Table 1:
Studies included in narrative review of web-based lifestyle interventions for cancer survivors.
| First author, year [ref] Country | Baseline Sample Characteristics | Delivery Format | Intervention Description | Behavior(s) Targeted | Intervention Duration/ Follow-up | Theoretical Framework | Measure(s) | Major Findings |
|---|---|---|---|---|---|---|---|---|
| Rabin, 2011 [25] USA | Sedentary young adult cancer survivors N=18/mean age=32 years/56 % female/94 % White |
Website | 2-arm RCT Access to a physical activity website for cancer survivors, Step in Motion. Set PA goals and log Control was given info about three cancer survivor websites that did not provide info about PA. | PA | 12 weeks | Transtheoretical Model Social Cognitive Theory | PA: PAR | Increased PA Baseline: 58.75 mins/week (44.54) vs. 39.00 (35.65), p=0.078 Follow-up: 161.25 (221.79) vs. 55.50 (77.48), p=0.48 Attrition Intervention: 5.6% at follow-up Control: 0% at follow-up |
| Hatchett,2013 [21] USA | Sedentary breast cancer survivors N=85/mean age= not reported/ aged 18+/100 % female/95 % White |
2-arm RCT Eight e-mails over 12 weeks Control group offered intervention after end of the trial |
PA | 12 weeks with measurements at 6 and 12 weeks | Social Cognitive Theory | PA: PAR | Increased PA Baseline: 0 days vs. 0 days Follow-up: 3.47 days (2.19) vs. 1.42 days (1.67), p<0.001 Attrition Overall: 12.9% at follow-up Intervention: 11.6% at follow-up Control: 14.3% at follow-up |
|
| Valle, 2013 [20] USA | Young adult cancer survivors N=86/mean age=32 years/91 % female/91 % White |
Website and Facebook | 2-arm RCT: FITNET or SC (self-help comparison) FITNET: Facebook group and study website access. Provides tools for goal setting, PA feedback, reminders to log PA SC: Assigned different Facebook group that provides information and weekly private messages with basic PA information. |
PA | 12 weeks | Social Cognitive Theory | PA: GLTEQ | Increased PA Fit NET: 187.6 mins/week (171.1) vs. 397.7 (778.4), p=0.009 Control: 199.3 mins/week (151.5) vs. 265.9 (228.1),p= 0.045 Attrition Overall: 18.6% at follow-up FITNET: 22.2% at follow up SC: 14.6% at follow-up |
| Bantum, 2014 [34] USA | Breast, colorectal, endometrium/uterine/ ovarian, non-Hodgkin’s lymphoma, lung, thyroid, and oral cancer survivors N= 352/ mean age = 51 years/ 82.1% female/ 87.2% White |
Website | Two-arm delayed-treatment RCT Online workshop (website) to encourage healthy lifestyle behaviors |
PA Diet Depression Fatigue |
6 weeks with 6-month follow-up | N/A | PA: GLTEQ Diet: Block Food Frequency Questionnaire |
Increased PA Intervention: 106 mins/week vs. 137 Control: 86.0 mins/week vs. 96.2 No change in diet Attrition Overall: 13.9% at 6-month follow-up Intervention: 16.5% at 6-month follow-up Control: 11.4% at 6 month follow-up |
| Berg, 2014 [31] USA | Young adults’ survivors of childhood cancer N= 24/mean age=23/ 71 % female/ 83% White |
Website and email | One-arm, pre/post-test design Website & 12 modules delivered via email bi-weekly Tailored feedback | PA Reducing alcohol/ cigarette use |
6 weeks | Theory of Reasoned Action | study questionnaire | No significant health behavior changes Attrition 4.2% at week 6; 20.8% at follow up |
| Frensham, 2018 [23] Australia | Sedentary adult cancer survivors N=91 mean age=66 years/52% female/ 96% White |
Website | 2-arm quasi-RCT 2 groups: Intervention and wait-list control Intervention: STRIDE website and weekly step goals. Website provides info on healthy lifestyles for cancer survivors |
PA Secondary: Weight management |
