Study design and protocol for moving forward: a weight loss intervention trial for African-American breast cancer survivors

Melinda R Stolley, Lisa K Sharp, Giamila Fantuzzi, Claudia Arroyo, Patricia Sheean, Linda Schiffer, Richard Campbell, Ben Gerber, Melinda R Stolley, Lisa K Sharp, Giamila Fantuzzi, Claudia Arroyo, Patricia Sheean, Linda Schiffer, Richard Campbell, Ben Gerber

Abstract

Background: Breast cancer survival rates are significantly lower among African-American women compared to white women. In addition, African-American women with breast cancer are more likely than white women to die from co-morbid conditions. Obesity is common among African-American women, and it contributes to breast cancer progression and the development and exacerbation of many weight-related conditions. Intervening upon obesity may decrease breast cancer and all-cause mortality among African-American breast cancer survivors.

Methods/design: Moving Forward is a weight loss intervention being evaluated in a randomized trial with a projected sample of 240 African American breast cancer survivors. Outcomes include body mass index, body composition, waist:hip ratio, and behavioral, psychosocial and physiological measures. Survivors are randomized to either a 6-month guided weight loss intervention that involves twice weekly classes and text messaging or a self-guided weight loss intervention based on the same materials offered in the guided program. The guided intervention is being conducted in partnership with the Chicago Park District at park facilities in predominantly African-American neighborhoods in Chicago. Recruitment strategies include direct contact to women identified in hospital cancer registries, as well as community-based efforts. Data collection occurs at baseline, post-intervention (6 months) and at a 12-month follow-up.

Discussion: This study evaluates a community-based, guided lifestyle intervention designed to improve the health of African-American breast cancer survivors. Few studies have addressed behavioral interventions in this high-risk population. If successful, the intervention may help reduce the risk for breast cancer recurrence, secondary cancers, and co-morbid conditions, as well as improve quality of life.

Trial registration: U.S. Clinicaltrials.gov number: NCT02482506, April 2015.

Figures

Fig. 1
Fig. 1
Study Design
Fig. 2
Fig. 2
Study Conceptual Framework. The independent variable is group assignment. It is expected that outcome results will be mediated by self efficacy at the individual level, social support at the interpersonal level and perceived access to healthy eating and exercise resources at the community level

