Dataset Information

Randomized Trial Comparing Telephone Versus In-Person Weight Loss Counseling on Body Composition and Circulating Biomarkers in Women Treated for Breast Cancer: The Lifestyle, Exercise, and Nutrition (LEAN) Study.

ABSTRACT:

Purpose

Obesity is associated with a higher risk of breast cancer mortality. The gold standard approach to weight loss is in-person counseling, but telephone counseling may be more feasible. We examined the effect of in-person versus telephone weight loss counseling versus usual care on 6-month changes in body composition, physical activity, diet, and serum biomarkers.

Methods

One hundred breast cancer survivors with a body mass index ≥ 25 kg/m(2) were randomly assigned to in-person counseling (n = 33), telephone counseling (n = 34), or usual care (UC) (n = 33). In-person and telephone counseling included 11 30-minute counseling sessions over 6 months. These focused on reducing caloric intake, increasing physical activity, and behavioral therapy. Body composition, physical activity, diet, and serum biomarkers were measured at baseline and 6 months.

Results

The mean age of participants was 59 ± 7.5 years old, with a mean BMI of 33.1 ± 6.6 kg/m(2), and the mean time from diagnosis was 2.9 ± 2.1 years. Fifty-one percent of the participants had stage I breast cancer. Average 6-month weight loss was 6.4%, 5.4%, and 2.0% for in-person, telephone, and UC groups, respectively (P = .004, P = .009, and P = .46 comparing in-person with UC, telephone with UC, and in-person with telephone, respectively). A significant 30% decrease in C-reactive protein levels was observed among women randomly assigned to the combined weight loss intervention groups compared with a 1% decrease among women randomly assigned to UC (P = .05).

Conclusion

Both in-person and telephone counseling were effective weight loss strategies, with favorable effects on C-reactive protein levels. Our findings may help guide the incorporation of weight loss counseling into breast cancer treatment and care.

SUBMITTER: Harrigan M

PROVIDER: S-EPMC4872022 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Randomized Trial Comparing Telephone Versus In-Person Weight Loss Counseling on Body Composition and Circulating Biomarkers in Women Treated for Breast Cancer: The Lifestyle, Exercise, and Nutrition (LEAN) Study.

Harrigan Maura M Cartmel Brenda B Loftfield Erikka E Sanft Tara T Chagpar Anees B AB Zhou Yang Y Playdon Mary M Li Fangyong F Irwin Melinda L ML

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20151123 7

<h4>Purpose</h4>Obesity is associated with a higher risk of breast cancer mortality. The gold standard approach to weight loss is in-person counseling, but telephone counseling may be more feasible. We examined the effect of in-person versus telephone weight loss counseling versus usual care on 6-month changes in body composition, physical activity, diet, and serum biomarkers.<h4>Methods</h4>One hundred breast cancer survivors with a body mass index ≥ 25 kg/m(2) were randomly assigned to in-pers ...[more]

PMID: 26598750

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Project description:PurposeThe ongoing integration of cancer genomic testing into routine clinical care has led to increased demand for cancer genetic services. To meet this demand, there is an urgent need to enhance the accessibility and reach of such services, while ensuring comparable care delivery outcomes. This randomized trial compared 1-year outcomes for telephone genetic counseling with in-person counseling among women at risk of hereditary breast and/or ovarian cancer living in geographically diverse areas.Patients and methodsUsing population-based sampling, women at increased risk of hereditary breast and/or ovarian cancer were randomly assigned to in-person (n = 495) or telephone genetic counseling (n = 493). One-sided 97.5% CIs were used to estimate the noninferiority effects of telephone counseling on 1-year psychosocial, decision-making, and quality-of-life outcomes. Differences in test-uptake proportions for determining equivalency of a 10% prespecified margin were evaluated by 95% CIs.ResultsAt the 1-year follow-up, telephone counseling was noninferior to in-person counseling for all psychosocial and informed decision-making outcomes: anxiety (difference [d], 0.08; upper bound 97.5% CI, 0.45), cancer-specific distress (d, 0.66; upper bound 97.5% CI, 2.28), perceived personal control (d, -0.01; lower bound 97.5% CI, -0.06), and decisional conflict (d, -0.12; upper bound 97.5% CI, 2.03). Test uptake was lower for telephone counseling (27.9%) than in-person counseling (37.3%), with the difference of 9.4% (95% CI, 2.2% to 16.8%). Uptake was appreciably higher for rural compared with urban dwellers in both counseling arms.ConclusionAlthough telephone counseling led to lower testing uptake, our findings suggest that telephone counseling can be effectively used to increase reach and access without long-term adverse psychosocial consequences. Further work is needed to determine long-term adherence to risk management guidelines and effective strategies to boost utilization of primary and secondary preventive strategies.