12 weeks with 3-month follow-up | Social Cognitive Theory | PA: New-Lifestyles Pedometer |
Increased PA after intervention (week 12) with no changes after follow-up Baseline-STRIDE vs control: 7055 steps/day (2633) vs 6667 steps/day (2993); p=.56 Week 12:STRIDE vs control: 9274 steps/day (3579) vs 7499 steps/day (3320) p= .04 Follow-up: STRIDE vs control: 8437 steps/day (3487) vs 7333 steps/day (4044) p=.55 Attrition Overall: 18.6% at 12 weeks; 18.6% at 3 month follow up Intervention: 23.5% at 12 weeks; 23.5% at 3 months Control: 13.7% at 12 weeks; 13.7% at 3 months |
| Lee, 2014 [28] South Korea | Breast cancer survivors N=59/ mean age = 42 years/ 100% female |
Website | Two-arm RCT: WSEDI vs control WSEDI: website containing tailored information on goal progress, action planning, goal setting and automatic feedback Control: 50-page educational booklet on diet and exercise |
PA Diet |
12 weeks | Transtheoretical Model | PA: 7-day diaries, study generated Diet: 3-day diet recall, diet quality index (DQI) |
Increased PA Baseline--WSEDI vs control: 10 (33.3) vs. 10 (34.5) Follow-up--WSEDI vs control: 19 (65.5) vs. 10 (35.7), p<0.0001 Increased vegetable & fruit intake Improved diet quality Attrition Overall: 3.4% at follow-up WSEDI: 3.4% at follow-up Control: 3.3% at follow-up |
| Forbes, 2015 [22] Canada | Breast, colorectal, and prostate cancer survivors N=95/mean age=65.1 years/56 % female/99 % White |
Website (online workshop) and emails | 2-arm RCT UCAN: 9 module behavior change program using the UWALK website to track their PA and weekly emails Control group received usual care (no intervention). | PA | 9 weeks | Theory of Planned Behavior | PA: GLTEQ | Increased PA Baseline-UCAN vs. control: 231 (269) vs. 212 (216) Follow-up-UCAN vs. control: 294 (354) vs. 241 (197) Attrition Overall: 11.6% at 9 weeks follow-up UCAN: 14.6% at 9 weeks follow-up control: 8.5% at 9 weeks follow-up |
| Hong, 2015 [27] USA | Older cancer survivors N=30/ median age = 69/ 70% female/73% White |
Mobile application | One-arm, pre/post-test design iCanFit: Mobile-enabled web application with goal setting, activity tracking, tips, and social networking |
PA | 8 – 12 weeks | Theory of goal setting | PA: study questionnaire | Increased PA Not engaged in physical activity and have no plan: 3 participants (12%) vs 0, p=0.083 Not engaged in physical activity but plan to do so in 3 months: 5 participants (19%) vs 0, p=0.022 Engaged in physical activity occasionally, but not on a regular basis: 7 participants (27%) vs 5, p=0.77 Engaged in regular physical activity, but started less than 3 months: 0 participants vs 5 (19%), p=0.022 Engaged in regular physical activity and has been doing so for 3 months: 11 participants (42%) vs 15 (58%), p=0.043 Attrition 13.3% at follow up |
| McCarroll, 2015 [39] USA | Endometrial and breast cancer survivors N=50 mean age= 58/ 100% female/ 88% White |
Website and mobile application | One-arm, pre/post-test design LoseIt! App: Commercially available food log, exercise log, daily body weight |
Secondary: PA Diet Weight mgmt. | 4 weeks | Social Cognitive Theory | PA: LoseIt app Diet: LoseIt app |
PA increased initially, then decreased at 4 weeks-Week 1 and 2 to week 4 showed a trend towards a significance (p = 0.09) Baseline: 77.5185 (± 156.6) kcals expended and 22.7 (± 44.0) Week 1: 971.8 kcals (± 1105.4) and time 182.3 min (± 196.6), p = 0.001 Week 2: 973.0 kcals (± 953.7) and 200.2 min (± 216.1), p = 1.00 Week 3: 826.2 kcals (± 958.6) and 181.2 min (± 244.0), p = 1.00 Week 4: 632.0 kcals (± 909.8) and 127.0 min (± 185.3), p = 1.00 Weight loss 105.0 ± 21.8 kg versus 98.6 ± 22.5 kg, p = 0.000 BMI: 34.9 ± 8.7 kg/m2 versus 33.9 ± 8.4 kg/m2, p = 0.000 waist circumference: 108.1 ± 14.9 cm versus 103.7 ± 15.1 cm, p = 0.0006 No change in diet Attrition 30% at follow-up |