References

    1. American Cancer Society . Cancer Facts and Figures 2004. Atlanta, GA: American Cancer Society; 2004.
    1. Joslyn SA, West MM. Racial differences in breast carcinoma survival. Cancer. 2000;88(1):114–123. doi: 10.1002/(SICI)1097-0142(20000101)88:1<114::AID-CNCR16>;2-J.
    1. Newman LA, Griffith KA, Jatoi I, Simon MS, Crowe JP, Colditz GA. Meta-Analysis of Survival in African American and White American Patients With Breast Cancer: Ethnicity Compared With Socioeconomic Status. J Clin Oncol. 2006;24(9):1342–1349. doi: 10.1200/JCO.2005.03.3472.
    1. National Cancer Institute et al. In: SEER Cancer Statistics Review, 1975–2007. Altekruse S, Kosary C, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, et al., editors. Bethesda, MD: National Cancer Institute; 2010.
    1. Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D. Comorbidity and Survival Disparities Among Black and White Patients With Breast Cancer. JAMA. 2005;294(14):1765–1772. doi: 10.1001/jama.294.14.1765.
    1. Eley JW, Hill HA, Chen VW, Austin DF, Wesley MN, Muss HB. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. 1994;272(12):947–954. doi: 10.1001/jama.1994.03520120057031.
    1. Gerend MA, Pai M. Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev. 2008;17(11):2913–2923. doi: 10.1158/1055-9965.EPI-07-0633.
    1. Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol. 2002;20(4):1128–1143. doi: 10.1200/JCO.20.4.1128.
    1. Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP. Obesity, Tamoxifen Use, and Outcomes in Women With Estrogen Receptor-Positive Early-Stage Breast Cancer. J Natl Cancer Inst. 2003;95(19):1467–1476. doi: 10.1093/jnci/djg060.
    1. Stephenson GD, Rose DP. Breast cancer and obesity: an update. Nutrition Cancer. 2003;45(1):1–16. doi: 10.1207/S15327914NC4501_1.
    1. McCullough ML, Feigelson HS, Diver WR, Patel AV, Thun MJ, Calle EE. Risk Factors for Fatal Breast Cancer in African-American Women and White Women in a Large US Prospective Cohort. Am J Epidemiol. 2005;162(8):734–742. doi: 10.1093/aje/kwi278.
    1. McKenzie F, Jeffreys M. Do Lifestyle or Social Factors Explain Ethnic/Racial Inequalities in Breast Cancer Survival? Epidemiol Rev. 2009;31:52–66. doi: 10.1093/epirev/mxp007.
    1. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, et al. Body Mass Index Before and After Breast Cancer Diagnosis: Associations with All-Cause, Breast Cancer, and Cardiovascular Disease Mortality. Cancer Epidemiol Biomark Prev. 2009;18(5):1403–1409. doi: 10.1158/1055-9965.EPI-08-1094.
    1. Reeves GK, Patterson J, Vessey MP, Yeates D, Jones L. Hormonal and other factors in relation to survival among breast cancer patients. Int J Cancer. 2000;89(3):293–299. doi: 10.1002/1097-0215(20000520)89:3<293::AID-IJC13>;2-R.
    1. Vatten LJ, Foss OP, Kvinnsland S. Overall survival of breast cancer patients in relation to preclinically determined total serum cholesterol, body mass index, height and cigarette smoking: a population-based study. Eur J Cancer. 1991;27(5):641–646. doi: 10.1016/0277-5379(91)90234-5.
    1. Kyogoku S, Hirohata T, Takeshita S, Nomura Y, Shigematsu T, Horie A. Survival of breast-cancer patients and body size indicators. Int J Cancer. 1990;46(5):824–831. doi: 10.1002/ijc.2910460513.
    1. Endogenous Hormones Breast Cancer Collaborative G Body Mass Index, Serum Sex Hormones, and Breast Cancer Risk in Postmenopausal Women. J Natl Cancer Inst. 2003;95(16):1218–1226. doi: 10.1093/jnci/djg022.
    1. McTiernan A, Rajan KB, Tworoger SS, Irwin M, Bernstein L, Baumgartner R, et al. Adiposity and Sex Hormones in Postmenopausal Breast Cancer Survivors. J Clin Oncol. 2003;21(10):1961–1966. doi: 10.1200/JCO.2003.07.057.
    1. Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madarnas Y, et al. Fasting Insulin and Outcome in Early-Stage Breast Cancer: Results of a Prospective Cohort Study. J Clin Oncol. 2002;20(1):42–51. doi: 10.1200/JCO.20.1.42.
    1. Blackburn GL, Wang KA. Dietary fat reduction and breast cancer outcome: results from the Women’s Intervention Nutrition Study (WINS) Am J Clin Nutr. 2007;86(3):878S–881S.
