Health policy: lost in transition, losing money, but caution precludes a "quick fix".

Cancer survivors represent a burgeoning patient population at risk for recurrence and co-morbidity. Their needs are great and we must find ways to deliver care that optimizes health, while not “breaking-the-bank.” Fragmentation of care contributes to higher health care costs.

Health behaviors and weight status of childhood cancer survivors and their parents: similarities and opportunities for joint interventions.

Childhood cancer survivors are at increased risk for chronic health conditions that may be influenced by their cancer treatment and unhealthy lifestyle behaviors. Despite the possibility that interventions targeting the survivor-parent dyad may hold promise for this population, a clearer understanding of the role of family factors and the lifestyle behaviors of both survivors and parents is needed. A mailed cross-sectional survey was conducted in 2009 to assess weight status (body mass index), lifestyle behaviors (eg, diet, physical activity), and the quality of the parent-child relationship among 170 childhood cancer survivors who were treated at MD Anderson Cancer Center and 114 of their parents (80% mothers).

Long-term dietary outcomes of the FRESH START intervention for breast and prostate cancer survivors.

Background: Cancer survivors are at increased risk for secondary cancers and other diseases. Healthy dietary practices may improve cancer survivors' health and well-being.

Objective: The durability of the effects of the FRESH START intervention, a program of sequentially tailored mailed materials, and standardized mailed materials (for controls) on cancer survivors' dietary outcomes was assessed over a 2-year period.

Social, demographic, and medical influences on physical activity in child and adolescent cancer survivors.

Objective: This study evaluated associations between social, environmental, demographic, and medical predictors, and child and adolescent survivors' physical activity (PA).

Methods: A structured telephone survey was conducted with 105 caregiver-survivor (aged 8-16 years) pairs and 36 caregivers of younger survivors (aged 6-7 years) alone. Participants completed measures assessing survivor PA and proposed predictors of PA including demographic, medical, social, and environmental influences.

Effect of low-fat diets on plasma levels of NF-κB-regulated inflammatory cytokines and angiogenic factors in men with prostate cancer.

Diet, nutritional status, and certain dietary supplements are postulated to influence the development and progression of prostate cancer. Angiogenesis and inflammation are central to tumor growth and progression, but the effect of diet on these processes remains uncertain. We explored changes in 50 plasma cytokines and angiogenic factors (CAF) in 145 men with prostate cancer enrolled in a preoperative, randomized controlled phase II trial with four arms: control (usual diet), low-fat (LF) diet, flaxseed-supplemented (FS) diet, and FS+LS diet.

Methylation variation at IGF2 differentially methylated regions and maternal folic acid use before and during pregnancy.

Folic acid (FA) supplementation before and during pregnancy has been associated with decreased risk of neural tube defects although recent reports suggest it may also increase the risk of other chronic diseases. We evaluated exposure to maternal FA supplementation before and during pregnancy in relation to aberrant DNA methylation at two differentially methylated regions (DMRs) regulating Insulin-like Growth Factor 2 (IGF2) expression in infants. Aberrant methylation at these regions has been associated with IGF2 deregulation and increased susceptibility to several chronic diseases.

Exercise among breast and prostate cancer survivors--what are their barriers?

Introduction: Despite proven benefits of regular physical activity, estimates indicate that few cancer survivors meet physical activity guidelines. The purpose of this paper is to identify and compare exercise barriers among cancer survivors, both cross-sectionally and longitudinally as they undergo home-based behavioral interventions.

Methods: Data on a sample of 452 breast and prostate cancer survivors who completed the FRESH START trial were analyzed collectively, as well as separately by cancer type.

CYberinfrastructure for COmparative effectiveness REsearch (CYCORE): improving data from cancer clinical trials.

