重不良事件。个体组母亲与对照组母亲相比，在体重指数、体重和腰围从基线到12个月的变化方面存在显著差异；相应女儿的腰围也存在显著差异（P < 0.05）。个体组与对照组以及团队组与对照组在腰围方面存在显著差异（分别为P = 0.0002和0.018），每周体育活动分钟数方面也存在显著差异（分别为P = 0.031和0.036），运动能力方面同样存在显著差异（两者均为P = 0.047）。
针对癌症幸存者及其家庭成员的定制印刷干预措施，有可能显著改善生活方式行为和健康结果。为了产生更大影响，需要更多研究将这项工作扩展到母女二元组之外。
