Nutrition Education among Cancer Survivors: Feasibility Results from the Healthy Eating and Living against Breast Cancer (HEAL‐Breast Cancer): A Pilot Randomized Controlled Trial
Authors: Parekh Niyati , Jiang Jieying , Buchan Marissa , Gibbs Healther , Krebs Paul 
Published: November 2023

Objective

Knowledge of nutrition among breast cancer patients is insufficient, despite their motivation to seek valid information about healthy food choices. The objective of this study was to determine the feasibility of interactive nutrition literacy workshops for cancer survivors, to inform the design of a larger multi‐center intervention.

Methods

Fifty nine non‐pregnant female patients, fluent in English, diagnosed with breast cancer who completed treatment (surgery, chemotherapy and/or radiation) within the previous 6 months were recruited through doctor referral. Participants were randomized to the intervention or control group. The intervention group attended 6 in‐person nutrition education sessions conducted by a Registered Dietitian and a chef, over a 3‐month period. The control group received brochures. Measures were completed at baseline and 3‐month follow up that consisted of the Nutrition Literacy Assessment Instrument (NLAI), which includes sections of Nutrition and Health, Macronutrients, Food Portions, Label Reading and Food Groups (primary outcome), the Block fruit/vegetable screener and general health literacy. Height and weight were measured.

Statistical analyses

Changes in nutrition, health literacy/food intakes from baseline to 3‐month follow‐up (within‐group change) were calculated in the control and intervention group, respectively. Effect sizes were reported using Cohen's d; as a feasibility pilot it was not powered to detect clinically significant differences.

Results

The mean age was 58 years, and participants were mostly White, with a college degree and employed (mean income $40,000+). Mean body mass index (BMI) was 31.6 kg/m2. 62 patients were screened and 59 consented and were randomized. Follow up rates were high: 25/28 (89%) for control and 24/31 (77%) for intervention. At baseline, participants received high scores for most NLAI assessment components (9 of 10, 14 of 15 or 5 of 6) except for food portions (5.7 of 9 for controls and 6 of 9 for the intervention group). At 3 month follow‐up, effect sizes (d) on the NLAI ranged from −0.16 to 0.5 and were indicative of clinically‐meaningful change. The study met its recruitment goals within a 6 month timeframe. Of the 25 patients in the intervention group, at follow up, 13 (52%) attended all 6 sessions, 8 attended 5 sessions (32%) and 4 attended 4 sessions (16%). Summative evaluation focus groups indicated: 1) Sessions were helpful and attending 6 was acceptable 2) Patients found social and emotional support, 3) Improvements should focus on information for special dietary needs and follow up/booster sessions.

Conclusions

This pilot study suggests that the intervention was acceptable and that scaling up of this intervention is feasible and could provide benefit to the breast cancer survivor population.

Support or Funding Information

This research was supported by an award to Drs. Niyati Parekh and Paul Krebs by the New York University's NYU Langone's Laura and Isaac Perlmutter Cancer Center.