Project description:ImportancePediatric obesity and hypertension are highly correlated. To mitigate both conditions, provision of counseling on nutrition, lifestyle, and weight to children with high blood pressure (BP) measurements is recommended.ObjectiveTo examine racial and ethnic disparities in receipt of nutrition, lifestyle, and weight counseling among patients with high BP at pediatric primary care visits stratified by patients' weight status.Design, setting, and participantsThis was a post hoc secondary analysis of the BP-CATCH study, a matched, stepped-wedge cluster randomized clinical trial investigating the best methods to screen children with high BP measurements and manage their care. Urban, suburban, and rural pediatric primary care practices across the US with a multidisciplinary team of at least 1 physician, 1 nurse and another practice associate, and a hypertension specialist for their practice group submitted baseline data from clinical encounters documented between November 2018 and January 2019. Practices identified the first 17 eligible patients with high BP measurements each month. This analysis was conducted from October 2023 to July 2024.ExposuresRace and ethnicity (Black, Hispanic, White, and other [Asian, multiracial, other races, and unknown race]) and weight status (with or without obesity).Main outcomes and measuresPrimary outcomes were receipt of counseling on nutrition, lifestyle, and weight during primary care visits. Baseline measures extracted from medical records included demographics, anthropometric measures, and systolic and diastolic BP.ResultsOf 2677 participants from 59 practices, 1516 (56.6%) were male; mean (SD) age was 10.8 (5.2) years. A total of 593 (21.1%) were Black; 414 (15.5%), Hispanic; 1111 (41.5%), White; and 559 (20.9%), other race and ethnicity. The overall crude unadjusted rates of receiving counseling were 63.5% (n = 1564 of 2463) for nutrition, 57.6% (n = 1419 of 2462) for lifestyle, 47.5% (n = 571 of 1202) for weight, and 46.4% (n = 1142 of 2461) for all counseling topics. Compared with the other 3 groups, Hispanic participants received significantly higher adjusted rates of nutrition (78.6%; 95% CI, 73.5%-83.8%), lifestyle (69.3%; 95% CI, 63.6%-74.9%), and all 3 (52.1%; 95% CI, 46.1%-58.2%) counseling topics. There were no significant differences in rates of receiving weight counseling between any pairs of groups. These findings were consistent in general among participants without obesity, and no significant pairwise differences were noted among participants with obesity except that nutrition counseling rates were significantly different between White participants and those reporting other race and ethnicity (68.3% [95% CI, 61.1%-75.4%] vs 81.6% [95% CI, 74.2%-89.1%]; Bonferroni-corrected P = .02).Conclusions and relevanceThis secondary analysis of the BP-CATCH trial found that among children with high BP measurements, racial and ethnic disparities in receiving nutrition, lifestyle, and all 3 counseling topics were significant, although no significant disparities in receipt of weight counseling were noted. Racial disparities in receipt of counseling were not observed in participants with and without obesity.Trial registrationClinicalTrials.gov Identifier: NCT03783650.

