Physical activity and nutrition interventions for older adults with cancer: a systematic review.

Cynthia C Forbes, Flavia Swan, Sarah L Greenley, Michael Lind, Miriam J Johnson

Journal: Journal of cancer survivorship : research and practice 2021;14(5):689-711

PMID: 32328828

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Plain Language Summary

Physical activity (PA) benefits people living with or beyond cancer by improving physical function and quality of life (QoL) during and after cancer treatment, and cancer-related outcomes. Furthermore, poor nutritional status is associated with worse overall survival and QoL in patients receiving chemotherapy than those with better nutritional status. The aim of this study was to summarize the current literature regarding activity and nutritional based interventions on health-related quality of life (HRQoL) in older adults with cancer delivered before, during or after active cancer treatments, or as part of best supportive care. This study is a systematic review and meta-analysis of 14 randomised-controlled studies. Results show that effects on QoL outcomes were mixed since most studies were not designed to test effectiveness; however, the evaluation phase trials showed positive trends in QoL related to lifestyle interventions. Authors conclude that activity/nutrition programmes targeting older adults should include candidate intervention components; the need to use a holistic and tailored approach with functional goals and some personal professional contact.

Abstract

PURPOSE

The aim of this review was to summarize the current literature for the effectiveness of activity and nutritional based interventions on health-related quality of life (HRQoL) in older adults living with and beyond cancer (LWBC).

METHODS

We conducted systematic structured searches of CINAHL, Embase, Medline, Cochrane CENTRAL databases, and bibliographic review. Two independent researchers selected against inclusion criteria: (1) lifestyle nutrition and/or activity intervention for people with any cancer diagnosis, (2) measured HRQoL, (3) all participants over 60 years of age and (4) randomized controlled trials.

RESULTS

Searches identified 5179 titles; 114 articles had full text review, with 14 studies (participant n = 1660) included. Three had nutrition and activity components, one, nutrition only and ten, activity only. Duration ranged from 7 days to 1 year. Interventions varied from intensive daily prehabilitation to home-based gardening interventions. Studies investigated various HRQoL outcomes including fatigue, general and cancer-specific quality of life (QoL), distress, depression, global side-effect burden and physical functioning. Eight studies reported significant intervention improvements in one or more QoL measure. Seven studies reported using a psychosocial/theoretical framework. There is a gap in tailored nutrition advice.

CONCLUSIONS

Among the few studies that targeted older adults with cancer, most were activity-based programmes with half reporting improvements in QoL. Future research should focus on or include tailored nutrition components and consider appropriate behaviour change techniques to maximize potential QoL improvement.

IMPLICATIONS FOR CANCER SURVIVORS

More research is needed to address the research gap regarding older adults as current recommendations are derived from younger populations.

Address: Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK. [email protected].; University of Hull, Allam Medical Building 3rd Floor, Cottingham Road, Kingston-Upon-Hull, East Yorkshire, HU6 7RX, UK. [email protected].; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.; Academy of Primary Care, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.; Cancer Research Group, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.

DOI: 10.1007/s11764-020-00883-x