nach oben

Erschienen in:

28.05.2021 | Original Article

Multidisciplinary lifestyle modification program (IM-FIT) for cancer survivors: implementation of a reimbursable model in a cancer hospital

verfasst von: Aimee J. Christie, Catherine Powers-James, Santhosshi Narayanan, Minxing Chen, Carol Eddy, Telma Gomez, Karla Crawford, Lorenzo Cohen, Gabriel Lopez

Erschienen in: Supportive Care in Cancer | Ausgabe 12/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

We examined the initial effects of a real-world application of a multimodal, reimbursable program to improve lifestyle and promote healthy weight loss in cancer survivors as part of their care.

Methods

The lifestyle program (Integrative Medicine Fitness Program; IM-FIT) focusing on increasing physical activity and strength training, improving nutrition, and facilitating stress management and behavior change was delivered in a group format over 12 weeks. Patients met weekly with a physical therapist, dietitian, and psychologist. Body composition and behavioral data were collected at the start and end of 12 weeks, as well as fitness, nutrition, and psychological data. The first cohort started in September 2017, and the last cohort ended in August 2019.

Results

Twenty-six patients (92% female; mean age = 62.7, SD = 9) completed the program, which was pre-approved and covered as in-network by their health insurance. Patients lost an average of 3.9% of their body weight (SD = − 2.2). There was a significant reduction in white bread and desserts and increase in legumes and non-dairy milk. Time spent in vigorous exercise (p < .001), strength training (p < .001), and total exercise (p < .001) significantly increased. Patients reported reduction in depression (7.76 to 4.29; p = .01), anxiety (6.14 to 3.29; p < .01), and overall distress (4.70 to 3.40; p < .01).

Conclusion

We demonstrated that a multi-disciplinary weight loss program can be tailored to cancer survivors leading to weight reduction and improvements in lifestyle factors and mental health. This program showed successful real-world implementation with insurance reimbursement.

Thomson CA, McCullough ML, Wertheim BC, Chlebowski RT, Martinez ME, Stefanick ML, Rohan TE, Manson JE, Tindle HA, Ockene J, Vitolins MZ, Wactawski-Wende J, Sarto GE, Lane DS, Neuhouser ML (2014) Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women’s health initiative. Cancer Prev Res 7(1):42–53. https://doi.org/10.1158/1940-6207.Capr-13-0258CrossRef

Antoni MH, Lutgendorf SK, Cole SW, Dhabhar FS, Sephton SE, McDonald PG, Stefanek M, Sood AK (2006) The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer 6(3):240–248. https://doi.org/10.1038/nrc1820CrossRefPubMedPubMedCentral

Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Taylor SK, Hood N (2012) Insulin- and obesity-related variables in early-stage breast cancer: correlations and time course of prognostic associations. J Clin Oncol 30(2):164–171. https://doi.org/10.1200/jco.2011.36.2723CrossRefPubMed

Ligibel JA, Campbell N, Partridge A, Chen WY, Salinardi T, Chen H, Adloff K, Keshaviah A, Winer EP (2008) Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. J Clin Oncol 26(6):907–912. https://doi.org/10.1200/jco.2007.12.7357CrossRefPubMed

Lutgendorf SK, DeGeest K, Dahmoush L, Farley D, Penedo F, Bender D, Goodheart M, Buekers TE, Mendez L, Krueger G, Clevenger L, Lubaroff DM, Sood AK, Cole SW (2011) Social isolation is associated with elevated tumor norepinephrine in ovarian carcinoma patients. Brain Behav Immun 25(2):250–255. https://doi.org/10.1016/j.bbi.2010.10.012CrossRefPubMed

Lutgendorf SK, Sood AK (2011) Biobehavioral factors and cancer progression: physiological pathways and mechanisms. Psychosom Med 73(9):724–730. https://doi.org/10.1097/PSY.0b013e318235be76CrossRefPubMedPubMedCentral

Andersen BL, Yang HC, Farrar WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson WE 3rd (2008) Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 113(12):3450–3458. https://doi.org/10.1002/cncr.23969CrossRefPubMed

Ornish D, Lin J, Chan JM, Epel E, Kemp C, Weidner G, Marlin R, Frenda SJ, Magbanua MJM, Daubenmier J, Estay I, Hills NK, Chainani-Wu N, Carroll PR, Blackburn EH (2013) Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol 14(11):1112–1120. https://doi.org/10.1016/s1470-2045(13)70366-8CrossRefPubMed

