DAMES: Daughters And MothErS Against Breast Cancer

Transcription

1 WORKING EVERYDAY TO PROVIDE THE HIGHEST QUALITY OF LIFE FOR PEOPLE WITH CANCER DAMES: Daughters And MothErS Against Breast Cancer WENDY DEMARK-WAHNEFRIED, PHD, RD PROFESSOR AND WEBB CHAIR OF NUTRITION SCIENCES ASSOCIATE DIRECTOR OF CANCER PREVENTION & CONTROL UNIVERSITY OF ALABAMA AT BIRMINGHAM

2 All women become like their mothers. That is their tragedy. Oscar Wilde Obesity is associated with poorer outcomes among women with breast cancer Obesity is associated with increased risk of breast cancer occurring in later life Is it possible to capitalize on the teachable moment of cancer and the mother-daughter bond to promote weight loss in overweight mothers with breast cancer and their overweight daughters as a means of tertiary AND primary prevention? - AND is it best to use team or individually-based tailoring? - AND how can you do it when pilot data show mothers and daughters live 354 miles apart?

3 DAMES Against Breast Cancer (R ) Pilot-Feasibility Trial to promote weight loss in overweight breast cancer patients and their overweight adult daughters Enroll 67 Mother-Daughter Dyads Home-based diet-exercise intervention aimed at weight loss: 1) Standardized Materials; 2) Tailored Materials (Independent Approach) 3) Tailored Materials (Team-Based Approach)

4 DAMES Tailored Intervention Materials

5 Eligibility Criteria MOTHERS Dx d w/dcis or Stage I-III breast cancer within past 5 yrs No evidence of progressive disease or 2 nd primaries Approved for contact by oncology care physician BMI: English-speaking & writing Completed the 5 th grade Community dwelling in US, Guam or Puerto Rico No pre-existing condition that precludes adherence to an unsupervised exercise intervention, e.g., scheduled for knee/hip surgery, dx d w/unstable angina, heart attack or CHF within past 6 M, untreated stage 3 HTN, paralysis. Exercise < 150 min/week Not currently enrolled in a weight loss program Have biological daughter age 21 or older DAUGHTERS Same as moms, but no dx of breast cancer

6 31 Self-Referrals 2516 Cancer Registry Cases 2336 Breast Cancer Cases Mailed Study Invitation 211 MD Denies Contact 56 Unusable address; 6 Deceased 2274 Total Potential Contactable Pool 1385 No response 332 No eligible daughter 209 Not interested 93 BMI < Eligible Moms Ascertained Daughters Sent Study Invitation 48 Medical Exclusions 35 Exercise >150 min/week 15 BMI >40 12 Enrolled in wt loss program 4 Non-English speakers Accrual Rate: 3% 84 Mother-Daughter Dyads Identified Sent Full Study Consent 9 Consents received after study closure 5 Lost interest 70 Mother-Daughter Dyads Consented 68 Dyads Randomized 5 No response 6 Not eligible 23 Not interested 4 Medical Exclusions 5 Exercise >150 min/week 9 BMI<25 3 BMI >40 2 Enrolled in wt loss program 2 Dyads Incomplete Baseline Assessment 18 Attention Control 25 Individually Tailored 25 Team Tailored 0 Moms/1 Daughter 4 Moms/3 Daughters 1 Moms/1 Daughters 6M Follow-Up Assessments (60 Dyads) 0 Moms/1 Daughters 2 Moms/2 Daughters 2 Moms/1 Daughter 12M Follow-Up Assessments (61 Dyads) Attrition: 10.3%

7 Characteristics of the Study Sample Mothers Daughters Age (x, sd, range) 61.3(7.4)(46-80) 37.7(1.4)(21-54) BMI (x, sd) 31.0(2.6) 32.9(1.4) Race (%) White Hispanic Black Asian 73% 7% 18% 2% Income <$40K/year (%) 31% 28% Cancer Stage (%) 0 18% I 43% II 31% III 4% missing 4% Months from diagnosis 24 (13) (2 61) Miles Apart 75 (86) (0-646)

8 Measures/Measurement Points Baseline Every 7 wks 6 M Every 7 wks 12 M Process Data Weight Status (BMI) self-report & actual Blood Pressure Physical Activity Self-report, accelerometers V0 2peak 2-Day Dietary Recalls Quality of Life Self-Efficacy/Readiness / /-/-/ / /-/-/ / Perceived Risk of CA Social Support Adult Attachment Demographics

9 Body Mass Index (kg/m 2 ) Team vs. Control: Moms p=.0497 Daughters: p=.7522 Dyad p=.0310 Individual vs. Control: Moms p=.0580 Daughters p=.6392 Dyad p=.0700

10 Waist Circumference (cm) Team vs. Control: Moms p=ns Daughters: p=ns Dyad p=.042 Individual vs. Control: Moms p=.005 Daughters p=.033 Dyad p=.0004

11 Weekly Minutes of Moderate-Vigorous Physical Activity Team vs. Control: Moms p=ns Daughters: p=ns Dyad p=.046 Individual vs. Control: Moms p=ns Daughters p=.006 Dyad p=.019

12 Caloric Intake (kcal/day)

13 Healthy Eating Index Team vs. Control: Moms p=.059 Daughters: p=ns Dyad p=ns Individual vs. Control: Moms p=.071 Daughters p=ns Dyad p=ns

14 Other Measures No Differences in - self-efficacy to exercise (though a trend in improved self-efficacy to adhere to a portion- controlled, calorierestricted diet in both experimental arms) - blood pressure - satisfaction with mother-daughter relationship - mental or physical quality of life

15 Losing Weight is a Family Affair Daughte r lost 10 pounds Mom lost 23 pounds Dog Rocky lost 11 pounds

16 Summary Because accrual rates are so low, motherdaughter weight loss interventions may have limited feasibility at least within the context of breast cancer Tailored print, mailed material weight loss interventions show high retention and promise. Future research is warranted with such interventions (especially team- or partner-based interventions) in survivorspouse, survivor-sister, as well as other self-selected dyads.

17 Thank-you! Questions? R21-CA92468 Isaac Lipkus, PhD Lee Jones, PhD Gretchen Kimmick, MD Bercedis Peterson, PhD Denise Snyder, MS, RD, CSO, LDN Stephanie Barrera, MS, RD, LD Mary Katherine Bispeck Daniel Hughes, PhD Thanks to all survivors who participated in this research!