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Link to original content: http://pubmed.ncbi.nlm.nih.gov/31755089/
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Meta-Analysis
. 2019 Nov 22;2019(11):CD011287.
doi: 10.1002/14651858.CD011287.pub2.

Dietary interventions for adult cancer survivors

Sorrel Burden  1 , Debra J Jones  1 , Jana Sremanakova  1 , Anne Marie Sowerbutts  1 , Simon Lal  2 , Mark Pilling  3 , Chris Todd  1
Affiliations
Meta-Analysis

Dietary interventions for adult cancer survivors

Sorrel Burden et al. Cochrane Database Syst Rev. .

Abstract

Background: International dietary recommendations include guidance on healthy eating and weight management for people who have survived cancer; however dietary interventions are not provided routinely for people living beyond cancer.

Objectives: To assess the effects of dietary interventions for adult cancer survivors on morbidity and mortality, changes in dietary behaviour, body composition, health-related quality of life, and clinical measurements.

Search methods: We ran searches on 18 September 2019 and searched the Cochrane Central Register of Controlled trials (CENTRAL), in the Cochrane Library; MEDLINE via Ovid; Embase via Ovid; the Allied and Complementary Medicine Database (AMED); the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and the Database of Abstracts of Reviews of Effects (DARE). We searched other resources including reference lists of retrieved articles, other reviews on the topic, the International Trials Registry for ongoing trials, metaRegister, Physicians Data Query, and appropriate websites for ongoing trials. We searched conference abstracts and WorldCat for dissertations.

Selection criteria: We included randomised controlled trials (RCTs) that recruited people following a cancer diagnosis. The intervention was any dietary advice provided by any method including group sessions, telephone instruction, written materials, or a web-based approach. We included comparisons that could be usual care or written information, and outcomes measured included overall survival, morbidities, secondary malignancies, dietary changes, anthropometry, quality of life (QoL), and biochemistry.

Data collection and analysis: We used standard Cochrane methodological procedures. Two people independently assessed titles and full-text articles, extracted data, and assessed risk of bias. For analysis, we used a random-effects statistical model for all meta-analyses, and the GRADE approach to rate the certainty of evidence, considering limitations, indirectness, inconsistencies, imprecision, and bias.

Main results: We included 25 RCTs involving 7259 participants including 977 (13.5%) men and 6282 (86.5%) women. Mean age reported ranged from 52.6 to 71 years, and range of age of included participants was 23 to 85 years. The trials reported 27 comparisons and included participants who had survived breast cancer (17 trials), colorectal cancer (2 trials), gynaecological cancer (1 trial), and cancer at mixed sites (5 trials). For overall survival, dietary intervention and control groups showed little or no difference in risk of mortality (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.77 to 1.23; 1 study; 3107 participants; low-certainty evidence). For secondary malignancies, dietary interventions versus control trials reported little or no difference (risk ratio (RR) 0.99, 95% CI 0.84 to 1.15; 1 study; 3107 participants; low-certainty evidence). Co-morbidities were not measured in any included trials. Subsequent outcomes reported after 12 months found that dietary interventions versus control probably make little or no difference in energy intake at 12 months (mean difference (MD) -59.13 kcal, 95% CI -159.05 to 37.79; 5 studies; 3283 participants; moderate-certainty evidence). Dietary interventions versus control probably led to slight increases in fruit and vegetable servings (MD 0.41 servings, 95% CI 0.10 to 0.71; 5 studies; 834 participants; moderate-certainty evidence); mixed results for fibre intake overall (MD 5.12 g, 95% CI 0.66 to 10.9; 2 studies; 3127 participants; very low-certainty evidence); and likely improvement in Diet Quality Index (MD 3.46, 95% CI 1.54 to 5.38; 747 participants; moderate-certainty evidence). For anthropometry, dietary intervention versus control probably led to a slightly decreased body mass index (BMI) (MD -0.79 kg/m², 95% CI -1.50 to -0.07; 4 studies; 777 participants; moderate-certainty evidence). Dietary interventions versus control probably had little or no effect on waist-to-hip ratio (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; 106 participants; low-certainty evidence). For QoL, there were mixed results; several different quality assessment tools were used and evidence was of low to very low-certainty. No adverse events were reported in any of the included studies.

Authors' conclusions: Evidence demonstrated little effects of dietary interventions on overall mortality and secondary cancers. For comorbidities, no evidence was identified. For nutritional outcomes, there was probably little or no effect on energy intake, although probably a slight increase in fruit and vegetable intake and Diet Quality Index. Results were mixed for fibre. For anthropometry, there was probably a slight decrease in body mass index (BMI) but probably little or no effect on waist-to-hip ratio. For QoL, results were highly varied. Additional high-quality research is needed to examine the effects of dietary interventions for different cancer sites, and to evaluate important outcomes including comorbidities and body composition. Evidence on new technologies used to deliver dietary interventions was limited.

PubMed Disclaimer

Conflict of interest statement

Sorrel Burden: none known. Debra J Jones: none known. Jana Sremanakova: I would like to declare the following existing/potential conflict of interest: salary paid to institution by Marie Curie. Anne Marie Sowerbutts: none known. Simon Lal: none known. Mark Pilling: none known. Chris Todd: none known.