Ornish D, Weidner G, Fair WR, Marlin R, Pettengill EB, Raisin CJ, Dunn-Emke S, Crutchfield L, Jacobs FN, Barnard RJ, Aronson WJ, McCormac P, McKnight DJ, Fein JD, Dnistrian AM, Weinstein J, Ngo TH, Mendell NR, Carroll PR (2005) Intensive lifestyle changes may affect the progression of prostate cancer. J Urol 174(3):1065–1069; discussion 1069–1070. https://doi.org/10.1097/01.ju.0000169487.49018.73

10.

Saxe GA, Major JM, Nguyen JY, Freeman KM, Downs TM, Salem CE (2006) Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction. Integr Cancer Ther 5(3):206–213. https://doi.org/10.1177/1534735406292042CrossRefPubMed

11.

Saxe GA, Major JM, Westerberg L, Khandrika S, Downs TM (2008) Biological mediators of effect of diet and stress reduction on prostate cancer. Integr Cancer Ther 7(3):130–138. https://doi.org/10.1177/1534735408322849CrossRefPubMed

12.

Rock CL, Thomson C, Gansler T, Gapstur SM, McCullough ML, Patel AV, Andrews KS, Bandera EV, Spees CK, Robien K, Hartman S, Sullivan K, Grant BL, Hamilton KK, Kushi LH, Caan BJ, Kibbe D, Black JD, Wiedt TL, McMahon C, Sloan K, Doyle C (2020) American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin 70(4):245–271. https://doi.org/10.3322/caac.21591CrossRefPubMed

13.

Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF (2014) 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 129(25 Suppl 2):S102-138. https://doi.org/10.1161/01.cir.0000437739.71477.eeCrossRefPubMed

14.

Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR (2003) Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 289(16):2083–2093. https://doi.org/10.1001/jama.289.16.2083CrossRefPubMed

15.

Diabetes Prevention Program (DPP) Research Group (2002) The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 25(12):2165–2171. https://doi.org/10.2337/diacare.25.12.2165CrossRef

16.

Witt CM, Balneaves LG, Cardoso MJ, Cohen L, Greenlee H, Johnstone P, Kücük Ö, Mailman J, Mao JJ (2017) A comprehensive definition for integrative oncology. J Natl Cancer Inst Monogr 2017(52). https://doi.org/10.1093/jncimonographs/lgx012

17.

Engel GL (2012) The need for a new medical model: a challenge for biomedicine. Psychodyn Psychiatry 40(3):377–396. https://doi.org/10.1521/pdps.2012.40.3.377CrossRefPubMed

18.

Arun B, Austin T, Babiera GV, Basen-Engquist K, Carmack CL, Chaoul A, Cohen L, Connelly L, Haddad R, Harrison C, Li Y, Mallaiah S, Nagarathna R, Parker PA, Perkins GH, Reuben JM, Shih YT, Spelman A, Sood A, Yang P, Yeung SJ (2017) A Comprehensive Lifestyle Randomized Clinical Trial: Design and Initial Patient Experience. Integr Cancer Ther 16(1):3–20. https://doi.org/10.1177/1534735416679516CrossRefPubMed

19.

Andersen BL, Farrar WB, Golden-Kreutz DM, Glaser R, Emery CF, Crespin TR, Shapiro CL, Carson WE 3rd (2004) Psychological, behavioral, and immune changes after a psychological intervention: a clinical trial. J Clin Oncol 22(17):3570–3580. https://doi.org/10.1200/jco.2004.06.030CrossRefPubMed

20.

Andersen BL, Farrar WB, Golden-Kreutz D, Emery CF, Glaser R, Crespin T, Carson WE 3rd (2007) Distress reduction from a psychological intervention contributes to improved health for cancer patients. Brain Behav Immun 21(7):953–961. https://doi.org/10.1016/j.bbi.2007.03.005CrossRefPubMedPubMedCentral

21.

Xenaki N, Bacopoulou F, Kokkinos A, Nicolaides NC, Chrousos GP, Darviri C (2018) Impact of a stress management program on weight loss, mental health and lifestyle in adults with obesity: a randomized controlled trial. J Mol Biochem 7(2):78–84PubMedPubMedCentral

22.

