Impact of Elimination or Reduction of Dietary Animal Proteins on Cancer Progression and Survival: Protocol of an Online Pilot Cohort Study

Anna Catany Ritter, Annarita Sabrina Egger, Jennifer Machacek, Rosa Aspalter, Anna Catany Ritter, Annarita Sabrina Egger, Jennifer Machacek, Rosa Aspalter

Abstract

Background: Current evidence suggests that the incidence of cancer is low in vegan populations, and experimental studies have revealed a significant role of dietary proteins in cancer development and progression. However, little data currently exists regarding the effect of a plant-based diet on the progression of diagnosed cancer.

Objective: The main objective of this study is to determine if a reduction or total elimination of animal protein from the diet can positively influence the outcome of an existing cancer and, in addition to standard oncological therapies, increase remission rates.

Methods: The primary aim of this online study is to test the effect on remission rates in cancer patients (primary outcome) with distinct self-selected dietary patterns (omnivore, lacto-ovo-vegetarian, vegan), and allow for an estimation of the effect size. Secondary outcomes are tumor behavior, relapse-free interval, therapies, therapy tolerability and side-effects, comorbidities, medication, quality of life, acceptance, and feasibility of the selected diet. Safety concerns exist for vegan diets (especially in cancer patients) and the study will carefully monitor for deterioration of health, tumor progression, or malnutrition. Furthermore, the study will evaluate the online portal as a study platform (technical and safety aspects, and sequence of displayed questionnaires) as well as the validity of self-reported and online-generated data.

Results: The study was performed between April, 2015 and June, 2016, and a preliminary evaluation of safety aspects was undertaken after June, 2016. Primary and secondary outcomes will be evaluated when the final patients complete the study in December, 2016.

Conclusions: This study will reveal information about the effects of dietary patterns on cancer disease and progression. The methodology of the study addresses several aspects and limitations of nutrition studies in cancer patients, such as precision of nutrition data, acceptance criteria, online methodology, and safety aspects.

Clinicaltrial: Clinicaltrials.gov NCT02437474; https://ichgcp.net/clinical-trials-registry/NCT02437474 (Archived by WebCite at http://www.webcitation.org/6jL7UUCVq).

Keywords: cancer; diet; disease outcome; neoplasms; omnivore; remission; vegans; vegetarians.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
How patients heard about the study (n=209).
Figure 2
Figure 2
The study protocol showing the 5 steps for each participant, the planned evaluations, and the number of participants and dropouts.
Figure 3
Figure 3
The participants’ opinions about data surveys (n=138).