Figures

1
1
PRISMA flow diagram for study selection.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Forest plot of comparison: 2 Dietary changes, outcome: 2.12 Mean fruit and vegetable servings (per day).
5
5
Forest plot of comparison: 2 Dietary changes, outcome: 2.18 Diet Quality Index .
6
6
Forest plot of comparison: 3 Changes in anthropometry, outcome: 3.5 Mean body mass index (kg/m²).
1.1
1.1. Analysis
Comparison 1 Overall survival, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Overall survival, Outcome 2 Morbidity.
2.1
2.1. Analysis
Comparison 2 Dietary changes, Outcome 1 Mean energy intake (kcal).
2.2
2.2. Analysis
Comparison 2 Dietary changes, Outcome 2 Adjusted mean energy intake (kcal).
2.3
2.3. Analysis
Comparison 2 Dietary changes, Outcome 3 Subgroup analysis energy intake (kcal) BMI > 25 kg/m² at 3 months.
2.4
2.4. Analysis
Comparison 2 Dietary changes, Outcome 4 Subgroup analysis energy intake (kcal) BMI > 25 kg/m² at 6 months.
2.5
2.5. Analysis
Comparison 2 Dietary changes, Outcome 5 Mean fruit servings (per day).
2.6
2.6. Analysis
Comparison 2 Dietary changes, Outcome 6 Fruit servings for each cancer site at 6 months.
2.7
2.7. Analysis
Comparison 2 Dietary changes, Outcome 7 Fruit servings for each cancer site at 12 months.
2.8
2.8. Analysis
Comparison 2 Dietary changes, Outcome 8 Fruit servings in different ethnic groups: breast cancer at 12 months.
2.9
2.9. Analysis
Comparison 2 Dietary changes, Outcome 9 Adjusted mean vegetable servings (per day).
2.10
2.10. Analysis
Comparison 2 Dietary changes, Outcome 10 Vegatable servings: uterine cancer.
2.11
2.11. Analysis
Comparison 2 Dietary changes, Outcome 11 Vegatable servings: breast cancer.
2.12
2.12. Analysis
Comparison 2 Dietary changes, Outcome 12 Mean fruit and vegetable servings (per day).
2.13
2.13. Analysis
Comparison 2 Dietary changes, Outcome 13 Adjusted mean fruit and vegetable servings (per day).
2.14
2.14. Analysis
Comparison 2 Dietary changes, Outcome 14 Fibre.
2.15
2.15. Analysis
Comparison 2 Dietary changes, Outcome 15 Fibre intake in participants on weight reduction.
2.16
2.16. Analysis
Comparison 2 Dietary changes, Outcome 16 Fibre intake in participants advised on health eating.
2.17
2.17. Analysis
Comparison 2 Dietary changes, Outcome 17 Diet Quality Index.
2.18
2.18. Analysis
Comparison 2 Dietary changes, Outcome 18 Diet Quality Index.
3.1
3.1. Analysis
Comparison 3 Changes in anthropometry, Outcome 1 Mean weight (kg).
3.2
3.2. Analysis
Comparison 3 Changes in anthropometry, Outcome 2 Adjusted mean weight (kg).
3.3
3.3. Analysis
Comparison 3 Changes in anthropometry, Outcome 3 Weight change.
3.4
3.4. Analysis
Comparison 3 Changes in anthropometry, Outcome 4 Adjusted mean body mass index (kg/m²).
3.5
3.5. Analysis
Comparison 3 Changes in anthropometry, Outcome 5 Mean body mass index (kg/m²).
3.6
3.6. Analysis
Comparison 3 Changes in anthropometry, Outcome 6 Mean difference body mass index (kg/m²).
3.7
3.7. Analysis
Comparison 3 Changes in anthropometry, Outcome 7 Weight loss.
3.8
3.8. Analysis
Comparison 3 Changes in anthropometry, Outcome 8 Lean body tissue.
3.9
3.9. Analysis
Comparison 3 Changes in anthropometry, Outcome 9 Body fat percentage.
3.10
3.10. Analysis
Comparison 3 Changes in anthropometry, Outcome 10 Change in body fat percentage.
3.11
3.11. Analysis
Comparison 3 Changes in anthropometry, Outcome 11 Mean waist‐to‐hip ratio.
3.12
3.12. Analysis
Comparison 3 Changes in anthropometry, Outcome 12 Waist‐to‐hip ratio for each cancer site at 3 months.
3.13
3.13. Analysis
Comparison 3 Changes in anthropometry, Outcome 13 Hip circumference change scores.
3.14
3.14. Analysis
Comparison 3 Changes in anthropometry, Outcome 14 Waist circumference change scores.
3.15
3.15. Analysis
Comparison 3 Changes in anthropometry, Outcome 15 Adjusted mean waist circumference (cm).
3.16
3.16. Analysis
Comparison 3 Changes in anthropometry, Outcome 16 Mean hip circumference (cm).
3.17
3.17. Analysis
Comparison 3 Changes in anthropometry, Outcome 17 Mean waist circumference (cm).
4.1
4.1. Analysis
Comparison 4 Quality of Life, Outcome 1 FACT‐G QoL.
4.2
4.2. Analysis
Comparison 4 Quality of Life, Outcome 2 FACT‐C QoL.
4.3
4.3. Analysis
Comparison 4 Quality of Life, Outcome 3 FACT‐B QoL.
4.4
4.4. Analysis
Comparison 4 Quality of Life, Outcome 4 SF‐36 QoL physical function score.
4.5
4.5. Analysis
Comparison 4 Quality of Life, Outcome 5 SF‐36 QoL mean change physical.
4.6
4.6. Analysis
Comparison 4 Quality of Life, Outcome 6 SF‐36 QoL mean change mental.
4.7
4.7. Analysis
Comparison 4 Quality of Life, Outcome 7 SF‐36 QoL mean change mental for each cancer site at 12 months.
4.8
4.8. Analysis
Comparison 4 Quality of Life, Outcome 8 Cancer‐related fatigue.
4.9
4.9. Analysis
Comparison 4 Quality of Life, Outcome 9 Global QoL questionnaire.
5.1
5.1. Analysis
Comparison 5 Biochemical measures, Outcome 1 Total cholesterol (mg/dl).
5.2
5.2. Analysis
Comparison 5 Biochemical measures, Outcome 2 Triglycerides (mg/dl) at 3 months.
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References to studies excluded from this review