Czepczor-Bernat K, Brytek-Matera A (2021) The impact of food-related behaviours and emotional functioning on body mass index in an adult sample. Eat Weight Disord 26(1):323–329. https://doi.org/10.1007/s40519-020-00853-3CrossRefPubMed

23.

Varela C, Andrés A, Saldaña C (2020) The behavioral pathway model to overweight and obesity: coping strategies, eating behaviors and body mass index. Eat Weight Disord 25(5):1277–1283. https://doi.org/10.1007/s40519-019-00760-2CrossRefPubMed

24.

Goodwin PJ, Segal RJ, Vallis M, Ligibel JA, Pond GR, Robidoux A, Blackburn GL, Findlay B, Gralow JR, Mukherjee S, Levine M, Pritchard KI (2014) Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol 32(21):2231–2239. https://doi.org/10.1200/jco.2013.53.1517CrossRefPubMed

25.

Wardle J, Chida Y, Gibson EL, Whitaker KL, Steptoe A (2011) Stress and adiposity: a meta-analysis of longitudinal studies. Obesity (Silver Spring) 19(4):771–778. https://doi.org/10.1038/oby.2010.241CrossRef

26.

Scott KA, Melhorn SJ, Sakai RR (2012) Effects of chronic social stress on obesity. Curr Obes Rep 1(1):16–25. https://doi.org/10.1007/s13679-011-0006-3CrossRefPubMedPubMedCentral

27.

Cuevas AG, Chen R, Thurber KA, Slopen N, Williams DR (2019) Psychosocial stress and overweight and obesity: findings from the Chicago Community Adult Health Study. Ann Behav Med 53(11):Np. https://doi.org/10.1093/abm/kaz008CrossRefPubMedPubMedCentral

28.

Khozin S, Blumenthal GM, Pazdur R (2017) Real-world data for clinical evidence generation in oncology. J Natl Cancer Inst 109(11). https://doi.org/10.1093/jnci/djx187

29.

Arney BE, Glover R, Fusco A, Cortis C, de Koning JJ, van Erp T, Jaime S, Mikat RP, Porcari JP, Foster C (2019) Comparison of RPE (rating of perceived exertion) scales for session RPE. Int J Sports Physiol Perform 14(7):994–996. https://doi.org/10.1123/ijspp.2018-0637CrossRefPubMed

30.

Doran GT (1981) There’s a S.M.A.R.T. Way to write management’s goals and objectives. Manage Rev 70:35–36

31.

Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS (2011) 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 43(8):1575–1581. https://doi.org/10.1249/MSS.0b013e31821ece12CrossRefPubMed

32.

Spitzer RL, Kroenke K, Williams JB, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097. https://doi.org/10.1001/archinte.166.10.1092CrossRefPubMed

33.

Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.xCrossRefPubMedPubMedCentral

34.

NCCN practice guidelines for the management of psychosocial distress. National Comprehensive Cancer Network (1999). Oncology (Williston Park) 13(5a):113–147

35.

McCullough ML, Patel AV, Kushi LH, Patel R, Willett WC, Doyle C, Thun MJ, Gapstur SM (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomarkers Prev 20(6):1089–1097. https://doi.org/10.1158/1055-9965.Epi-10-1173CrossRefPubMed

36.

Vergnaud AC, Romaguera D, Peeters PH, van Gils CH, Chan DS, Romieu I, Freisling H, Ferrari P, Clavel-Chapelon F, Fagherazzi G, Dartois L, Li K, Tikk K, Bergmann MM, Boeing H, Tjønneland A, Olsen A, Overvad K, Dahm CC, Redondo ML, Agudo A, Sánchez MJ, Amiano P, Chirlaque MD, Ardanaz E, Khaw KT, Wareham NJ, Crowe F, Trichopoulou A, Orfanos P, Trichopoulos D, Masala G, Sieri S, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HB, Ros MM, May A, Wirfält E, Sonestedt E, Johansson I, Hallmans G, Lund E, Weiderpass E, Parr CL, Riboli E, Norat T (2013) Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study1,4. Am J Clin Nutr 97(5):1107–1120. https://doi.org/10.3945/ajcn.112.049569CrossRefPubMed

37.

