Lifestyle Modification to Reduce Risk of Chronic Disease in Women After Cancer

Background: Female cancer survivors often experience a range of unpleasant health sequelae following active treatment including menopausal symptoms and weight gain (Eakin et al., 2006; Gupta et al. 2006). Being overweight in combination with other modifiable risk factors such as physical inactivity and unhealthy diet can substantially increase women’s risk of developing other chronic diseases such as cardiovascular disease and type 2 diabetes (World Cancer Research Fund/American Institute for Cancer Research, 2007). Current guidelines for cancer survivors recommend regular physical activity and exercise, a diet high in plant foods and maintaining a healthy body weight to reduce both the risk of cancer recurrence and chronic disease (World Cancer Research Fund/American Institute for Cancer Research, 2007). With evidence that even modest reductions in body weight/body mass index and waist circumference can reduce the lifetime risk of chronic disease (Kearns, Dee, Fitzgerald, Doherty & Perry, 2014; Australian Institute of Health and Welfare (AIHW), 2017).

Aims: This study aimed to evaluate the effect of the e-health enabled multiple health behaviour change intervention (Women’s Wellness after Cancer Program or WWACP) on secondary outcomes of body weight, body mass index, waist circumference, physical activity and vegetable intake.

Methods: The WWACP intervention included evidence based health education about physical activity and exercise, healthy eating and healthy weight management, with structured step-by-step guidelines, nurse coaching and goal setting to facilitate positive health behaviour change. Data were collected using self-report online survey, interview administered survey and standard anthropometric measures. Physical activity was measured using the Short IPAQ (Craig et al., 2003) and habitual dietary intake using the Food Frequency Questionnaire (Giles & Ireland 1996; Cancer Council Victoria, 2009). Descriptive and inferential analysis was undertaken using Statistical Package for Social Sciences version 22.0 (IBM Corp, 2013) and compared the difference between intervention and control groups post intervention (using ANCOVAs and Cohen’s d).

Results: A total of 351 women participated in the trial, with an average age of 53 years (SD = 8). After adjusting for pre-intervention scores there was a significant difference between intervention and control groups for body weight, body mass index, waist circumference and daily serves of vegetables (p <0.05) and these were associated with a small-moderate effect (Cohen’s d). While there was no statistically significant difference in walking, moderate or vigorous physical activity between groups, there was a clinically significant increase in all types of physical activity in the intervention group over time.

Conclusion: Results of this study suggest that the structured health behaviour change intervention is effective in reducing risk factors for chronic disease in women after cancer. With increasing survival rates after cancer and rising rates of obesity and chronic disease, interventions such as the Women’s Wellness after Cancer Program are likely to make an important contribution to improving the health of individual women following cancer diagnosis and also to reducing the impact and burden of chronic disease.