Abrams 2014 {published data only}
    1. Abrams DI. Milking the evidence: diet does matter. Journal of Clinical Oncology 2014;32(22):2290‐2. - PubMed
Anderson 2014 {published data only}
    1. Anderson A, Craigie A, Caswell S, Treweek S, Stead M, Macleod M, et al. The impact of bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomized controlled trial. British Medical Journal 2014;348:1823. - PMC - PubMed
Arends 2014 {published data only}
    1. Arends J, Theobald S, Schmid J, Bartsch HH. Nutritional training increases long‐term fruit and vegetable consumption in women with early breast cancer ‐ a randomized controlled trial. Metabolism and Nutrition in Oncology 2014;2(1):1‐7.
Arnold 2015 {published data only}
    1. Arnold K, Andridge R, Logan A, Yee L, Lustberg M, Orchard T. Healthy eating index scores are associated with inflammatory markers in breast cancer survivors. Federation of American Societies for Experimental Biology 2015;29(1):Suppl.
Boddie 2010 {published data only}
    1. Boddie AM, Berglund MS, Hernandez M, Paxton RJ, Hajek RA, Valero‐Hernandez MA, et al. Preliminary results from the ovarian nutrition education (ONE) study. Federation of American Societies for Experimental Biology 2010;24(1):Suppl.
Bourke 2014 {published data only}
    1. Bourke L, Gilbert S, Hooper R, Steed LA, Joshi M, Catto JW, et al. Lifestyle changes for improving disease‐specific quality of life in sedentary men on long‐term androgen‐deprivation therapy for advanced prostate cancer: a randomized controlled trial. European Urology 2014;66(3):51‐2. - PubMed
Brewer 2015 {published data only}
    1. Brewer KC, Peterson CE, Beckmeyer‐Borowko A, Otoo MA, Hoskins K, Davis F, et al. Access to high quality food and survival from ovarian cancer: an analysis of Cook County, Illinois. Gynecologic Oncology 2015;137(Suppl 1):103‐4.
Campbell 2009 {published data only}
    1. Campbell MK, Carr C, Devellis B, Switzer B, Biddle A, Amamoo MA, et al. A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Annals of Behavioral Medicine 2009;38(2):71‐85. - PMC - PubMed
Capozzi 2012 {published data only}
    1. Capozzi LC, Lau H, Reimer RA, McNeely M, Giese‐Davis J, Culos‐Reed SN. Exercise and nutrition for head and neck cancer patients: a patient oriented, clinic‐supported randomized controlled trial. BMC Cancer 2012;12:446. - PMC - PubMed
Chlebowski 2008 {published data only}
    1. Chlebowski RT, Blackburn GL, Hoy MK, Thomson CA, Giuliano, AE, McAndrew P, et al. Survival analyses from the Women's Intervention Nutrition Study (WINS) evaluating dietary fat reduction and breast cancer outcome. Journal of Clinical Oncology 2008;26(15 Suppl):12. [Abstract nr 522]
Chlebowski 2013 {published data only}
    1. Chlebowski RT. Nutrition and physical activity influence on breast cancer incidence and recurrence. 13th International Conference of the Primary Therapy of Early Breast Cancer; 2013 Mar13‐16; St.Gallen, Switzerland. 2013:5.
Chlebowski 2015 {published data only}
    1. Chlebowski RT, Blackburn GL. Final survival analysis from the randomized women's intervention nutrition study (WINS) evaluating dietary intervention as adjuvant breast cancer therapy. Cancer Research 2015;75(9):Suppl.
del Rocio Berglund 2012 {published data only}
    1. Rocio Berglund M, Paxton RJ, Garcia‐Prieto C, Hernandez M, Hajek RA, Handy BC, et al. A randomized parallel‐group dietary feasibility study for stage II‐IV ovarian cancer survivors. Federation of American Societies for Experimental Biology 2012;26(1):Suppl. - PubMed
del Rocio Berglund 2012a {published data only}
    1. Rocio Berglund M, Paxton RJ, Garcia‐Prieto C, Hernandez M, Hajek RA, Handy BC, et al. Evaluation of a telephone‐delivered dietary behavior intervention for ovarian cancer survivors. Federation of American Societies for Experimental Biology 2012;26(1):Suppl.
Delvin 2014 {published data only}
    1. Delvin E, Souberbielle JC, Viard JP, Salle B. Role of vitamin D in acquired immune and autoimmune diseases. Critical Reviews in Clinical Labroratory Sciences 2014;51(4):232‐47. - PubMed
Demark‐Wahnefried 2008 {published data only}
    1. Demark‐Wahnefried W, Case LD, Blackwell K, Marcom PK, Kraus W, Aziz N, et al. Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Clinical Breast Cancer 2008;8(1):70‐9. - PubMed
Dennis Parker 2014 {published data only}
    1. Dennis Parker EA, Sheppard VB, Adams‐Campbell L. Compliance with national nutrition recommendations among breast cancer survivors in "stepping stone". Integrative Cancer Therapies 2014;13(2):114‐20. - PMC - PubMed
De Waele 2015 {published data only}
    1. Waele E, Mattens S, Honore P, Spapen H, Greve J, Pen JJ. Nutrition therapy in cachectic cancer patients. The Tight Caloric Control (TiCaCo) pilot trial. Appetite 2015;91:298‐301. - PubMed
Djuric 2010 {published data only}
    1. Djuric Z, Ellsworth J, Rapai M, Weldon A, Kim J, Sen A. A diet and exercise intervention in women being treated for breast cancer. American Association for Cancer Research 2010;70(8):Suppl.
