Yun, Y.H., Kim, Y.A., Lee, M.K., Sim, J.A., Nam, B.H., Kim, S., . . . Park, S. (2017). A randomized controlled trial of physical activity, dietary habit, and distress management with the Leadership and Coaching for Health (LEACH) program for disease-free cancer survivors. BMC Cancer, 17, 298-017-3290-9.

To assess if cancer survivors’ physical activity, dietary habits, and distress management would benefit from a Leadership and Coaching for Health (LEACH) program

Participants were randomly assigned to the LEACH Program (LP) intervention group or the usual care (UC) control group. 

LP group received a one-hour health education workshop (topics covered included physical activity, dietary habits, and distress management), a three-hour leadership workshop, and individual telephone coaching for 24 weeks. A total of 16 tele-coaching sessions were held: 30 minutes per week for 12 sessions, 30 minutes per 2 weeks for 2 sessions, and 30 minutes per month for 2 sessions. 
The UC group was asked to continue their usual care and received a health education booklet on dietary habits, physical activity, and distress management, as well as a four-hour lecture on physical activity, dietary habits, distress management, and a screening for a second cancer.  

Patient evaluations took place at baseline, 3 months, 6 months, and 12 months.

• N = 206 cancer survivors
• AGE: 20 years or older
• MALES: 42 (20.39%)  
• FEMALES: 164 (79.61%)
• CURRENT TREATMENT: Immunotherapy
• KEY DISEASE CHARACTERISTICS: Cancer survivors who completed primary cancer treatment within the last 24 months for breast, stomach, colon (other than rectal), and lung cancer within 18 months of completion of primary treatment. 
• OTHER KEY SAMPLE CHARACTERISTICS: Platelet count of greater than or equal to 100,000/mm³, have serum hemoglobin of greater than or equal to 10 g/dl, and have not already met two or more behavioral goals aimed for in the study.

• SITE: Multi-site
• SETTING TYPE: Not specified

PHASE OF CARE: Survivorship

12 month randomized control trial, patients evaluated at 0, 3, 6, and 12 months.

Cancer registry from 10 South Korean teaching hospitals; questionnaire based on the “Rules for National Cancer Prevention: Dietary Practice Guideline” and the Korean National Health and Nutrition Examination Survey data; METs (kcal/kg per week) for physical activity; Post-Traumatic Growth Inventory; Seven Habit Profile; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; Diener’s Satisfaction With Life Scale; Hospital Anxiety and Depression Scale; Impact of Events Scale-Revised; Medical Outcomes Study Social Support Survey; Ten Rules for Highly Effective Health Behavior

There was no significant difference between the two groups; UC and LP for primary or secondary outcomes.

For primary outcome, UC and LP groups did not significantly differ in intake of fruit and vegetable intake, and physical activity, but differed at 12 months in post-traumatic positive growth (p = 0.065).

For secondary outcomes, from baseline to 3 months, the LP group showed a  greater decrease in the anxiety score (p = 0.025), a greater increase in social functioning score  (p = 0.018), and a greater decrease in appetite loss (p = 0.048) and financial difficulties (p = 0.036).

From baseline to 12 months, the LP group showed a decrease in fatigue (p = 0.065) and an increase in number of 10 Rules for Highly Effective Health Behavior adhered to by patients. Patient subjective cancer-induced stress in response to specific traumatic events, scored between UC and LP groups, were marginally significant from baseline to 12 months (p = 0.068).
 

Participants’ primary behaviors of physical activity and dietary habits did not change due to this program. Participants’ management of their anxiety, social functioning, and symptoms did somewhat improve. 

• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Dropout rate of 42 before baseline with an additional 55 by the end of the study. At 12 months, the final number of participants was 151, down from 248 at randomization.

Long-term cancer survivors partnering with healthcare professionals may be helpful in reducing distress and anxiety in cancer survivors who recently completed cancer treatment. Increased education and training is needed for the long-term cancer survivors to coach.