Fatigue Reduction Diet in Breast Cancer Survivors: A Pilot Randomized Clinical Trial Suzanna M. Zick, Justin Colacino, Maria Cornellier, Katie Surnow, Tohfa Khabir, Zora Djuric Department of Family Medicine UMHS, Department of Nutritional Sciences and Environmental Health Sciences UMSPH, University of Michigan, Ann Arbor
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Fatigue Reduction Diet in Breast Cancer Survivors: A Pilot ... · Would a 3-month dietary intervention (Fatigue Reduction Diet) compared to an attention control (General Health Curriculum)
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Fatigue Reduction Diet in Breast
Cancer Survivors: A Pilot
Randomized Clinical Trial
Suzanna M. Zick, Justin Colacino, Maria Cornellier,
Katie Surnow, Tohfa Khabir, Zora Djuric
Department of Family Medicine UMHS, Department of
Nutritional Sciences and Environmental Health Sciences
UMSPH, University of Michigan, Ann Arbor
Disclosure Slide
Suzanna M. Zick, ND, MPH
Research Associate Professor
University of Michigan
Ann Arbor, Michigan
Dr. Zick indicates that she has nothing to
disclose:
Why is Fatigue Important?
Negative impact on all areas of function
More distressing and greater impact on the activities of daily living than any other conditions associated with cancer such as…
pain, poor sleep, and depression.
PDQ Cancer Information Summaries. Bethesda (MD): National Cancer Institute (US); 2014 Aug 28.
Why Diet?
Associated with a lower likelihood of having
persistent fatigue in breast cancer survivors
higher quality diets
diets high in fiber, lower in total fat
high in fruits and vegetables
high in omega-3 fatty acids relative to omega-6 fatty
acids
Zick SM, Sen A, Han-Markey TL, Harris RE. Oncol Nurs Forum. Jan 2013;40(1):E41-49.
Purpose Would a 3-month dietary intervention (Fatigue
Reduction Diet) compared to an attention
control (General Health Curriculum) would be:
Feasible
Decrease fatigue
Improve sleep quality
If changes in serum nutrients were associated
with changes in fatigue or sleep
Participants
Adult BC survivors, stage 0-III
BMI between 18.5 and 35 kg/m2,
Completed cancer treatments > one year ago
Fatigue (>4 on BFI)
Low fruit and vegetable intake (<5.5 serv./day)
No other causes of fatigue
Assessments
3-study visits
Screening
BFI, 7-day food record
Baseline and 3-month
BFI, PSQI, 7-day food record , blood
3-unannounced 24-hr dietary recalls
Interventions
Both arms:
Individualized counseling using the theoretical
framework of Bandura's social cognitive theory
8-counseling visits
Baseline and 3-month in-person
Weeks 1 to 4, 7, and 10 by 15-minute telephone call
Bandura A. Health Educ Behav. Apr 2004;31(2):143-164
Theoretical Basis
Bandura A. Health Educ Behav. Apr 2004;31(2):143-164
Personal
Factors
Environ-mental
Factors
Behavioral
Factors
Thoughts
and Actions
Beliefs and Cognitive
Competencies Stemming
from Social Influences
Behavior that
Determines
Environment
Attention Control: General
Health Curriculum Flu and cold
Hearing loss
Healthy skin and hair
Healthy eye site
Cell phone and cancer
risk
Drug disposal
Oral Health
Colorectal cancer
screening
Fatigue Reduction Diet
Isocaloric
60 kcal Fruit for
60 kcal of
carbohydrate rich
food (potato chips)
Used daily food
checklists
Results: Study Flow
Assessed for eligibility
50
Fatigue Reduction Diet
15
Completed 3 Months
14
General Health Curriculum
15
Completed 3 Months
15
Excluded
20
Results: Baseline Characteristics
No significant differences
between groups
93% White
Mean at baseline:
Fatigue 5.5
PSQI 7.2
BMI 28 kg/m2
Age 62 (47 - 81)
Diagnosed 7 years ago
At Diagnosis:
Postmenopausal (53%)
ER positive breast cancer
(80%)
60% either Stage 2 or 3
Treatments for BC:
Surgery (100%)
Chemotherapy (63%)
Results: Fatigue and Sleep
Measures
5.6
7.5
8.8
4.9
8.5
9.5
FATIGUE INVENTORY
PSQI PSQI>5
General Health Curriculum
Pre Post
5.4
6.8
8.3
3
3.9 3.9
BRIEF FATIGUE
INVENTORY
PSQI PSQI>5
Fatigue Reduction Diet
Pre Post
** *
*
Impact on Serum Fatty Acids
Impact on Serum Carotenoids
Correlations of Changes in Serum
Nutrients with Changes in Fatigue and
Sleep Quality
Fatigue Sleep Quality
Serum Fatty Acids
SFAb (%) -0.42 -0.11
MUFAb (%) -0.08 -0.23
N6 PUFAb (%) 0.43 0.18
N3 PUFAb (%) -0.22 0.32
N3/N6b Fatty acid ratio -0.45a 0.25
DHAb (%) -0.22 0.46
EPAb (%) -0.49a 0.36
Serum Carotenoids
Total carotenoids -0.06 0.12
Results: Adherence
Daily Check Lists
Fruits 82%
Vegetables 85%
Omega-3 rich 76%
Whole Grains 66%
Average in-person
Counseling
Baseline 18 minutes
Final 13 minutes
Average Phone
Counseling
14 minutes
Limitations and Strengths
Small sample size
Mainly white educated sample
No measures of mechanisms
Longitudinal design
Serum measures of compliance
High retention rate
Attention control group
Conclusions
Food exchange method:
increases consumption of vegetables, whole grains,
fruits, fish, nuts/seeds
Increase serum fatty acids and carotenoids
Diet quality independent of weight loss matters
Diet changes were brought about using short
telephone counseling
Zick SM, Colacino J, Cornellier M, Khabir T, Surnow K, Djuric Z.
Breast Cancer Res Treat. 2017 Jan;161(2):299-310. Breast Cancer