Emond 2010 {published data only}
    1. Emond JA, Patterson RE, Natarajan L, Laughlin GA, Gold EB, Pierce JP. The protective effect of a dietary intervention on additional breast cancer events is limited to those with higher baseline testosterone. Cancer Research 2010;70(24):Suppl.
Ferdowsian 2007 {published data only}
    1. Ferdowsian HR, Barnard ND. The role of diet in breast and prostate cancer survival. Ethnicity & Disease 2007;17(2 Suppl 2):18‐22. - PubMed
Flynn 2010 {published data only}
    1. Flynn MM, Reinert SE. Comparing an olive oil‐enriched diet to a standard lower‐fat diet for weight loss in breast cancer survivors: a pilot study. Journal of Women's Health 2010;19(6):1155‐61. - PubMed
Frensham 2014 {published data only}
    1. Frensham LJ, Zarnowiecki DM, Parfitt G, Stanley RM, Dollman J. Steps toward improving diet and exercise for cancer survivors (STRIDE): a quasi‐randomized controlled trial protocol. BMC Cancer 2014;14:428. - PMC - PubMed
Fukui 2014 {published data only}
    1. Fukui JA, Rothwell A, Danesh H, Adelson KB, Morris GJ, Irie H, et al. Comparison of weight loss among early‐stage breast cancer patients post chemotherapy: nutrition education in combination with weight loss acupuncture versus nutrition education alone. Journal of Clinical Oncology 2014;32:5.
Garrett 2013 {published data only}
    1. Garrett CR, Bekaii‐Saab TS, Ryan T, Fisher GA, Clive S, Kavan P, et al. Randomized phase 2 study of pegylated SN‐38 (EZN‐2208) or irinotecan plus cetuximab in patients with advanced colorectal cancer. John Wiley and Sons Inc. 2013;119(24):4223‐30. - PubMed
George 2015 {published data only}
    1. George SM, Ballard R, Shikany JM, Crane TE, Neuhouser ML. A prospective analysis of diet quality and endometrial cancer among 84,415 postmenopausal women in the Women's Health Initiative. Annals of Epidemiology 2015;25(10):788‐93. - PMC - PubMed
Giallauria 2014 {published data only}
    1. Giallauria F, Gentile M, Chiodini P, Berrino F, Mattiello A, Maresca L, et al. Exercise training reduces high mobility group box‐1 protein levels in women with breast cancer: findings from the DIANA‐5 study. Monaldi Archives for Chest Disease 2014;82(2):61‐7. - PubMed
Goodwin 2019 {published data only}
    1. Goodwin PJ, Segal R, Vallis M, Ligibel JA, Pond GR, Robidoux A, et al. Lifestyle intervention study (LISA) in early breast cancer (BC): an RCT of the effects of a telephone‐based weight loss intervention (with educational materials) vs educational materials alone on disease‐free survival (DFS). Cancer Research. 2019; Vol. 79, issue 4:Suppl 1.
Hagemann 2019 {published data only}
    1. Hagemann AR, Leon A, Liu J, Kuroki LM, Thaker PH, McCourt CK, et al. Behavioral weight loss interventions are insufficient to address the obesity crisis in endometrial cancer survivors: results of a randomized, controlled trial. Gynecologic Oncology 2019;154:Suppl 1.
Haggerty 2014 {published data only}
    1. Haggerty AF, Allison K, Sarwer DB, Spitzer J, Raggio G, Chu C. The use of technology‐based weight loss intervention for endometrial cancer survivors with obesity. 45th Annual Meeting on Women's Cancer of the Society of Gynecologic Oncology; 2014 Mar 22‐25;Tampa, FL United States. 2014:50‐1.
Hershman {published data only}
    1. Hershman DL, Greenlee H, Awad D, Kalinsky K, Maurer M, Kranwinkel G, et al. Randomized, single blind trial comparing limited and intensive survivorship interventions following adjuvant therapy in a multiethnic cohort of breast cancer survivors. Cancer Research 2012;72(24):Suppl.
Ho 2013 {published data only}
    1. Ho JW, Lee AM, Macfarlane DJ, Fong DY, Leung S, Cerin E, et al. Study protocol for "Moving Bright, Eating Smart" ‐ a phase 2 clinical trial on the acceptability and feasibility of a diet and physical activity intervention to prevent recurrence in colorectal cancer survivors. BMC Public Health 2013;13:487. - PMC - PubMed
Hung 2013 {published data only}
    1. Hung Y, Bauer J, Horsley P, Coll J, Bashford J, Isenring E. Telephone delivered nutrition and exercise counselling for cancer survivors following autologous stem cell transplantation ‐ a pilot, randomised controlled trial. International MASCC/ISOO Symposium: Supportive Care in Cancer; 2013 Jun 27‐29; Berlin, Germany. 2013:165‐6.
James 2011 {published data only}
    1. James EL, Stacey F, Chapman K, Lubans DR, Asprey G, Sundquist K, et al. Exercise and nutrition routine improving cancer health (ENRICH): the protocol for a randomized efficacy trial of a nutrition and physical activity program for adult cancer survivors and carers. BMC Public Health 2011;11:236. - PMC - PubMed
James 2015 {published data only}
    1. James EL, Stacey FG, Chapman K, Boyes AW, Burrows T, Girgis A, et al. Impact of a nutrition and physical activity intervention (ENRICH) (Exercise and Nutrition Routine Improving Cancer Health) on health behaviors of cancer survivors and carers: a pragmatic randomized controlled trial. BMC Cancer 2015;15:710. - PMC - PubMed