Rehm CD, Marquez ME, Spurrell-Huss E, Hollingsworth N, Parsons AS (2017) Lessons from launching the diabetes prevention program in a large integrated health care delivery system: a case study. Popul Health Manag 20(4):262–270. https://doi.org/10.1089/pop.2016.0109CrossRefPubMedPubMedCentral

38.

Ballon-Landa E, Parsons JK (2018) Nutrition, physical activity, and lifestyle factors in prostate cancer prevention. Curr Opin Urol 28(1):55–61. https://doi.org/10.1097/mou.0000000000000460CrossRefPubMed

39.

Zhang ZQ, Li QJ, Hao FB, Wu YQ, Liu S, Zhong GC (2020) Adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and pancreatic cancer incidence and mortality: a prospective cohort study. Cancer Med 9(18):6843–6853. https://doi.org/10.1002/cam4.3348CrossRefPubMedPubMedCentral

40.

Zuniga KB, Chan JM, Ryan CJ, Kenfield SA (2020) Diet and lifestyle considerations for patients with prostate cancer. Urol Oncol 38(3):105–117. https://doi.org/10.1016/j.urolonc.2019.06.018CrossRefPubMed

41.

Friedenreich CM, Stone CR, Cheung WY, Hayes SC (2020) Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectr 4(1):pkz080. https://doi.org/10.1093/jncics/pkz080CrossRefPubMed

42.

Leung AWY, Chan RSM, Sea MMM, Woo J (2017) An overview of factors associated with adherence to lifestyle modification programs for weight management in adults. Int J Environ Res Public Health 14(8). https://doi.org/10.3390/ijerph14080922

43.

Somerset SM, Graham L, Markwell K (2011) Depression scores predict adherence in a dietary weight loss intervention trial. Clin Nutr 30(5):593–598. https://doi.org/10.1016/j.clnu.2011.04.004CrossRefPubMed

44.

Lopez G, Eddy C, Liu W, Li Y, Chen M, Bruera E, Cohen L (2019) Physical therapist-led exercise assessment and counseling in integrative cancer care: effects on patient self-reported symptoms and quality of life. Integr Cancer Ther 18:1534735419832360. https://doi.org/10.1177/1534735419832360CrossRefPubMedPubMedCentral

45.

Yi JC, Syrjala KL (2017) Anxiety and depression in cancer survivors. Med Clin N Am 101(6):1099–1113. https://doi.org/10.1016/j.mcna.2017.06.005CrossRefPubMed

46.

Lopez G, McQuade J, Cohen L, Williams JT, Spelman AR, Fellman B, Li Y, Bruera E, Lee RT (2017) Integrative oncology physician consultations at a comprehensive cancer center: analysis of demographic, clinical and patient reported outcomes. J Cancer 8(3):395–402. https://doi.org/10.7150/jca.17506CrossRefPubMedPubMedCentral

47.

Pagoto SL, Schneider KL, Oleski JL, Luciani JM, Bodenlos JS, Whited MC (2012) Male inclusion in randomized controlled trials of lifestyle weight loss interventions. Obesity (Silver Spring) 20(6):1234–1239. https://doi.org/10.1038/oby.2011.140CrossRef

48.

Gilchrist SC, Barac A, Ades PA, Alfano CM, Franklin BA, Jones LW, La Gerche A, Ligibel JA, Lopez G, Madan K, Oeffinger KC, Salamone J, Scott JM, Squires RW, Thomas RJ, Treat-Jacobson DJ, Wright JS (2019) Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors: a scientific statement from the American Heart Association. Circulation 139(21):e997–e1012. https://doi.org/10.1161/cir.0000000000000679CrossRefPubMedPubMedCentral

Titel: Multidisciplinary lifestyle modification program (IM-FIT) for cancer survivors: implementation of a reimbursable model in a cancer hospital
verfasst von: Aimee J. Christie
Catherine Powers-James
Santhosshi Narayanan
Minxing Chen
Carol Eddy
Telma Gomez
Karla Crawford
Lorenzo Cohen
Gabriel Lopez
Publikationsdatum: 28.05.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 12/2021
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-021-06305-7

Springer Medizin

Multidisciplinary lifestyle modification program (IM-FIT) for cancer survivors: implementation of a reimbursable model in a cancer hospital