Fatigue Reduction Diet in Breast

Cancer Survivors: A Pilot

Randomized Clinical Trial

Suzanna M. Zick, Justin Colacino, Maria Cornellier,

Katie Surnow, Tohfa Khabir, Zora Djuric

Department of Family Medicine UMHS, Department of

Nutritional Sciences and Environmental Health Sciences

UMSPH, University of Michigan, Ann Arbor

Disclosure Slide

Suzanna M. Zick, ND, MPH

Research Associate Professor

University of Michigan

Ann Arbor, Michigan

Dr. Zick indicates that she has nothing to

disclose:

Why is Fatigue Important?

Negative impact on all areas of function

More distressing and greater impact on the activities of daily living than any other conditions associated with cancer such as…

pain, poor sleep, and depression.

PDQ Cancer Information Summaries. Bethesda (MD): National Cancer Institute (US); 2014 Aug 28.

Why Diet?

Associated with a lower likelihood of having

persistent fatigue in breast cancer survivors

higher quality diets

diets high in fiber, lower in total fat

high in fruits and vegetables

high in omega-3 fatty acids relative to omega-6 fatty

acids

Zick SM, Sen A, Han-Markey TL, Harris RE. Oncol Nurs Forum. Jan 2013;40(1):E41-49.

Purpose Would a 3-month dietary intervention (Fatigue

Reduction Diet) compared to an attention

control (General Health Curriculum) would be:

Feasible

Decrease fatigue

Improve sleep quality

If changes in serum nutrients were associated

with changes in fatigue or sleep

Participants

Adult BC survivors, stage 0-III

BMI between 18.5 and 35 kg/m2,

Completed cancer treatments > one year ago

Fatigue (>4 on BFI)

Low fruit and vegetable intake (<5.5 serv./day)

No other causes of fatigue

Assessments

3-study visits

Screening

BFI, 7-day food record

Baseline and 3-month

BFI, PSQI, 7-day food record , blood

3-unannounced 24-hr dietary recalls

Interventions

Both arms:

Individualized counseling using the theoretical

framework of Bandura's social cognitive theory

8-counseling visits

Baseline and 3-month in-person

Weeks 1 to 4, 7, and 10 by 15-minute telephone call

Bandura A. Health Educ Behav. Apr 2004;31(2):143-164

Theoretical Basis

Bandura A. Health Educ Behav. Apr 2004;31(2):143-164

Personal

Factors

Environ-mental

Factors

Behavioral

Factors

Thoughts

and Actions

Beliefs and Cognitive

Competencies Stemming

from Social Influences

Behavior that

Determines

Environment

Attention Control: General

Health Curriculum Flu and cold

Hearing loss

Healthy skin and hair

Healthy eye site

Cell phone and cancer

risk

Drug disposal

Oral Health

Colorectal cancer

screening

Fatigue Reduction Diet

Isocaloric

60 kcal Fruit for

60 kcal of

carbohydrate rich

food (potato chips)

Used daily food

checklists

Results: Study Flow

Assessed for eligibility

50

Fatigue Reduction Diet

15

Completed 3 Months

14

General Health Curriculum

15

Completed 3 Months

15

Excluded

20

Results: Baseline Characteristics

No significant differences

between groups

93% White

Mean at baseline:

Fatigue 5.5

PSQI 7.2

BMI 28 kg/m2

Age 62 (47 - 81)

Diagnosed 7 years ago

At Diagnosis:

Postmenopausal (53%)

ER positive breast cancer

(80%)

60% either Stage 2 or 3

Treatments for BC:

Surgery (100%)

Chemotherapy (63%)

Results: Fatigue and Sleep

Measures

5.6

7.5

8.8

4.9

8.5

9.5

FATIGUE INVENTORY

PSQI PSQI>5

General Health Curriculum

Pre Post

5.4

6.8

8.3

3

3.9 3.9

BRIEF FATIGUE

INVENTORY

PSQI PSQI>5

Fatigue Reduction Diet

Pre Post

** *

*

Impact on Serum Fatty Acids

Impact on Serum Carotenoids

Correlations of Changes in Serum

Nutrients with Changes in Fatigue and

Sleep Quality

Fatigue Sleep Quality

Serum Fatty Acids

SFAb (%) -0.42 -0.11

MUFAb (%) -0.08 -0.23

N6 PUFAb (%) 0.43 0.18

N3 PUFAb (%) -0.22 0.32

N3/N6b Fatty acid ratio -0.45a 0.25

DHAb (%) -0.22 0.46

EPAb (%) -0.49a 0.36

Serum Carotenoids

Total carotenoids -0.06 0.12

Results: Adherence

Daily Check Lists

Fruits 82%

Vegetables 85%

Omega-3 rich 76%

Whole Grains 66%

Average in-person

Counseling

Baseline 18 minutes

Final 13 minutes

Average Phone

Counseling

14 minutes

Limitations and Strengths

Small sample size

Mainly white educated sample

No measures of mechanisms

Longitudinal design

Serum measures of compliance

High retention rate

Attention control group

Conclusions

Food exchange method:

increases consumption of vegetables, whole grains,

fruits, fish, nuts/seeds

Increase serum fatty acids and carotenoids

Diet quality independent of weight loss matters

Diet changes were brought about using short

telephone counseling

Zick SM, Colacino J, Cornellier M, Khabir T, Surnow K, Djuric Z.

Breast Cancer Res Treat. 2017 Jan;161(2):299-310. Breast Cancer

Res Treat. 2017 Jan;161(2):299-310

Future Directions

Explore the possible mechanisms

Larger clinical trial

Delivering intervention via Facebook

Resources

Overview of the FRD (PDF)

FRD Checklist (PDF)

FRD Price Comparison Booklet

Tips for Eating Out or Away from Home

Example Recipes