Lifestyle-related effects of the web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) intervention for cancer survivors: a randomized controlled trial

Abstract

PurposeThe web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) responds to the needs of cancer survivors and oncology care providers to improve the counseling related to self-management of lifestyle and psychosocial challenges. In present study, overall intervention effects and the effects of using specific components were evaluated on vegetable, fruit, whole grain bread, and fish consumption, physical activity (PA), and smoking behavior.MethodsCancer survivors from 21 Dutch hospitals were recruited for a randomized controlled trial (N = 432). Intervention effects after 6 months were evaluated using multilevel linear regression analysis (complete cases and intention-to-treat). By conducting moderation analyses, additional effects of following the behavior-related modules were explored. The false discovery rate correction was applied to account for multiple testing.ResultsAfter 6 months, 409 participants completed follow-up (dropout = 11.5 %). Indications were found that access to the intervention may result in increases of moderate PA and vegetable intake. The moderate PA increase was meaningful: 74.74 min p/w higher increase in the intervention condition. Effect sizes of moderate PA (d = .25) and vegetable (d = .37) consumption were comparable to prior effective interventions. Visiting behavior-related modules affected moderate PA, fruit, and fish consumption. However, after correction for multiple testing, significances expired. No significant intervention effect was found on smoking behavior due to low numbers of smokers.Implications for Cancer SurvivorsAlthough the effectiveness was only shown only to a limited extend, this study provided several indications that this theory-based, comprehensive, and personalized eHealth intervention provides valuable content to complement usual cancer aftercare.

Psychometric properties of the Dutch extended Cancer Survivors’ Unmet Needs measure (CaSUN-NL)

“…Both studies show that many cancer survivors had unmet needs in these domains (Kanera, Bolman, Willems, et al., 2016; Willems et al., 2016a). This is in line with the conclusion of Duijts et al.…”

“…During this process, the CaSUN‐NL was extended with five items on return to work and four on lifestyle, because return to work and lifestyle are prominent issues among cancer survivors and cancer survivors may also experience unmet needs in these domains (Demark‐Wahnefried & Jones, 2008; Duijts et al., 2014; Harding, 2012; Küsters, Lechner, Willems, Bolman, & Mesters, 2012; Stergiou‐Kita et al., 2014; Wolin & Colditz, 2013). The CaSUN‐NL was subsequently applied in the two Dutch studies (hereafter called “first study” and “second study”; Kanera, Bolman, Mesters, et al., 2016; Kanera, Bolman, Willems, et al., 2016; Kanera, Willems et al., 2016; Willems et al., 2015, 2016a,b). …”

“…In the Netherlands, only a few studies have identified the unmet needs of cancer survivors (Jansen, van Uden‐Kraan, van Zwieten, Witte, & Verdonck‐de Leeuw, 2015; Kanera, Bolman, Willems, & Mesters, 2016; Pauwels, Charlier, De Bourdeaudhuij, Lechner, & Van Hoof, 2013; Willems et al., 2016a,b). For our two studies (Kanera, Bolman, Mesters, et al., 2016; Willems et al., 2016a), the validated CaSUN was regarded as the most appropriate general questionnaire to specifically investigate the unmet needs of cancer survivors (Bender et al., 2012; Brennan, Butow, Spillane, & Boyle, 2016; Geller et al., 2014; Harrison et al., 2011; Hodgkinson, Butow, Fuchs, et al., 2007; Hodgkinson, Butow, Hunt, et al., 2007; Rowlands, Janda, McKinnon, Webb, & Beesley, 2015; Smith et al., 2013; Urbaniec, Collins, Denson, & Whitford, 2011).…”

A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study (Preprint)

“…Additionally, similar results were not observed in our intent-to-treat analysis. To our knowledge, only three Web-based intervention studies among cancer survivors have intervened on dietary intake [24,29,32], with two showing improvements [29,33]. It could be that 3-months was not sufficient to produce changes in dietary intake in our sample.…”

“…Web-based approaches offer a potential to overcome both provider and participant (cost, time, and distance) barriers [21]. More recently, there has been an increase in advocacy for Web-based interventions among cancer survivors [22,23], as well as interventions designed for cancer survivors [24][25][26][27][28][29][30][31], with several demonstrating improvements in lifestyle behaviors [28,29,[31][32][33][34].…”