Ko 2010 {published data only}
    1. Ko LK, Campbell MK, Lewis MA, Earp J, Devellis B. Mediators of fruit and vegetable consumption among colorectal cancer survivors. Journal of Cancer Survivorship 2010;4(2):149‐58. - PMC - PubMed
Koner 2012 {published data only}
    1. Koner S, Basak J, Chakraborty A, Bhattacharya Majumder D, Dasgupta S, et al. Community therapy by early breast cancer detection and its prevention by lifestyle modification. IMPAKT Breast Cancer Conference; 2012 May 3‐5; Brussels Belgium. 2012:49.
Koutoukidis 2019 {published data only}
    1. Koutoukidis DA, Beeken RJ, Manchanda R, Burnell M, Ziauddeen N, Michalopoulou M, et al. Diet, physical activity, and health‐related outcomes of endometrial cancer survivors in a behavioral lifestyle program: the Diet and Exercise in Uterine Cancer Survivors (DEUS) parallel randomized controlled pilot trial. International Journal of Gynecological Cancer 2019;29(3):531‐40. - PubMed
Kwiatkowski 2017 {published data only}
    1. Kwiatkowski F, Mouret‐Reynier M‐A, Duclos M, et al. Long‐term improvement of breast cancer survivors' quality of life by a 2‐week group physical and educational intervention: 5‐year update of the 'PACThe' trial. British Journal of Cnacer 2017; Vol. 116, issue 11:1389–93. - PMC - PubMed
Lee 2014 {published data only}
    1. Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY. A Web‐based self‐management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. International Journal of Nursing Studies 2014;51(12):1557‐67. - PubMed
Lee 2018 {published data only}
    1. Lee CF, Ho JWC, Fong DYT, Macfarlane DJ, Cerin E, Lee AM, et al. Dietary and physical activity interventions for colorectal cancer survivors: a randomized controlled trial. Science Report 2018;8(1):5731. - PMC - PubMed
Li 2008 {published data only}
    1. Li Z, Aronson WJ, Arteaga JR, Hong K, Thames G, Henning SM, et al. Feasibility of a low‐fat/high‐fiber diet intervention with soy supplementation in prostate cancer patients after prostatectomy. European Journal of Clinical Nutrition 2008;62(4):526‐36. - PubMed
Ligibel 2019 {published data only}
    1. Ligibel JA, Basen‐Engquist K, Bea JW. Weight management and physical activity for breast cancer prevention and control. American Society of Clinical Oncology Educational Book 2019;39:e22‐e33. - PubMed
Lynch 2014 {published data only}
    1. Lynch BM, Courneya KS, Sethi P, Patrao TA, Hawkes AL. A randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors: effects on sedentary behavior. Cancer 2014;120(17):2665‐72. - PubMed
McCarroll 2014 {published data only}
    1. McCarroll ML, Armbruster S, Frasure HE, Gothard MD, Gil KM, Kavanagh M, et al. Self‐efficacy, quality of life, and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): a randomized controlled trial. Gynecological Oncology 2014;132(2):397‐402. - PubMed
McDonald 2014 {published data only}
    1. McDonald C, Bauer J, Capra S, Coll J. The muscle mass, omega‐3, diet, exercise and lifestyle (MODEL) study ‐ a randomised controlled trial for women who have completed breast cancer treatment. BMC Cancer 2014;14:264. - PMC - PubMed
Moriya 2014 {published data only}
    1. Moriya T, Fukatsu K, Okamoto K, Shinto E, Ueno H, Hase K, et al. Effects of preoperative use of an immune‐enhancing diet on postoperative complications and long‐term outcome: a randomized clinical trial in colorectal cancer surgery in Japanese patients. 36th European Society for Clinical Nutrition and Metabolism, ESPEN Congress; 2014 Sep 6‐9; Geneva Switzerland. 2014:247.
Nelson 2008 {published data only}
    1. Nelson N. Dietary intervention trial reports no effect on survival after breast cancer. Journal of the National Cancer Institute 2008;100(6):386‐7. - PubMed
O'Neill 2010 {published data only}
    1. O'Neill RF, Haseen F, Murray LJ, O'Sullivan JM, Cantwell MM. A randomised controlled trial to evaluate the efficacy of a 6 month dietary and physical activity intervention for prostate cancer patients receiving androgen deprivation therapy. Trials 2010;9(3):431‐40. - PubMed
Park 2019 {published data only}
    1. Park SH, Knobf MT, Kerstetter J, Jeon S. Adherence to American Cancer Society guidelines on nutrition and physical activity in female cancer survivors: results from a randomized controlled trial (Yale fitness intervention trial). Cancer Nursing 2019;42(3):242‐50. - PMC - PubMed
Pasanisi 2009 {published data only}
    1. Pasanisi P, Villarini A, Bruno E, Raimondi M, Gargano G, Berrino F. Benefits of a healthy diet for cancer patients. Joint ECCO 15‐34th ESMO Multidisciplinary Congress; 2009 Sep 20‐24; Berlin Germany. 2009:45.
Paxton 2012 {published data only}
    1. Paxton RJ, Garcia‐Prieto C, Rocio Berglund M, Hernandez M, Hajek RA, Handy BC, et al. A randomized parallel‐group dietary feasibility study for stage II‐IV ovarian cancer survivors. Gynecological Oncology 2012;124(3):410‐6. - PMC - PubMed
