Abstract
Background
Higher intakes of cruciferous vegetables (CVs) and green leafy vegetables (GLVs) in
observational studies are associated with improvements in survival and cancer-related
biomarkers in patients diagnosed with head and neck cancer (HNC). These results have
yet to be corroborated in a randomized clinical trial (RCT).
Objective
Determine the feasibility of implementing a 12-week RCT to increase CV and GLV intake
in posttreatment HNC survivors.
Design and participants
This was a two-arm RCT conducted among 24 posttreatment HNC survivors. Survivors were
recruited from a southeastern, National Cancer Institute–designated Comprehensive
Cancer Center between January 2015 and September 2016.
Intervention
There were two groups: (1) an experimental group (n=12) receiving weekly 15- to 30-minute
telephone dietary counseling from a registered dietitian nutritionist stressing 2.5
cups per week CVs and 3.5 cups per week GLVs, and (2) an attention control group (n=12)
receiving weekly 15- to 30-minute telephone dietary counseling from a registered dietitian
nutritionist focusing on general healthy eating for cancer survivors. Participants
completed a baseline survey, three 24-hour dietary recalls, phlebotomy, and anthropometric
measures prior to randomization and at the end of the 12-week study period. The experimental
group also completed weekly vegetable record recalls.
Main outcome measures
Primary outcomes included feasibility, recruitment, retention, adherence, and safety.
Secondary outcomes included inflammatory markers and carotenoids.
Statistical analyses performed
Descriptive statistics were generated for demographic, epidemiological, and clinical
variables as well as the primary feasibility outcomes. Between- and within-group comparisons
of mean serum cytokine and carotenoid levels were performed using appropriate statistical
tests depending on their respective distributions for the purpose of generating preliminary
effect sizes.
Results
Overall, 350 incident HNC cases were screened for eligibility, and 98 were eligible
for study participation. Reasons for ineligibility and exclusion included deceased
(n=93); wrong or inactive telephone numbers, or unable to be reached, or lost to follow-up
(n=93); not meeting inclusion criteria (n=39); and too ill to participate (n=27).
Of the 98 eligible HNC cases, 24 agreed to participate, for an enrollment rate of
25%. The most common reason for nonparticipation was distance (n=48), as participants
were asked to report for two on-site assignments. The retention rate was 96%. Mean
intervention adherence rates for weekly goals were 67% CV, 74% GLV, and 71% overall.
Completion rate of weekly counseling calls was 90%. The experimental group reported
an overall mean increase of 5.5 cups GLV and 3.5 cups CV per week from baseline intake,
respectively. No significant between- or within-arm differences were observed for
inflammatory markers or carotenoids.
Conclusion
A posttreatment intervention aimed at increasing CV and GLV intake in HNC survivors
is feasible. A larger RCT is needed to assess the efficacy of this intervention on
disease outcomes.
Keywords
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Biography
S. L. Crowder is a doctoral candidate, University of Illinois, Urbana
Biography
K. G. Douglas is a research assistant, University of Illinois, Urbana
Biography
Y. T. Chen is a research assistant, University of Illinois, Urbana
Biography
L. Moody is a doctoral candidate, University of Illinois, Urbana
Biography
J. W. Erdman, Jr, is a professor emeritus, Department of Food Science and Human Nutrition and the Division of Nutritional Sciences, University of Illinois at Urbana-Champaign
Biography
M. Black is a laboratory technician, University of Illinois, Urbana
Biography
A. D. Frugé is an assistant professor and director, Didactic Program in Dietetics, Auburn University, Auburn, AL
Biography
A. Delk-Licata is a doctoral candidate, University of Alabama-Birmingham, Birmingham
Biography
W. R. Carroll is department chair and professor, Otolaryngology - Head and Neck, University of Alabama-Birmingham, Birmingham
Biography
S. A. Spencer is a radiation oncologist, University of Alabama-Birmingham, Birmingham
Biography
L. Q. Rogers is a professor, Department of Nutrition Sciences, University of Alabama-Birmingham, Birmingham
Biography
W. Demark-Wahnefried is a professor and Webb endowed chair of nutrition sciences, University of Alabama-Birmingham, Birmingham
Biography
J. L. Locher is a professor, Department of Medicine, University of Alabama-Birmingham, Birmingham.
Biography
A. E. Arthur is an assistant professor and Sylvia D. Stroup Scholar in Nutrition and Cancer, Department of Food Science and Human Nutrition and the Division of Nutritional Sciences, University of Illinois at Urbana-Champaign; and an oncology registered dietitian nutritionist, Carle Cancer Center, Carle Foundation Hospital, Urbana, IL
Article info
Publication history
Published online: January 17, 2019
Accepted:
November 7,
2018
Received:
July 12,
2018
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was supported by an NIH/NCI Cancer Prevention and Control Training Grant: R25 CA047888, a Research Enhancement Project Grant from the University of Alabama at Birmingham Center for Palliative and Supportive Care, an Academy of Nutrition and Dietetics Oncology DPG Small Research Grant, a K07 Career Academic Leadership Award from NIH/NIA (AG043588), and an USDA National Institute of Food and Agriculture, Hatch project 1011487. S. L. Crowder and L. Moody were supported by a Carle Illinois Cancer Scholars for Translational and Applied Research Fellowship.
AUTHOR CONTRIBUTIONS A. E. Arthur, W. R. Carroll, S. A. Spencer, J. L. Locher, W. Demark-Wahnefried, and L. Q. Rogers designed the study. S. L. Crowder, A. Delk-Licata, A. D. Frugé, and A. E. Arthur conducted the study. J. W. Erdman, Jr, and M. Black performed carotenoid analysis, and L. Moody performed DNA methylation analysis. Y. T. Chen and K. G. Douglas assisted with statistical methods. S. L. Crowder and A. E. Arthur wrote the first draft of the manuscript with contributions from all authors. All authors reviewed and commented on subsequent drafts of the manuscript.
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© 2019 by the Academy of Nutrition and Dietetics.