Improved approaches and methodologies are needed to conduct comparative effectiveness research (CER) in oncology. While cancer therapies continue to emerge at a rapid pace, the review, synthesis, and dissemination of evidence-based interventions across clinical trials lag in comparison. Rigorous and systematic testing of competing therapies has been clouded by age-old problems: poor patient adherence, inability to objectively measure the environmental influences on health, lack of knowledge about patients' lifestyle behaviors that may affect cancer's progression and recurrence, and limited ability to compile and interpret the wide range of variables that must be considered in the cancer treatment.

Conducting cancer control and survivorship research via cooperative groups: a report from the American Society of Preventive Oncology.

As the number of cancer survivors expands, the need for cancer control and survivorship research becomes increasingly important. The National Cancer Institute (NCI) Cooperative Groups may offer a viable platform to perform such research. Observational, preventive, and behavioral research can often be performed within the cooperative group setting, especially if resources needed for evaluation are fairly simple, if protocols are easily implemented within the typical clinical setting, and if interventions are well standardized.

Scientific bias arising from sampling, selective recruitment, and attrition: the case for improved reporting.

In human research, the ability to generalize study findings is incumbent not only on an accurate understanding of the study protocol and measures but also on a clear understanding of the study population. Differential recruitment and attrition has the potential of introducing bias and threatening the generalizability of study findings; yet, relatively few scientific publications report data on sampling, subject exclusion, and dropout. A 4-month census sampling (September-December 2009) of research articles and short communications in this journal (n=116) was no exception.

Folic acid supplementation before and during pregnancy in the Newborn Epigenetics STudy (NEST).

Background: Folic acid (FA) added to foods during fortification is 70-85% bioavailable compared to 50% of folate occurring naturally in foods. Thus, if FA supplements also are taken during pregnancy, both mother and fetus can be exposed to FA exceeding the Institute of Medicine's recommended tolerable upper limit (TUL) of 1,000 micrograms per day (μg/d) for adult pregnant women. The primary objective is to estimate the proportion of women taking folic acid (FA) doses exceeding the TUL before and during pregnancy, and to identify correlates of high FA use.

Updated evidence in support of diet and exercise interventions in cancer survivors.

Background: A growing body of evidence suggests that diet and exercise behaviors and body weight status influence health-related outcomes after a cancer diagnosis. This review synthesizes the recent progress in lifestyle interventions in light of current guidelines put forth by the American Cancer Society (ACS), the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the American College of Sports Medicine (ACSM).

Methods: The PubMed database was searched for terms of cancer survivor(s) or neoplasms/survivor, cross-referenced with MeSH terms of lifestyle, health behavior, physical activity, exercise, body weight, obesity, weight loss, diet, nutrition, and intervention studies and limited to randomized controlled trials (RCTs) that had retention rates exceeding 75%.

Extant health behaviors and uptake of standardized vs tailored health messages among cancer survivors enrolled in the FRESH START trial: a comparison of fighting-spirits vs fatalists.

Objective: Cancer coping styles have been associated with several cancer-related outcomes. We examined whether baseline lifestyle behaviors differed between cancer survivors with fatalistic vs fighting-spirit coping styles, and whether there was differential response to two diet-exercise mailed-print interventions, one standardized and another individually tailored.

Methods: Baseline differences by coping style are presented for 628 breast and prostate cancer survivors who participated in the FRESH START trial, along with multivariable analyses on rates of uptake by coping style and arm assignment for those completing the 2-year trial.

Lifestyle counseling and supplementation with flaxseed or walnuts influence the management of metabolic syndrome.

A healthy lifestyle may ameliorate metabolic syndrome (MetS); however, it remains unclear if incorporating nuts or seeds into lifestyle counseling (LC) has additional benefit. A 3-arm, randomized, controlled trial was conducted among 283 participants screened for MetS using the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. Participants were assigned to a LC on the AHA guidelines, LC + flaxseed (30 g/d) (LCF), or LC + walnuts (30 g/d) (LCW) group.

Effect of intermittent fasting with or without caloric restriction on prostate cancer growth and survival in SCID mice.