    1. Pierce BL, Ballard-Barbash R, Bernstein L, Baumgartner RN, Neuhouser ML, Wener MH, et al. Elevated Biomarkers of Inflammation Are Associated With Reduced Survival Among Breast Cancer Patients. J Clin Oncol. 2009;27(21):3437–3444. doi: 10.1200/JCO.2008.18.9068.
    1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–814. doi: 10.1001/jama.2014.732.
    1. Kant AK, Graubard BI, Kumanyika SK. Trends in Black-White Differentials in Dietary Intakes of U.S. Adults, 1971–2002. Am J Prev Med. 2007;32(4):264–272. doi: 10.1016/j.amepre.2006.12.011.
    1. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523–1529. doi: 10.1001/jama.282.16.1523.
    1. Whitt M, Kumanyika S, Bellamy S. Amount and Bouts of Physical Activity in a Sample of African-American Women. Med Sci Sports Exerc. 2003;35(11):1887–1893. doi: 10.1249/01.MSS.0000093618.60631.C3.
    1. Dennis Parker EA, Sheppard VB, Adams-Campbell L. Compliance with national nutrition recommendations among breast cancer survivors in “Stepping Stone”. Integr Cancer Ther. 2014;13(2):114–20. doi: 10.1177/1534735413503550.
    1. Paxton RJ, Jones LA, Chang S, Hernandez M, Hajek RA, Flatt SW, et al. Was race a factor in the outcomes of the women’s health eating and living study? Cancer. 2011;117(16):3805–3813. doi: 10.1002/cncr.25957.
    1. Paxton RJ, Taylor WC, Chang S, Courneya KS, Jones LA. Lifestyle behaviors of African American breast cancer survivors: a Sisters Network, Inc. study. PLoS One. 2013;8(4):e61854. doi: 10.1371/journal.pone.0061854.
    1. Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D, et al. Ethnicity and Breast Cancer: Factors Influencing Differences in Incidence and Outcome. J Natl Cancer Inst. 2005;97(6):439–448. doi: 10.1093/jnci/dji064.
    1. Stolley MR, Sharp LK, Oh A, Schiffer L. A weight loss intervention for African American breast cancer survivors, 2006. Prev Chronic Dis. 2009;6(1):A22.
    1. Djuric Z, Mirasolo J, Kimbrough LV, Brown DR, Heilbrun LK, Canar L, et al. A Pilot Trial of Spirituality Counseling for Weight Loss Maintenance in African American Breast Cancer Survivors. J Natl Med Assoc. 2009;101(6):552. doi: 10.1016/S0027-9684(15)30940-8.
    1. Djuric Z, DiLaura NM, Jenkins I, Darga L, Jen CKL, Mood D, et al. Combining Weight-Loss Counseling with the Weight Watchers Plan for Obese Breast Cancer Survivors. Obes Res. 2002;10(7):657–665. doi: 10.1038/oby.2002.89.
    1. Mefferd K, Nichols J, Pakiz B, Rock C. A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors. Breast Cancer Res Treat. 2007;104(2):145–152. doi: 10.1007/s10549-006-9410-x.
    1. de Waard F, Ramlau R, Mulders Y, de Vries T, van Waveren S. A feasibility study on weight reduction in obese postmenopausal breast cancer patients. Eur J Cancer Prev. 1993;2(3):233–238. doi: 10.1097/00008469-199305000-00007.
    1. Goodwin P, Esplen MJ, Butler K, Winocur J, Pritchard K, Brazel S, et al. Multidisciplinary weight management in locoregional breast cancer: results of a phase II study. Breast Cancer Res Treat. 1998;48(1):53–64. doi: 10.1023/A:1005942017626.
    1. McTiernan A, Ulrich C, Kumai C, Bean D, Schwartz RM, Mahloch J, et al. Anthropometric and hormone effects of an eight-week exercise-diet intervention in breast cancer patients: results of a pilot study. Cancer Epidemiol Biomark Prev. 1998;7(6):477–481.
    1. Foster GD, Wadden TA, Swain RM, Anderson DA, Vogt RA. Changes in resting energy expenditure after weight loss in obese African American and white women. Am J Clin Nutr. 1999;69(1):13–17.
    1. Kumanyika S. Obesity Treatment in Minorities. In: Wadden T, Stunkard A, editors. Handbook of Obesity Treatment. New York: Guilford Press; 2002. pp. 416–446.
    1. Greenlee HA, Crew KD, Mata JM, McKinley PS, Rundle AG, Zhang W, et al. A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors. Obesity (Silver Spring) 2013;21(1):65–76. doi: 10.1002/oby.20245.
    1. Wilson DB, Porter JS, Parker G, Kilpatrick J. Anthropometric changes using a walking intervention in African American breast cancer survivors: a pilot study. Prev Chronic Dis. 2005;2(2):A16.
