Abstract A011: Lifestyle behavior change interventions among adult rural cancer survivors: A systematic review
Authors: Werts Samantha J. , Robles-Morales Rogelio , Bea Jennifer W. , Thomson Cynthia A. 
Published: January 2023

Abstract
Introduction: Though lifestyle behavior, such as dietary pattern or physical activity, has been shown to improve symptoms related to cancer treatment and secondary comorbidities (i.e., pain, fatigue, poor functionality), adherence to health-promoting behavioral interventions is low, particularly among older, rural-dwelling survivors of cancer. Shifting population dynamics in cancer survivorship regarding both aging and rurality indicate that it is crucial to understand the health needs of this older, lower resourced population if acceptable and effective lifestyle interventions are to be developed and implemented. This review aimed to summarize lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors. Methods: A systematic search of five databases (i.e., PubMed, CINAHL, CENTRAL, EMBASE, PsycINFO) identified randomized controlled trials and controlled clinical trials which targeted diet and/or physical activity change in adult cancer survivors living in rural areas. The conduct and reporting of this review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The protocol for this review was registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42021282313). Articles were screened for eligibility by two independent reviewers and data were extracted using an a priori developed form. Results: Eight studies met the inclusion criteria. Average participant age was 59.9 years (range: 29-90 years). While three studies (37%) reported a mean sample age of 65 years or greater, none identified a priori inclusion criteria encompassing both older age and rurality. Most studies were conducted in Australia (n=4) or the United States (n=3), focused on breast cancer survivors (n=4), and included survivors at least 6-weeks post-treatment (n=5). Six (75%) had a fully remote or hybrid delivery model. Results from the three interventions which enrolled a mean study sample of 65 years or greater indicated that lower percentages of older, rural-dwelling participants met study goals related to fruit, vegetable, and saturated fat intake than younger and/or urban survivors. Older, rural-dwelling survivors reported greater improvements in physical function and physical activity post-intervention than older, urban-dwelling participants. Conclusions: Few studies have been conducted to evaluate the efficacy of lifestyle behavior change intervention among rural-dwelling survivors of cancer. None have been designed for older survivors living in rural areas, despite lower adherence to lifestyle behavior recommendations for survivors. There is a need to identify feasible and effective approaches to influence clinically meaningful behavior change for this population. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with older, rural-dwelling survivors of cancer.
Citation Format: Samantha J. Werts, Rogelio Robles-Morales, Jennifer W. Bea, Cynthia A. Thomson. Lifestyle behavior change interventions among adult rural cancer survivors: A systematic review [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A011.