Pellegrini 2014 {published data only}
    1. Pellegrini M. Diet and lifestyle in the prevention of cancer recurrence. European Biotechnology Congress; 2014 May 15‐18;Lecce Italy. 2014:16‐17.
Rack 2010 {published data only}
    1. Rack B, Andergassen U, Neugebauer J, Salmen J, Hepp P, Sommer H, et al. The German SUCCESS C study ‐ the first European lifestyle study on breast cancer. Breast Care (Basel, Switzerland) 2010;5(6):395‐400. - PMC - PubMed
Reddy 2005 {published data only}
    1. Reddy GK, Tripathy D. Dietary fat reduction improves relapse‐free survival in postmenopausal women previously treated for early‐stage breast cancer: results from a phase III women's intervention nutrition study. Clinical Breast Cancer 2005;6(2):112‐4.
Rock 2015 {published data only}
    1. Rock CL, Flatt SW, Byers TE, Colditz GA, Demark‐Wahnefried W, Ganz PA, et al. Results of the exercise and nutrition to enhance recovery and good health for you (ENERGY) trial: a behavioral weight loss intervention in overweight or obese breast cancer survivors. Journal of Clinical Oncology 2015;33(28):3169‐76. - PMC - PubMed
Sedlacek 2011 {published data only}
    1. Sedlacek SM, Playdon MC, Wolfe P, McGinley JN, Wisthoff MR, Daeninck EA, et al. Effect of a low fat versus a low carbohydrate weight loss dietary intervention on biomarkers of long term survival in breast cancer patients (CHOICE): study protocol. BMC Cancer 2011;11:287. - PMC - PubMed
Song 2015 {published data only}
    1. Song S, Hwang E, Moon HG, Noh DY, Lee JE. Dietary patterns and health‐related quality of life among Korean breast cancer survivors. Federation of American Societies for Experimental Biology 2015;29(1):Suppl.
Stacey 2017 {published data only}
    1. Stacey FG, Lubans DR, Chapman K, Bisquera A, James EL. Maintenance of lifestyle changes at 12‐month follow‐up in a nutrition and physical activity trial for cancer survivors. American Journal of Health Behaviour 2017;41(6):784‐95. - PubMed
Stricker 2013 {published data only}
    1. Stricker CT, Palmer SC, Panzer SL, Syrjala KL, Baker KS, McCabe MS, et al. Breast cancer survivors' outcomes and satisfaction following delivery of a survivorship care plan: results of a multicenter trial. Cancer Research 2013;73(24):Suppl.
Thiebaut 2006 {published data only}
    1. Thiebaut AC, Schatzkin A, Ballard‐Barbash R, Kipnis V. Dietary fat and breast cancer: contributions from a survival trial. Journal of the National Cancer Institute 2006;98(24):1753‐55. - PubMed
Thomas 2009 {published data only}
    1. Thomas R, Williams MMA, Prasannan C. Development of a post adjuvant exit lifestyle toolbox. Joint ECCO 15 ‐ 34th ESMO Multidisciplinary Congress; 2009; Sep 20‐24; Berlin Germany. 2009:210.
Thompson 2012 {published data only}
    1. Thompson HJ, Sedlacek SM, Paul D, Wolfe P, McGinley JN, Playdon MC, et al. Effect of dietary patterns differing in carbohydrate and fat content on blood lipid and glucose profiles based on weight‐loss success of breast‐cancer survivors. Breast Cancer Research 2012;14(1):1. - PMC - PubMed
Thomson 2014 {published data only}
    1. Thomson CA, Crane TE, Wertheim BC, Neuhouser ML, Li W, et al. Diet quality and survival after ovarian cancer: results from the Women's Health Initiative. Journal of the National Cancer Institute 2014;106(11):314. - PMC - PubMed
Tyagi 2005 {published data only}
    1. Tyagi P. Updated data from the Iressa survival in lung cancer trial. Clinical Lung Cancer 2005;6(6):340‐2. - PubMed
Urowitz 2012 {published data only}
    1. Urowitz S, Chiu W, Cockburn M, Dunlop B, Fierini D, Himel D, et al. Building recipes and understanding nutrition for cancer‐survivor health (BRUNCH). Journal of Nutrition, Education & Behaviour 2012;44(4):384‐6. - PubMed
Van Der Werf 2015 {published data only}
    1. Werf A, Blauwhoff‐Buskermolen S, Langius JA, Berkhof J, Verheul HM, van der Schueren MA. The effect of individualized nutritional counseling on muscle mass and treatment outcome in patients with metastatic colorectal cancer undergoing chemotherapy: a randomized controlled trial protocol. BMC Cancer 2015;15:98. - PMC - PubMed
Villasenor 2014 {published data only}
    1. Villasenor A, Flatt SW, Marinac C, Natarajan L, Pierce JP, Patterson RE. Postdiagnosis C‐reactive protein and breast cancer survivorship: findings from the WHEL study. Cancer Epidemiology, Biomarkers and Prevention 2014;23(1):189‐99. - PMC - PubMed
Vona‐Davis 2015 {published data only}
    1. Vona‐Davis L, Abraham J, Bonner D, Gilleland D, Hobbs G, Kurian S, et al. Effect of a 12‐week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple‐negative breast cancer: a randomized, controlled trial. Cancer Research 2015;75(9):Suppl.
Xing 2014 {published data only}
    1. Xing MY, Xu SZ, Shen P. Effect of low‐fat diet on breast cancer survival: a meta‐analysis. Asian Pacific Journal of Cancer Prevention 2014;15(3):1141‐4. - PubMed