    1. Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise behaviors. Prev Med. 1987;16(6):825–836. doi: 10.1016/0091-7435(87)90022-3.
    1. Latimer L, Walker LO, Kim S, Pasch KE, Sterling BS. Self-efficacy scale for weight loss among multi-ethnic women of lower income: a psychometric evaluation. J Nutr Educ Behav. 2011;43(4):279–283. doi: 10.1016/j.jneb.2010.09.007.
    1. Grow HM, Saelens BE, Kerr J, Durant NH, Norman GJ, Sallis JF. Where Are Youth Active? Roles of Proximity, Active Transport, and Built Environment. Med Sci Sports Exerc. 2008;40(12):2071–2079. doi: 10.1249/MSS.0b013e3181817baa.
    1. Friedl KE, DeLuca JP, Marchitelli LJ, Vogel JA. Reliability of body-fat estimations from a four-compartment model by using density, body water, and bone mineral measurements. Am J Clin Nutr. 1992;55(4):764–770.
    1. Going SB, Massett MP, Hall MC, Bare LA, Root PA, Williams DP, et al. Detection of small changes in body composition by dual-energy x-ray absorptiometry. Am J Clin Nutr. 1993;57(6):845–850.
    1. Beaton GH. Approaches to analysis of dietary data: relationship between planned analyses and choice of methodology. Am J Clin Nutr. 1994;59:253S–262S.
    1. Block G, Hartman AM, Dresser CM, Carroll MD, Gannon J, Gardner L. A data-based approach to diet questionnaire design and testing. Am J Epidemiol. 1986;124(3):453–469.
    1. Liu K. Statistical issues related to semiquantitative food-frequency questionnaires. Am J Clin Nutr. 1994;59:262S–265S.
    1. Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology. 1990;1(1):58–64. doi: 10.1097/00001648-199001000-00013.
    1. Norris J, Harnack L, Carmichael S, Pouane T, Wakimoto P, Block G. U.S. trends in nutrient intake: the 1987 and 1992 National Health Interview Surveys. Am J Public Health. 1997;87(5):740–746. doi: 10.2105/AJPH.87.5.740.
    1. Hartman AM, Block G, Chan W, Williams J, McAdams M, Banks WL., Jr Reproducibility of a self-administered diet history questionnaire administered three times over three different seasons. Nutr Cancer. 1996;25(3):305–315. doi: 10.1080/01635589609514454.
    1. Kriska AM, Caspersen CJ. Introduction to a Collection of Physical Activity Questionnaires. Med Sci Sports Exerc. 1997;29(6):5. doi: 10.1097/00005768-199706001-00003.
    1. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, et al. Physical activity levels before and after a diagnosis of breast carcinoma. Cancer. 2003;97(7):1746–1757. doi: 10.1002/cncr.11227.
    1. Godin G, Shephard R. Godin leisure-time exercise questionnaire. Med Sci Sports Exerc. 1997;29(6s):S36.
    1. Ainsworth BE, Sternfeld B, Slattery ML, Daguise V, Zahm SH. Physical activity and breast cancer: evaluation of physical activity assessment methods. Cancer. 1998;83(3 Suppl):611–620. doi: 10.1002/(SICI)1097-0142(19980801)83:3+<611::AID-CNCR3>;2-A.
    1. Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–188. doi: 10.1249/mss.0b013e31815a51b3.
    1. Sasaki JE, John D, Freedson PS. Validation and comparison of ActiGraph activity monitors. J Sci Med Sport. 2011;14(5):411–416. doi: 10.1016/j.jsams.2011.04.003.
    1. Carmichael AR. Obesity and prognosis of breast cancer. Obes Rev. 2006;7(4):333–340. doi: 10.1111/j.1467-789X.2006.00261.x.
    1. Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care. 2007;45(5 Suppl 1):S3–S11. doi: 10.1097/01.mlr.0000258615.42478.55.
    1. Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999;85(5):1186–1196. doi: 10.1002/(SICI)1097-0142(19990301)85:5<1186::AID-CNCR24>;2-N.
    1. Stanton AL, Bernaards CA, Ganz PA. The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer. J Natl Cancer Inst. 2005;97(6):448–456. doi: 10.1093/jnci/dji069.
    1. Stolley MR, Sharp LK, Wells AM, Simon N, Schiffer L. Health Behaviors and Breast Cancer: Experiences of Urban African American Women. Health Educ Behav. 2006;33(5):604–624. doi: 10.1177/1090198106290845.
    1. Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall; 1986.
    1. Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282–298. doi: 10.4278/0890-1171-10.4.282.