References

    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1;136(5):E359–86. doi: 10.1002/ijc.29210.
    1. Key TJ, Appleby PN, Rosell MS. Health effects of vegetarian and vegan diets. Proc Nutr Soc. 2006 Feb;65(1):35–41.
    1. Uzunlulu M, Telci CO, Oguz A. Association between metabolic syndrome and cancer. Ann Nutr Metab. 2016 Feb 20;68(3):173–179. doi: 10.1159/000443743.
    1. Cowey S, Hardy RW. The metabolic syndrome: a high-risk state for cancer? Am J Pathol. 2006 Nov;169(5):1505–22. doi: 10.2353/ajpath.2006.051090.
    1. Polednak AP. Temporal trend in the U.S. black-white disparity in mortality rates from selected alcohol-related chronic diseases. J Ethn Subst Abuse. 2008;7(2):154–64. doi: 10.1080/15332640802055558.
    1. Solomons NW. Plant-based diets are traditional in developing countries: 21st century challenges for better nutrition and health. Asia Pac J Clin Nutr. 2000 Sep;9 Suppl 1:S41–54.
    1. Larsson SC, Wolk A. Meat consumption and risk of colorectal cancer: a meta-analysis of prospective studies. Int J Cancer. 2006 Dec 1;119(11):2657–64. doi: 10.1002/ijc.22170.
    1. Inoue-Choi M, Sinha R, Gierach GL, Ward MH. Red and processed meat, nitrite, and heme iron intakes and postmenopausal breast cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer. 2016 Apr 1;138(7):1609–18. doi: 10.1002/ijc.29901.
    1. Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A, Nailler L, Boutron-Ruault M, Clavel-Chapelon F, Krogh V, Palli D, Panico S, Tumino R, Ricceri F, Bergmann MM, Boeing H, Li K, Kaaks R, Khaw K, Wareham NJ, Crowe FL, Key TJ, Naska A, Trichopoulou A, Trichopoulos D, Leenders M, Peeters PH, Engeset D, Parr CL, Skeie G, Jakszyn P, Sánchez M, Huerta JM, Redondo ML, Barricarte A, Amiano P, Drake I, Sonestedt E, Hallmans G, Johansson I, Fedirko V, Romieux I, Ferrari P, Norat T, Vergnaud AC, Riboli E, Linseisen J. Meat consumption and mortality--results from the European Prospective Investigation into Cancer and Nutrition. BMC Med. 2013;11:63. doi: 10.1186/1741-7015-11-63.
    1. Norat T, Bingham S, Ferrari P, Slimani N, Jenab M, Mazuir M, Overvad K, Olsen A, Tjønneland A, Clavel F, Boutron-Ruault MC, Kesse E, Boeing H, Bergmann MM, Nieters A, Linseisen J, Trichopoulou A, Trichopoulos D, Tountas Y, Berrino F, Palli D, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Engeset D, Lund E, Skeie G, Ardanaz E, González C, Navarro C, Quirós JR, Sanchez MJ, Berglund G, Mattisson I, Hallmans G, Palmqvist R, Day NE, Khaw KT, Key TiJ, San JM, Hémon B, Saracci R, Kaaks R, Riboli E. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. 2005 Jun 15;97(12):906–16. doi: 10.1093/jnci/dji164.
    1. Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson K. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr. 1999 Sep;70(3 Suppl):516S–524S.
    1. Craig WJ. Health effects of vegan diets. Am J Clin Nutr. 2009 May;89(5):1627S–1633S. doi: 10.3945/ajcn.2009.26736N.
    1. Wiseman M. The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc. 2008 Aug;67(3):253–6. doi: 10.1017/S002966510800712X.
    1. Bouvard V, Loomis D, Guyton KZ, Grosse Y, Ghissassi FE, Benbrahim-Tallaa L, Guha N, Mattock H, Straif K, International Agency for Research on Cancer Monograph Working Group Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015 Dec;16(16):1599–600. doi: 10.1016/S1470-2045(15)00444-1.
    1. McGuire S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr. 2016 Mar;7(2):418–9. doi: 10.3945/an.116.012211.
    1. Conroy SM, Maskarinec G, Park S, Wilkens LR, Henderson BE, Kolonel LN. The effects of soy consumption before diagnosis on breast cancer survival: the Multiethnic Cohort Study. Nutr Cancer. 2013;65(4):527–37. doi: 10.1080/01635581.2013.776694.
    1. Messina MJ, Loprinzi CL. Soy for breast cancer survivors: a critical review of the literature. J Nutr. 2001 Nov;131(11 Suppl):3095S–108S.
    1. Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, Flatt SW, Zheng Y, Zheng W, Pierce JP, Shu XO. Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Am J Clin Nutr. 2012 Jul;96(1):123–32. doi: 10.3945/ajcn.112.035972.