References to studies awaiting assessment

Brown 2018 {published data only}
    1. Brown JC, Yung RL, Gobbie‐Hurder A, Shockro L, O'Connor K, Campbell N, et al. Randomized trial of a clinic‐based weight loss intervention in cancer survivors. Journal of Cancer Survivorship 2018;12(2):186‐95. - PMC - PubMed
Parekh 2018 {published data only}
    1. Parekh N, Jiang J, Buchan M, Meyers M, Gibbs H, Krebs P. Nutrition literacy among cancer survivors: feasibility results from the Healthy Eating and Living Against Breast Cancer (HEAL‐BCa) study: a pilot randomized controlled trial. Journal of Cancer Education 2018;33(6):1239‐49. - PubMed
Zuniga 2019 {published data only}
    1. Zuniga KE, Parma DL, Muñoz E, Spaniol M, Wargovich M, Ramirez AG. Dietary intervention among breast cancer survivors increased adherence to a Mediterranean‐style, anti‐inflammatory dietary pattern: the Rx for Better Breast Health Randomized Controlled Trial. Breast Cancer Research and Treatment 2019;173(1):145‐54. - PMC - PubMed

References to ongoing studies

Alberts 2008 {published data only}
    1. Diet and physical activity change or usual care in improving progression‐free survival in patients with previously treated stage II, III, or IV ovarian, fallopian tube, or primary peritoneal cancer. www.clinicaltrials.gov/ct2/show/NCT00719303. First received 21 July 2008.
Anderson 2017 {published data only}
    1. The women’s wellness after cancer program: a multisite, single‐blinded, randomised controlled trial protocol. BMC Cancer 2017; Vol. 17:98. - PMC - PubMed
Asprey 2009 {published data only}
    1. Promotion of healthy lifestyle and risk modification for cancer survivors and their partners/caregivers (ENRICH: Exercise and Nutrition Routine Improving Cancer Health). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=320954. First received 18 December 2009.
Blomhoff 2012 {published data only}
    1. Effect of the new Norwegian food based dietary guidelines on chronic diseases in colorectal cancer survivors (NFS). https://clinicaltrials.gov/ct2/show/NCT01570010. First received 4 April 2012.
Cirauqui 2014 {published data only}
    1. Prevention of breast cancer recurrence through weight control, diet, and physical activity intervention (PREDICOP). https://clinicaltrials.gov/ct2/show/NCT02035631. First received 14 January 2014.
Clinton 2014 {published data only}
    1. Harvesting health program in improving diet and physical activity level in cancer survivors. https://clinicaltrials.gov/ct2/show/NCT02268188. First received 20 October 2014.
Coups 2009 {published data only}
    1. Internet‐based weight‐loss program for colorectal cancer survivors. https://clinicaltrials.gov/ct2/show/NCT01032590. First received 15 December 2009.
Demark‐Wahnefried 2019 {published data only}
    1. Adapting multiple behavior interventions that effectively improve cancer survivor health cancer survivor health (AMPLIFY). https://clinicaltrials.gov/ct2/show/NCT04000880. First received 27 June 2019.
Dittus 2012 {published data only}
    1. An internet‐based weight loss and exercise intervention for breast cancer survivors (iWEB). https://clinicaltrials.gov/ct2/show/NCT01728506. First received 19 November 2012.
Ferrante 2016 {published data only}
    1. eHealth weight loss program in African American breast cancer survivors. https://clinicaltrials.gov/ct2/show/NCT02699983. First received 7 March 2016.
Frensham 2013 {published data only}
    1. STRIDE (Steps TowaRd Improving Diet and Exercise): an online lifestyle intervention for cancer survivors living in South Australia. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363608. First received 29 April 2013.
Greenlee 2011 {published data only}
