JMIR Publications

ABSTRACT

Background:

Diet and exercise may be associated with quality of life and survival in men with prostate cancer. Remotely delivered web-based behavioral interventions may be a scalable approach to support behavior change.

Objective:

To determine the feasibility and acceptability of a remotely delivered web-based behavioral intervention among men with prostate cancer.

Methods:

We conducted a multi-site, 4-arm pilot randomized controlled trial of a 3-month intervention among men with all stages of prostate cancer (TrueNTH Community of Wellness). Eligibility included self-reported prostate cancer diagnosis, having a personal device that connected to the Internet, being 18 years old, and the ability to read English and receive text messages and email. Men receiving chemotherapy or radiation, or who reported contraindications to exercise, could participate with physician clearance. Participants were randomized (1:1:1:1) to additive intervention levels: (1) website; (2) website plus personalized diet and exercise prescription; (3) website, personalized prescription, plus Fitbit and text messages; and (4) website, personalized prescription, Fitbit, text messages plus two 30-min calls, one with an exercise trainer and one with a registered dietician. Our primary outcomes were feasibility (accrual, attrition) and acceptability (survey data, website use); secondarily, we describe self-reported diet and exercise behavior at enrollment and 3 and 6 months.

Results:

Between August 2017 and September 2018, 202 men consented and were randomized (Level 1: 49, Level 2: 51, Level 3: 50, Level 4: 52). 160 men completed the on-boarding process and were exposed to their randomly assigned intervention (38, 38, 42, 42 in Levels 1-4, respectively). Follow-up was 83% at 3 months and 77% at 6 months. Participants had a median age of 70 years and were primarily white and college educated. Website visit frequency increased across levels (median: 2, 9, 11, 16, Levels 1-4, respectively, over 3 months). The majority were satisfied or very satisfied with the intervention (51%, 64%, 52%, 64%, Levels 1-4, respectively). Percentage reporting being very satisfied was highest in Level 4 participants (24% vs. 10%, 12%, 11% for Levels 1-3, respectively), whereas frequency of dissatisfaction was highest among Level 1 participants (13% vs. 2%, 7%, and 4% for Levels 2-4, respectively). We observed small improvements in diet at 3 months, particularly among men in Level 4 compared to Level 1.

Conclusions:

This pilot demonstrated the feasibility of a web-based, remotely delivered, tailored behavioral intervention for men with prostate cancer. Future study is warranted to evaluate how to increase the effect of the intervention on behaviors while maintaining sustainability and scalability, and design and implement such tools in more diverse populations. Clinical Trial: clinicaltrials.gov NCT03406013