    1. Zhang Y, Kang H, Li B, Zhang R. Positive effects of soy isoflavone food on survival of breast cancer patients in China. Asian Pac J Cancer Prev. 2012;13(2):479–82.
    1. McCullough ML, Gapstur SM, Shah R, Jacobs EJ, Campbell PT. Association between red and processed meat intake and mortality among colorectal cancer survivors. J Clin Oncol. 2013 Aug 1;31(22):2773–82. doi: 10.1200/JCO.2013.49.1126.
    1. Richman EL, Stampfer MJ, Paciorek A, Broering JM, Carroll PR, Chan JM. Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression. Am J Clin Nutr. 2010 Mar;91(3):712–21. doi: 10.3945/ajcn.2009.28474.
    1. Elkort RJ, Baker FL, Vitale JJ, Cordano A. Long-term nutritional support as an adjunct to chemotherapy for breast cancer. J Parenter Enteral Nutr. 1981;5(5):385–90.
    1. Evans WK, Nixon DW, Daly JM, Ellenberg SS, Gardner L, Wolfe E, Shepherd FA, Feld R, Gralla R, Fine S. A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. J Clin Oncol. 1987 Jan;5(1):113–24.
    1. Boudreau F, Moreau M, Côté J. Effectiveness of computer tailoring versus peer support web-based interventions in promoting physical activity among insufficiently active Canadian adults with type 2 diabetes: protocol for a randomized controlled trial. JMIR Res Protoc. 2016;5(1):e20. doi: 10.2196/resprot.5019.
    1. Harvey-Berino J, Krukowski RA, Buzzell P, Ogden D, Skelly J, West DS. The accuracy of weight reported in a web-based obesity treatment program. Telemed J E Health. 2011 Nov;17(9):696–9. doi: 10.1089/tmj.2011.0032.
    1. Sepucha KR, Feibelmann S, Cosenza C, Levin CA, Pignone M. Development and evaluation of a new survey instrument to measure the quality of colorectal cancer screening decisions. BMC Med Inform Decis Mak. 2014;14:72. doi: 10.1186/1472-6947-14-72.
    1. Food and Cancer Foodandcancer. 2016. [2016-03-01].
    1. Orlich MJ, Singh PN, Sabaté J, Jaceldo-Siegl K, Fan J, Knutsen S, Beeson WL, Fraser GE. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern Med. 2013 Jul 8;173(13):1230–8. doi: 10.1001/jamainternmed.2013.6473.
    1. Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003 May;6(3):259–69. doi: 10.1079/PHN2002430.
    1. Bundesministerium der Justiz und Verbraucherschutz Bundesdatenschutzgesetz (BDSG) 2016. [2016-03-01]. Erhebung, Verarbeitung oder Nutzung personenbezogener Daten im Auftrag .
    1. Survey Monkey . 2016. [2016-07-12]. .
    1. Aune D, Navarro Rosenblatt DA, Chan DS, Vieira AR, Vieira R, Greenwood DC, Vatten LJ, Norat T. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015 Jan;101(1):87–117. doi: 10.3945/ajcn.113.067157.
    1. Rosato V, Edefonti V, Bravi F, Bosetti C, Bertuccio P, Talamini R, Dal Maso L, Montella M, Ferraroni M, La Vecchia C, Decarli A. Nutrient-based dietary patterns and prostate cancer risk: a case-control study from Italy. Cancer Causes Control. 2014 Apr;25(4):525–32. doi: 10.1007/s10552-014-0356-8.
    1. Richman EL, Carroll PR, Chan JM. Vegetable and fruit intake after diagnosis and risk of prostate cancer progression. Int J Cancer. 2012 Jul 1;131(1):201–10. doi: 10.1002/ijc.26348.
    1. Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, Al-Delaimy WK, Thomson CA, Kealey S, Hajek R, Parker BA, Newman VA, Caan B, Rock CL. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol. 2007 Jun 10;25(17):2345–51. doi: 10.1200/JCO.2006.08.6819.
    1. Cheng Z, Hu J, King J, Jay G, Campbell TC. Inhibition of hepatocellular carcinoma development in hepatitis B virus transfected mice by low dietary casein. Hepatology. 1997 Nov;26(5):1351–4. doi: 10.1002/hep.510260538.
    1. O'Keefe SJ, Li JV, Lahti L, Ou J, Carbonero F, Mohammed K, Posma JM, Kinross J, Wahl E, Ruder E, Vipperla K, Naidoo V, Mtshali L, Tims S, Puylaert PG, DeLany J, Krasinskas A, Benefiel AC, Kaseb HO, Newton K, Nicholson JK, de Vos WM, Gaskins HR, Zoetendal EG. Fat, fibre and cancer risk in African Americans and rural Africans. Nat Commun. 2015;6:6342. doi: 10.1038/ncomms7342.
    1. Mohr SB, Gorham ED, Garland CF, Grant WB, Garland FC. Are low ultraviolet B and high animal protein intake associated with risk of renal cancer? Int J Cancer. 2006 Dec 1;119(11):2705–9. doi: 10.1002/ijc.22213.