Project description:BackgroundDistance lifestyle counseling for weight control is a promising public health intervention in the work setting. Information about the cost-effectiveness of such interventions is lacking, but necessary to make informed implementation decisions. The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aimed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective.MethodsA randomized controlled trial comparing a program with two modes of intervention delivery against self-help. 1386 Employees from seven companies participated (67% male, mean age 43 (SD 8.6) years, mean BMI 29.6 (SD 3.5) kg/m2). All groups received self-directed lifestyle brochures. The two intervention groups additionally received a workbook-based program with phone counseling (phone; n=462) or a web-based program with e-mail counseling (internet; n=464). Body weight was measured at baseline and 24 months after baseline. Quality of life (EuroQol-5D) was assessed at baseline, 6, 12, 18 and 24 months after baseline. Resource use was measured with six-monthly diaries and valued with Dutch standard costs. Missing data were multiply imputed. Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves.ResultsAt two years the incremental cost-effectiveness ratio was €1009/kg weight loss in the phone group and €16/kg weight loss in the internet group. The cost-utility analysis resulted in €245,243/quality adjusted life year (QALY) and €1337/QALY, respectively. The results from a complete-case analysis were slightly more favorable. However, there was considerable uncertainty around all outcomes.ConclusionsNeither intervention mode was proven to be cost-effective compared to self-help.

Project description:ObjectiveTo compare a remotely supervised weight loss and exercise intervention to lifestyle counseling for effects on cardiovascular disease risk, disease activity, and patient-reported outcomes in older patients with rheumatoid arthritis (RA) and overweight/obesity.MethodsTwenty older (60-80 years), previously sedentary participants with seropositive RA and overweight/obesity were randomized to 16 weeks of either Supervised Weight loss and Exercise Training (SWET) or Counseling Health As Treatment (CHAT). The SWET group completed aerobic training (150 minutes/week moderate-to-vigorous intensity), resistance training (two days/week), and a hypocaloric diet (7% weight loss goal). The CHAT control group completed two lifestyle counseling sessions followed by monthly check-ins. The primary outcome was a composite metabolic syndrome z-score (MSSc) derived from fasting glucose, triglycerides, high density lipoprotein-cholesterol, minimal waist circumference, and mean arterial pressure. Secondary outcomes included RA disease activity and patient-reported outcomes.ResultsBoth groups improved MSSc (absolute change -1.67 ± 0.64 in SWET; -1.34 ± 1.30 in CHAT; P < 0.01 for both groups) with no between-group difference. Compared with CHAT, SWET significantly improved body weight, fat mass, Disease Activity Score-28 C-reactive protein, and patient-reported physical health, physical function, mental health, and fatigue (P < 0.04 for all between-group comparisons). Based on canonical correlations for fat mass, cardiorespiratory fitness, and leg strength, component-specific effects were strongest for (1) weight loss improving MSSc, physical health, and mental health; (2) aerobic training improving physical function and fatigue; and (3) resistance training improving Disease Activity Score-28 C-reactive protein.ConclusionIn older patients with RA and overweight/obesity, 16 weeks of remotely supervised weight loss, aerobic training, and resistance training improve cardiometabolic health, patient-reported outcomes, and disease activity. Less intensive lifestyle counseling similarly improves cardiovascular disease risk profiles, suggesting an important role for integrative interventions in the routine clinical care of this at-risk RA population.

Dataset Information

Randomized Trial Comparing Telephone Versus In-Person Weight Loss Counseling on Body Composition and Circulating Biomarkers in Women Treated for Breast Cancer: The Lifestyle, Exercise, and Nutrition (LEAN) Study.

Purpose

Methods

Results

Conclusion

Publications

Randomized Trial Comparing Telephone Versus In-Person Weight Loss Counseling on Body Composition and Circulating Biomarkers in Women Treated for Breast Cancer: The Lifestyle, Exercise, and Nutrition (LEAN) Study.

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