survivorship promotion in reducing igf-1 trial

Conditions: Breast Cancer; Prostate Cancer; Lung Cancer; Colon Cancer; Melanoma of Skin; Endometrial Cancer; Liver Cancer; Pancreatic Cancer; Rectal Cancer; Kidney Cancer; Other Solid Malignant Tumors

Summary: this is a prospective, single-center randomized trial with three arms, and an allocation ratio of 1:1:1. the study design is an efficacy study to evaluate the effect of metformin and coach-directed behavioral weight loss versus self-directed weight loss on insulin-like growth factor (igf)-1 and igf-1 to the igfbp-iii ratio blood levels after 6 and 12 months of intervention. the coach-directed behavioral weight loss arm is a web-based remote delivery and communication system that promotes healthy behavioral changes. the metformin arm is a pharmaceutical intervention of oral metformin. this is a secondary prevention study for men and women who have survived solid malignant tumors


Eligibility criteria:
inclusion criteria: * women and men ages 18 or older * have been previously diagnosed with a malignant solid tumor, completed their required surgical, and/or chemotherapy and/or radiation curative intent therapy at least three months prior to enrollment, and have an anticipated treatment-free life span of 12 months or longer. chemoprophylaxis with tamoxifen or aromatase inhibitors for breast cancer in women and anti- luteinizing hormone-releasing hormone (lhrh) therapy for prostate cancer in men will be permitted. * have a bmi of 25 kg/m\^2 or greater and weight \<=400 lbs. * willingness to accept randomization to each of the three arms * willingness to change diet, physical activity, and weight * regular access to computer with a reliable internet connection * ability to send and receive emails * ability to complete online forms * access to phone * willingness to provide written informed consent exclusion criteria: * women who are breastfeeding, pregnant, or planning pregnancy within the next year * medication-treated diabetes * fasting blood glucose \>=200 mg/dl, or fasting blood glucose \>=126 and \ =7% * current or prior regular use of metformin within the past 3 months * uncontrolled concurrent medical condition likely to limit compliance with the study interventions * received any chemotherapy (unless anti-hormonal therapy) and/or radiation three months or less prior to the proposed intervention date * have a prior history of lactic acidosis by self-report * prior or planned bariatric surgery * have significant renal disease or dysfunction defined as estimated glomerular filtration rate (egfr)\<45 * have significant hepatic dysfunction \[aspartate aminotransferase (ast)/alanine transaminase (alt) ≥ 2 x upper limit of normal (uln) or reported liver disease\] * self-reported average consumption of \> 14 alcoholic drink per week * currently enrolled or planned to enroll in weight loss program * hemoglobin \<9 g/dl * platelet count \<100 * white blood cell count (wbc) \<2.5 * plans to relocate from the area within one years * use of prescription weight loss medication(s) (e.g., lorcaserin, topiramate/phentermine, phentermine, liraglutide, and bupropion/naltrexone), including off label use of drugs for weight loss or over-the-counter weigh loss medications such as orlistat within the past 6 months.