Digital health behaviour change interventions targeting physical activity and diet in cancer survivors: a systematic review and meta-analysis

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Abstract

Purpose

The number of cancer survivors has risen substantially due to improvements in early diagnosis and treatment. Health behaviours such as physical activity (PA) and diet can reduce recurrence and mortality, and alleviate negative consequences of cancer and treatments. Digital behaviour change interventions (DBCIs) have the potential to reach large numbers of cancer survivors.

Methods

We conducted a systematic review and meta-analyses of relevant studies identified by a search of Medline, EMBASE, PubMed and CINAHL. Studies which assessed a DBCI with measures of PA, diet and/or sedentary behaviour were included.

Results

Fifteen studies were identified. Random effects meta-analyses showed significant improvements in moderate-vigorous PA (seven studies; mean difference (MD) = 41 min per week; 95% CI 12, 71) and body mass index (BMI)/weight (standardised mean difference (SMD) = −0.23; 95% CI −0.41, −0.05). There was a trend towards significance for reduced fatigue and no significant change in cancer-specific measures of quality of life (QoL). Narrative synthesis revealed mixed evidence for effects on diet, generic QoL measures and self-efficacy and no evidence of an effect on mental health. Two studies suggested improved sleep quality.

Conclusions

DBCIs may improve PA and BMI among cancer survivors, and there is mixed evidence for diet. The number of included studies is small, and risk of bias and heterogeneity was high. Future research should address these limitations with large, high-quality RCTs, with objective measures of PA and sedentary time.

Implications for cancer survivors

Digital technologies offer a promising approach to encourage health behaviour change among cancer survivors.

Electronic supplementary material

The online version of this article (doi:10.1007/s11764-017-0632-1) contains supplementary material, which is available to authorized users.

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Most cited references 71

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The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

Susan Michie, Michelle Richardson, Marie Johnston … (2014)

CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.

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Author and article information

Contributors

Anna L. Roberts: anna.roberts.15@ucl.ac.uk

Abigail Fisher: +44 (0)20 7679 1722 , abigail.fisher@ucl.ac.uk

Journal

Journal ID (nlm-ta): J Cancer Surviv

Journal ID (iso-abbrev): J Cancer Surviv

Title: Journal of Cancer Survivorship

Publisher: Springer US (New York )

ISSN (Print): 1932-2259

ISSN (Electronic): 1932-2267

Publication date (Electronic): 4 August 2017

Publication date PMC-release: 4 August 2017

Publication date (Print): 2017

Volume: 11

Issue: 6

Pages: 704-719

Affiliations

[1 ]ISNI 0000000121901201, GRID grid.83440.3b, Department of Behavioural Science & Health, , University College London, ; Gower Street, London, WC1E 6BT UK

[2 ]ISNI 0000 0001 2299 5510, GRID grid.5115.0, The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, , Anglia Ruskin University, ; Cambridge, UK

[3 ]ISNI 0000000121901201, GRID grid.83440.3b, Institute of Health Informatics, , University College London, ; London, UK

Article

Publisher ID: 632

DOI: 10.1007/s11764-017-0632-1

PMC ID: 5671545

PubMed ID: 28779220

SO-VID: 39b99d3c-ea13-4b46-b8c1-2e9ddeaf7863

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 29 November 2016

Date accepted : 14 July 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;

Funded by: FundRef http://dx.doi.org/10.13039/501100000384, Higher Education Funding Council for England;

Funded by: FundRef http://dx.doi.org/10.13039/501100000289, Cancer Research UK;

Award ID: C1418/A14133

Award Recipient : Malgorzata Heinrich

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: behaviour change,digital interventions,physical activity,cancer survivors,diet,sedentary behaviour

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: behaviour change, digital interventions, physical activity, cancer survivors, diet, sedentary behaviour

Digital health behaviour change interventions targeting physical activity and diet in cancer survivors: a systematic review and meta-analysis

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Abstract

Purpose

Methods

Results

Conclusions

Implications for cancer survivors

Electronic supplementary material

Related collections

UCL: UN SDG 03 Good Health and Well-Being

Most cited references 71

Bias in meta-analysis detected by a simple, graphical test

Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.

The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

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