| Kanera, 2016 [35] Netherlands | Breast cancer survivors and others N=462/mean age= 55.9 years/ 79.9% female |
Online workshop (website) | Two-arm RCT---KNW intervention and usual care KNW: self-management program |
PA Diet Smoking |
12 months | Theory of Planned Behavior Self-regulation theory I-Change Model | PA: SQUASH Diet: Adapted Dutch Standard Questionnaire on Food Consumption |
Increased moderate PA---significant differences between arms: B = 117.738, p = .037, p fdr = .148, d = –0.25, f2 = .007 Short-term increase in vegetable intake Complete cases: B = 9.15, p = .027, p fdr = .148, d = −0.37, f2 = −.013; Intention-to-treat: B = 9.57, p = .023, p fdr = .160 Attrition Overall: 11.5% at 6 months : 17.5% at 12 months follow-up KNW: 18.6% at 6 months; 27% at 12 months Control: 4.3% at 6 months; 8.2% at 12 months |
| Kuijpers 2016 [33] Netherlands | Breast cancer survivors N=92/mean age = 49.5/ 100% female |
Website | One-arm, pre/post-test design MijnAVL: website with access to medical records, personalized healthy lifestyle materials, PA feedback and support |
PA | 16 weeks | Social Cognitive Theory | PA: IPAQ | No significant change in PA Baseline: 2793 (MET-min/ week) Follow-up: 3724.2 (MET-min/ week) Attrition 0% at follow-up |
| Lynch, 2016 [30] USA | Overweight testicular and breast cancer survivors N=46/mean age=39/65% female/98% White |
Website and email | One-arm, pre/post-test design Intervention: Commercially available website (Lean Eating)3 daily components: exercise, nutritional/behavioral modification, health lessons. Daily email reminders to log, coach assistant |
Weight management Secondary: PA Diet | 12 months with measurements at 0, 6, and 12 months | Social Cognitive Theory | Study generated questionnaire | No change in PA Body fat %: Baseline: 26.6% (4.7) 6 months: 24.4% (5.3), p=0.0004 12 months: 22.2% (4.9), p=0.002 Attrition 41% at 6 months; 51% at month 12 |
| Puszkiewicz, 2016 [32] United Kingdom | Breast, prostate, and colorectal cancer survivors N=11/mean age = 45/ 82% female/ 82% White British |
Mobile application | One-arm, pre/post-test design GAINFitness: Commercially available PA mobile application; goal setting, PA plans |
PA Secondary: Weight mgmt. |
6 weeks | N/A | PA: GLTEQ | Increased PA significant increase in strenuous PA between baseline (median=40, IQR=105) and follow-up (median=120, IQR=150), (z=−2.80, P=.002) Mild PA: baseline (median=150, IQR=90) and follow-up (median=80, IQR=120), (z=−2.21, P=.031 No change in BMI: 23.9 (5.2) vs 23.4 (5.0), p=0.828 Attrition 0% at follow-up |
| Golsteijn, 2018 [36] Netherlands | Colorectal or prostate cancer survivors N= 510/ mean age = 66 years/ 13% female |
Website | 2-arm RCT: OncoActive vs usual care Computer-tailored PA intervention with interactive website and print materials Provides feedback, goal setting | PA | 16 weeks 2 month follow-up post intervention |
I-Change Model Social Cognitive Theory Transtheoretical Model Health Belief Model Precaution Adoption Process Model Goal setting theories Health action process approach Theories of self-regulation | PA: ActiGraph Accelerometer, SQUASH |
