The role of technology in supporting improved nutrition and physical activity in people with cancer

May 27, 2019

This blog is by Dr Nicole Kiss, Clinical Research Fellow, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University. Nicole was asked to discuss her recent publication on technology-supported interventions for adults with cancer, which was published in JMIR Mhealth recently.

A recent review found that self-guided interventions using technology improved physical activity and fatigue over short term periods of six months. There was also some benefit to diet quality and quality of life in the short term but mixed findings for body weight, muscle mass and cardiometabolic health.

Currently more than 32 million people worldwide are living with a cancer diagnosis. In 2020 it is anticipated that over 17 million people will be diagnosed with cancer, while the number of people having survived a cancer diagnosis is expected to surpass 20 million by the year 2026 in the United States alone. New treatment options over the past 10 years, such as immunotherapy, have improved survival rates across most cancers with cancer now considered a chronic disease. This has resulted in a high demand within our health system for treatment and quality cancer care both during treatment and in the longer term following cancer treatment.

Nutrition and physical activity are important elements of cancer care. We know that malnutrition can affect as many as 40% of people with cancer and can have a significant impact on quality of life, ability to cope with treatment and survival. On the other hand, following completion of cancer treatment a high quality diet and achieving adequate physical activity are important lifestyle factors to reduced obesity which is associated with poorer survival. Among cancer survivors less than 1 in 5 meet national dietary recommendations and less than half meet physical activity recommendations. Personalised nutrition and physical activity advice from health professionals such as dietitians, physiotherapists and exercise physiologists can improve quality of life, muscle strength, cardiometabolic health, physical function and wellbeing. However, the high demand for health care can make accessing this personalised care unachievable for many people with cancer.

There is a growing interest in the use of technology to deliver health care through platforms such as the internet, smart phones and wearable devices. Studies in the general population have shown the ability of technology supported health care to improve diet quality and physical activity levels. The problem is that health care provided through these platforms may still need a substantial amount of health professional time to facilitate how this care is provided. There is considerable potential to harness technology to self-guide people through interventions to improve their nutrition and physical activity but we are currently unaware if there is enough evidence to support the effectiveness of this type of health care.

Therefore, to help understand this we undertook a review of studies that had used a technology platform to provide a nutrition and/or physical activity intervention using minimal facilitation by a health professional to determine the impact on health outcomes. The review included sixteen studies, conducted across the United States, Europe and Asia, with a total of 2,684 participants were included in the review. Many of the studies did not follow participants longer than six months so the longer term benefit is uncertain.

One of the issues the review revealed was that most studies did not specifically target people whose diet and physical activity behaviours were poor, meaning these were not criteria for participating in the study. In fact some studies reported their participant had better than average diet quality and physical activity levels when they entered the study which limits the ability of the researchers to demonstrate improvements from their intervention. Future research needs to reach people who require support but in the current health system are unable to access the care they need.

The full version of this review is available as: Kiss N, Baguley BJ, Ball K, Daly RM, Fraser SF, Granger CL, Ugalde A Technology-Supported Self-Guided Nutrition and Physical Activity Interventions for Adults With Cancer: Systematic Review JMIR Mhealth Uhealth 2019;7(2):e12281

To read the full manuscript click here.