    1. Allen NE, Appleby PN, Key TJ, Bueno-de-Mesquita HB, Ros MM, Kiemeney LA, Tjønneland A, Roswall N, Overvad K, Weikert S, Boeing H, Chang-Claude J, Teucher B, Panico S, Sacerdote C, Tumino R, Palli D, Sieri S, Peeters P, Quirós JR, Jakszyn P, Molina-Montes E, Chirlaque M, Ardanaz E, Dorronsoro M, Khaw K, Wareham N, Ljungberg B, Hallmans G, Ehrnström R, Ericson U, Gram IT, Parr CL, Trichopoulou A, Karapetyan T, Dilis V, Clavel-Chapelon F, Boutron-Ruault M, Fagherrazzi G, Romieu I, Gunter MJ, Riboli E. Macronutrient intake and risk of urothelial cell carcinoma in the European prospective investigation into cancer and nutrition. Int J Cancer. 2013 Feb 1;132(3):635–44. doi: 10.1002/ijc.27643.
    1. Yang SY, Kim YS, Song JH, Chung SJ, Lee IH, Hong KJ, Lee EJ, Kim DH, Yim JY, Park MJ, Lim SH, Kim JS. Dietary risk factors in relation to colorectal adenoma. Korean J Gastroenterol. 2012 Aug;60(2):102–8.
    1. Gold EB, Flatt SW, Pierce JP, Bardwell WA, Hajek RA, Newman VA, Rock CL, Stefanick ML. Dietary factors and vasomotor symptoms in breast cancer survivors: the WHEL Study. Menopause. 2006;13(3):423–33. doi: 10.1097/01.gme.0000185754.85328.44.
    1. Gold EB, Pierce JP, Natarajan L, Stefanick ML, Laughlin GA, Caan BJ, Flatt SW, Emond JA, Saquib N, Madlensky L, Kealey S, Wasserman L, Thomson CA, Rock CL, Parker BA, Karanja N, Jones V, Hajek RA, Pu M, Mortimer JE. Dietary pattern influences breast cancer prognosis in women without hot flashes: the women's healthy eating and living trial. J Clin Oncol. 2009 Jan 20;27(3):352–9. doi: 10.1200/JCO.2008.16.1067.
    1. Donegan WL, Hartz AJ, Rimm AA. The association of body weight with recurrent cancer of the breast. Cancer. 1978 Apr;41(4):1590–4.
    1. Chen X, Lu W, Zheng W, Gu K, Chen Z, Zheng Y, Shu XO. Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat. 2010 Aug;122(3):823–33. doi: 10.1007/s10549-009-0708-3.
    1. Thomson CA, Rock CL, Giuliano AR, Newton TR, Cui H, Reid PM, Green TL, Alberts DS, Women's Healthy Eating & Living Study Group Longitudinal changes in body weight and body composition among women previously treated for breast cancer consuming a high-vegetable, fruit and fiber, low-fat diet. Eur J Nutr. 2005 Feb;44(1):18–25. doi: 10.1007/s00394-004-0487-x.
    1. Cheng C, Adams GB, Perin L, Wei M, Zhou X, Lam BS, Da SS, Mirisola M, Quinn DI, Dorff TB, Kopchick JJ, Longo VD. Prolonged fasting reduces IGF-1/PKA to promote hematopoietic-stem-cell-based regeneration and reverse immunosuppression. Cell Stem Cell. 2014 Jun 5;14(6):810–23. doi: 10.1016/j.stem.2014.04.014.
    1. Hine C, Mitchell JR. Saying no to drugs: fasting protects hematopoietic stem cells from chemotherapy and aging. Cell Stem Cell. 2014 Jun 5;14(6):704–5. doi: 10.1016/j.stem.2014.05.016.
    1. Lefever S, Dal M, Matthíasdóttir A. Online data collection in academic research: advantages and limitations. Br J Educ Technol. 2007 Jul;38(4):574–582. doi: 10.1111/j.1467-8535.2006.00638.x.
    1. Longin R, Grasse M, Aspalter R, Waldherr K. Effectiveness of the online weight reduction program KiloCoach and comparison with other evaluated commercial direct intervention and online programs. Obes Facts. 2012;5(3):372–83. doi: 10.1159/000339726.
    1. Postrach E, Aspalter R, Elbelt U, Koller M, Longin R, Schulzke J, Valentini L. Determinants of successful weight loss after using a commercial web-based weight reduction program for six months: cohort study. J Med Internet Res. 2013;15(10):e219. doi: 10.2196/jmir.2648.
    1. Schover LR, Yuan Y, Fellman BM, Odensky E, Lewis PE, Martinetti P. Efficacy trial of an Internet-based intervention for cancer-related female sexual dysfunction. J Natl Compr Canc Netw. 2013 Nov;11(11):1389–97.
    1. Kenter R, Warmerdam L, Brouwer-Dudokdewit C, Cuijpers P, van Straten A. Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects. BMC Psychiatry. 2013 Jan;13:43. doi: 10.1186/1471-244X-13-43.
    1. Jonasson J, Linné Y, Neovius M, Rössner S. An Internet-based weight loss programme -- a feasibility study with preliminary results from 4209 completers. Scand J Public Health. 2009 Jan;37(1):75–82. doi: 10.1177/1403494807085066.

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