Increased PA Acti Graph Baseline-Onco Active vs usual care: 271 (211) vs. 293 (230), p=0.30 Follow-up—Onco Active vs usual care: 331 (234) vs. 301 (219), p-0.006 SQUASH Baseline—Onco Active vs usual care: 780 (721) vs. 873 (764), p=0.29 Follow-up—Onco Active vs usual care: 1145 (883) vs. 213 (943), p<0.001 Attrition Overall: 4.4% at 16 weeks; 7.3% at 2 month follow up; Intervention: 6.0% at 16 weeks 9.6% at 2 month follow-up post intervention Control: 2.6% at 16 weeks 4.8% at 2 month follow-up |
| Paxton, 2017 [26] USA | Breast cancer survivors N=71/mean age = 52 years/ 100% female/ 83% African American |
Website & Email | Two-arm RCT Parallel-group feasibility study ALIVE: Randomized to physical activity or diet email-based intervention |
PA Diet |
12 weeks | Social Cognitive Theory TTM Goal-setting theory Social marketing |
PA: study generated questionnaire Diet: study generated questionnaire |
Increased PA PA arm: +165 mins/week (68) vs Diet arm: +75 mins/week (62), p<0.001 Diet---saturated fat PA arm: −1.0 grams/day (1.3) vs Diet arm: −0.8 (1.2), p=0.46 Diet---vegetables and fruits PA arm: +0.6 cups/day (0.3)vs Diet arm: +1.0 (0.3), p=0.35 Attrition Overall: 38% at 3 months PA arm: 41.2% at 12 weeks Diet arm: 35.1% at 12 weeks |
| Short, 2017 [37] Australia | Breast cancer survivors N = 492/ mean age = 55 years / 100% female |
Website | 3-arm RCT Three-arms: (1) a computer-tailored three-module intervention delivered monthly; (2) a computer-tailored three-module intervention delivered weekly (over the first 3 weeks) or (3) a computer-tailored single module intervention | PA | 12 weeks | Social Cognitive Theory | PA: GLTEQ | Increased PA in each arm from baseline to follow-up: Arm 1: 90.08 mins/week (106.63) vs 216.99 (219.99), p < 0.05 Arm 2: 97.17 mins/week (124.10) vs 186.08 (157.89), p < 0.05 Arm 3: 96.15 mins/week (119.63) vs 186.05 (172.56), p < 0.05 Attrition Overall: 68 % at 12 weeks follow-up Arm 1: 71 % Arm 2: 73 % Arm 3: 61 % |
| Uhm, 2017 [38] South Korea | Breast cancer survivors N=356/mean age = 50.3/ 100% female |
Mobile application | Quasi two-arm RCT Smart After Care: Access to mobile PA application and pedometer Control: Treatment as usual-given PA brochure | PA QoL Secondary: BMI (weight management | 12 weeks | N/A | PA: IPAQ-SF | Increased PA (METs) Intervention---Baseline 2050.6 ± 2182.2 vs Follow-up 3026.9 ± 2489.5, p < 0.05 Control---Baseline 2091.5 ± 1811.2 vs Follow-up 2560.4 ± 2354.9, p < 0.05 No change in BMI: Intervention--Baseline 23.3 ± 3.1 vs Follow-up 23.3 ± 3.1 Control---Baseline 23.3 ± 3.3 vs Follow-up 23.3. ± 3.4 Attrition Overall: 3.9% at 6-weeks 4.8% at 12-weeks Intervention: 5.6% at 6 weeks 6.7% at 12 weeks Control: 2.3% at 6 weeks 2.8% at 12 weeks |
| Trinh, 2018 [24] Canada | Prostate cancer survivors N=46/mean age=73.2 years/100% male/ 80.4% White |
Mobile application | One-arm, pre-/post-test design Feasibility study Rise Tx: Access to application aimed at increasing PA |
Secondary: PA | 12 weeks 3-month follow-up | N/A | PA: Acti Graph Accelerometer | Increased PA significantly from baseline to 12 weeks post Baseline: 93.1 mins/week (14.5) 12 weeks: 137.1 mins/week (22.8), p = .010 3-months post-intervention: 122.1 (23.9) mins/week, p = .18 Attrition 4.7% at follow-up |
Abbreviations: BMI: Body Mass Index; GLTEQ: Godin Leisure-Time Exercise Questionnaire; IPAQ: International Physical Activity Questionnaires; IPAQ-SF: International Physical Activity Questionnaires short form PA: Physical activity; METs: Metabolic equivalents; N/A: Not applicable; PAR: Seven-Day Physical Activity Recall; QoL: Quality of Life; RCT: Randomized control trial; SQUASH: Short Questionnaire to Assess Health-Enhancing
*
Weight was measured using a scale.