    1. Richard L, Potvin L, Kishchuk N, Prlic H. Assessment of the integration of the ecological approach in health promotion programs. Am J Health Promot. 1996;10(4):318–328. doi: 10.4278/0890-1171-10.4.318.
    1. Martin PD, Dutton GR, Brantley PJ. Self-Efficacy as a Predictor of Weight Change in African-American Women[ast][ast] Obesity. 2004;12(4):646–651. doi: 10.1038/oby.2004.74.
    1. Walcott-Mcquigg J. Psychological factors influencing cardiovascular risk reduction behavior in low and middle income African-American women. Natl Black Nurses Assoc. 2000;11(1):27–35.
    1. Ainsworth BE, Wilcox S, Thompson WW, Richter DL, Henderson KA. Personal, social, and physical environmental correlates of physical activity in African-American women in South Carolina. Am J Prev Med. 2003;25(3, Supplement 1):23–29. doi: 10.1016/S0749-3797(03)00161-2.
    1. Thomas JL, Stewart DW, Lynam IM, Daley CM, Befort C, Scherber RM, et al. Support needs of overweight African American women for weight loss.(Report) Am J Health Behav. 2009;33(4):339. doi: 10.5993/AJHB.33.4.1.
    1. Wolfe W. A review: maximizing social support--a neglected strategy for improving weight management with African-American women. Ethn Dis. 2004;14(2):212–218.
    1. King AC, Jeffery RW, Fridinger F, Dusenbury L, Provence S, Hedlund SA, et al. Environmental and Policy Approaches to Cardiovascular Disease Prevention Through Physical Activity: Issues and Opportunities. Health Educ Behav. 1995;22(4):499–511. doi: 10.1177/109019819502200407.
    1. Robinson T. Applying the Socio-ecological Model to Improving Fruit and Vegetable Intake Among Low-Income African Americans. J Community Health. 2008;33(6):395–406. doi: 10.1007/s10900-008-9109-5.
    1. Kumanyika S. Ethnic minorities and weight control research priorities: Where are we now and where do we need to be? Prev Med. 2008;47(6):583–586. doi: 10.1016/j.ypmed.2008.09.012.
    1. Huang TT, Drewnowski A, Kumanyika SK, Glass TA. A systems-oriented multilevel framework for addressing obesity in the 21st century. Prev Chronic Dis. 2009;6(3):A97.
    1. Fallon EA, Wilcox S, Ainsworth BE. Correlates of Self-Efficacy for Physical Activity in African American Women. Women Health. 2005;41(3):47–62. doi: 10.1300/J013v41n03_03.
    1. NIH/NHLBI Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. Obes Res. 1998;6:51S–209S. doi: 10.1002/j.1550-8528.1998.tb00690.x.
    1. Gerber BS, Stolley MR, Thompson AL, Sharp LK, Fitzgibbon ML. Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: a feasibility study. Health Informatics J. 2009;15(1):17–25. doi: 10.1177/1460458208099865.
    1. Stolley MR, Fitzgibbon ML, Schiffer L, Sharp LK, Singh V, Van Horn L, et al. Obesity Reduction Black Intervention Trial (ORBIT): six-month results. Obesity. 2009;17(1):100–106. doi: 10.1038/oby.2008.488.
    1. Roy A, Bhaumik DK, Aryal S, Gibbons RD. Sample Size Determination for Hierarchical Longitudinal Designs with Differential Attrition Rates. Biometrics. 2007;63(3):699–707. doi: 10.1111/j.1541-0420.2007.00769.x.
    1. Hedeker D, Gibbons RD. Longitudinal data analysis. Hoboken, NJ: Wiley; 2006.
    1. Weathers B, Frances K, Barg A, Collier C, Hughes H. Perceptions of changes in weight among African American breast cancer survivors. Psycho-Oncology. 2006;15(2):174–179. doi: 10.1002/pon.939.
    1. Fitzgibbon ML, Stolley MR. Environmental changes may be needed for prevention of overweight in minority children. Pediatr Ann. 2004;33(1):45–49. doi: 10.3928/0090-4481-20040101-12.
    1. Burdette HL, Whitaker RC. Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children. Prev Med. 2004;38(1):57–63. doi: 10.1016/j.ypmed.2003.09.029.
    1. Ross CE, Mirowsky J. Neighborhood disadvantage, disorder, and health. J Health Soc Behav. 2001;42:258–276. doi: 10.2307/3090214.
    1. Kong A, Tussing-Humphreys LM, Odoms-Young AM, Stolley MR, Fitzgibbon ML. Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women. Obes Rev. 2014;15(Suppl 4):62–92. doi: 10.1111/obr.12203.

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