    1. S1008: exercise, diet, & counseling in improving weight loss in overweight female breast or colorectal cancer survivors. https://clinicaltrials.gov/ct2/show/NCT01453452. First received 17 October 2011.
Groarke 2018 {published data only}
    1. A pilot trial to investigate the impact of a personalised self‐management lifestyle programme using mobile technology on the health and well‐being of cancer survivors. http://www.isrctn.com/ISRCTN18676721. First received 2 May 2018.
Heinrich 2015 {published data only}
    1. Advancing survivorship after cancer: outcomes trial. http://www.isrctn.com/ISRCTN17421871. First received 29 July 2015.
Ho Wai‐chu 2012 {published data only}
    1. Diet and physical activity intervention in CRC survivors. https://clinicaltrials.gov/ct2/show/NCT01708824. First received 17 October 2012.
Irwin 2014 {published data only}
    1. Lifestyle, exercise and nutrition study 2 (LEAN 2). https://clinicaltrials.gov/ct2/show/NCT02110641. First received 10 April 2014.
Jernigan 2015 {published data only}
    1. Weight loss referral for healthier survivorship in obese stage I‐II endometrial cancer survivors or atypical hyperplasia. https://clinicaltrials.gov/ct2/show/NCT02342730. First received 21 January 2015.
Lawler 2014 {published data only}
    1. Get Healthy after Breast Cancer ‐ examining the feasibility and acceptability of referring breast cancer survivors to the NSW ‘Get Healthy Service’ – a telephone‐delivered program targeting physical activity, healthy diet and weight loss. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365601. First received 22 January 2014. - PubMed
Lechner 2012 {published data only}
    1. Lifestyle change, self‐management, and problem solving in daily life in cancer survivors; an online portal for change and support. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=NTR3375. First received 29 March 2012.
Ligibel 2013 {published data only}
    1. Healthy living after cancer: weight management pilot study. https://clinicaltrials.gov/ct2/show/NCT01978899. First received 8 November 2013.
Mathews 2012 {published data only}
    1. My lifestyle intervention of food and exercise (MyLIFE). https://clinicaltrials.gov/ct2/show/NCT01630499. First received 28 June 2012.
O'Connor 2018 {published data only}
    1. Exercise and nutrition education in improving physical function and quality of life in older breast cancer survivors. https://clinicaltrials.gov/ct2/show/NCT03751449. First received 22 November 2018.
Park 2013 {published data only}
    1. A lifestyle intervention for breast cancer survivors (TTMI). https://clinicaltrials.gov/ct2/show/NCT01819324. First received 27 March 2013.
Pasanisi 2012 {published data only}
    1. 1177 A randomized controlled trial of diet, physical activity and breast cancer recurrences – the DIANA‐5 study. https://www.ejcancer.com/article/S0959‐8049(12)71772‐0/abstract. July 2012V; Vol. 48, issue Suppl 5:S283–S284.
Quintiliani 2015 {published data only}
    1. Weight management among breast cancer survivors. https://clinicaltrials.gov/ct2/show/NCT02387671. First received 13 March 2015.
Resnick 2014 {published data only}
    1. Protein‐sparing modified fast intervention for weight loss in obese endometrial cancer survivors. https://clinicaltrials.gov/ct2/show/NCT02135562. First received 12 May 2014.

Additional references

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Broggio 2019
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Chlebowski, 2006
    1. Chlebowski RT, Blackburn GL, Thomson CA, Nixon DW, Shapiro A, Hoy MK, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the women's intervention nutrition study. Journal of the National Cancer Institute 2006; Vol. 98, issue 24:1767‐76. - PubMed
Daar 2007
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Deeks 2011
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