Introduction: Caloric restriction (CR) delays cancer growth in animals, though translation to humans is difficult. We hypothesized intermittent fasting (i.e.

Promoting healthy lifestyles in older cancer survivors to improve health and preserve function.

Currently, there are about 7 million cancer survivors in this country aged 65 and older, and this number is expected to increase rapidly, given trends toward aging and improvements in early detection and treatment. Unfortunately, cancer survivors are at risk for several comorbid conditions and accelerated functional decline. A previous cross-sectional study of 688 older breast and prostate cancer survivors found significant associations between lifestyle practices and levels of physical functioning, with positive associations noted for physical activity and fruit and vegetable consumption and negative associations observed for dietary fat.

Associations between leisure-time physical activity and health-related quality of life among adolescent and adult survivors of childhood cancers.

Objective: Survivors of childhood cancer are at an increased risk for reduced quality of life (QOL), yet few studies have explored factors associated with improving health-related QOL (HRQOL) in this population. We thus explored the relationship between physical activity (PA) and HRQOL among survivors of childhood cancer.

Methods: A total of 215 survivors of childhood lymphoma, leukemia, and central nervous system cancers completed mailed surveys that elicited information regarding leisure-time PA (LTPA) measured in metabolic equivalents, HRQOL, and diagnostic and demographic factors.

Nutrition during and after cancer therapy.

Diet and nutritional factors play a large role in influencing both the quality and quantity of life after the diagnosis of cancer. The oncology nurse is well-positioned to: 1) help ensure that nutritional needs are met for patients who are newly diagnosed, undergoing active treatment, or have advanced disease; 2) facilitate referral of patients with more intensive nutritional needs to registered dietitians; and 3) promote the importance of weight management and a healthful plant-based diet, low in saturated fat and simple sugars, and high in fruits and vegetables and unrefined whole grains, to patients likely to join the ranks of an ever-expanding population of cancer survivors--who now constitute roughly 4% of the US population and number more than 11 million.

Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors.

Background: Older cancer survivors are at increased risk for secondary cancers, cardiovascular disease, obesity, and functional decline and, thus, may benefit from health-related interventions. However, to the authors' knowledge, little is known regarding the health behaviors of older cancer survivors and the associations of those behaviors with quality-of-life outcomes, especially during the long-term post-treatment period.

Methods: In total, 753 older (aged > or =65 years) long-term survivors (> or =5 years postdiagnosis) of breast, prostate, and colorectal cancer completed 2 baseline telephone interviews to assess their eligibility for a diet and exercise intervention trial.

Predictors of variation in serum IGF1 and IGFBP3 levels in healthy African American and white men.

Background: Individual variation in circulating insulinlike growth factor-1 (IGF1) and its major binding protein, insulinlike growth factor binding protein-3 (IGFBP3), have been etiologically linked to several chronic diseases, including some cancers. Factors associated with variation in circulating levels of these peptide hormones remain unclear.

Methods: Multiple linear regression models were used to determine the extent to which sociodemographic characteristics, lifestyle factors, personal and family history of chronic disease, and common genetic variants, the (CA)n repeat polymorphism in the IGF1 promoter and the IGFBP3-202 A/C polymorphism (rs2854744) predict variation in IGF1 or IGFBP3 serum levels in 33 otherwise healthy African American and 37 white males recruited from Durham Veterans Administration Medical Center.

Meta-analysis of the effects of flaxseed interventions on blood lipids.

Background: Several clinical trials have investigated the effects of flaxseed and flaxseed-derived products (flaxseed oil or lignans) on blood lipids; however, the findings have been inconsistent.

Objective: We aimed to identify and quantify the effectiveness of flaxseed and its derivatives on blood lipid profiles.

Design: A comprehensive literature search was performed on the basis of English reports of randomized controlled trials of flaxseed or its derivatives on lipid profiles in adults, which were published from January 1990 to October 2008.