Pity the telephone. These days, most people would prefer to communicate by email, text, or social media rather than pick up the phone and talk. But don’t write it off as a 20th-century technology—a team of Australian researchers has found that a telephone support system can improve lifestyle choices among colorectal cancer survivors.1
Although health behaviors, especially physical activity, can have significant effects on physical functioning, quality of life, and fatigue among cancer survivors, many patients with colorectal cancer fall short of recommended goals—60% are overweight and 62% don’t get enough physical activity. The Australian team, led by Anna Hawkes, PhD, set out to determine whether a telephone-delivered program called CanChange could have positive effects on behaviors and health.
The CanChange program is drawn from core components of Acceptance and Commitment Therapy (ACT), a cognitive behavioral approach that uses acceptance and mindfulness to support behavior change. The ACT strategies were used to enhance positive lifestyle behaviors focused on physical activity, diet, and smoking.
The researchers recruited 1,410 colorectal cancer survivors within 12 months of diagnosis and randomly assigned them to usual care or the CanChange intervention. The usual care group received four patient education brochures and a quarterly newsletter containing health information and recommendations. The CanChange group received 11 telephone-based health counseling sessions over a 6-month period, including instruction on self-management techniques, a handbook, regular motivational postcards, a pedometer, and the same quarterly newsletter that the usual care group received.
Adherence to the CanChange program was good—72% of participants received all 11 telephone sessions and 77% received at least eight sessions. The call duration ranged from 13 minutes to 1 hour.
Compared with the usual care group, the CanChange program provided modest but important improvements in participants’ health behaviors.
“We found a significant and positive difference in the physical activity of people who participated in the CanChange program,” Dr. Hawkes said. After 12 months, mean time spent in moderate physical activity had increased from 37 to 59 minutes per week in CanChange subjects but decreased from 42 to 35 minutes per week in usual care recipients. Vigorous physical activity—low in both groups at baseline—showed little change in either group.
“CanChange participants also maintained their body mass index [BMI], whereas those who didn’t take part in the trial significantly increased their BMI. Participants also reduced their fat intake and increased their vegetable intake,” Dr. Hawkes said.
CanChange participants saw no improvement in health-related quality of life, cancer-related fatigue, alcohol intake, or smoking.
In their study report, the researchers wrote that the effect of the CanChange program may have been mitigated by targeting multiple health behaviors rather than focusing on a single behavior. Nonetheless, carcinogenesis is a multifactorial process and changing multiple health behaviors may be necessary to have an impact on cancer outcomes and public health.
However, the CanChange program showed that the telephone is still a useful method of reaching and counseling patients. “Telephone-delivered programs are acceptable to cancer survivors as they are convenient, flexible, and can be delivered across the country,” Dr. Hawkes said. “They are also relatively low cost.”
1. Hawkes AL, Chambers SK, Pakenham KI, et al. Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol. 2013;31:2313-2320.