Harleen Kaur

Background/Objectives: Fasting has been proposed as a non-pharmacologic method of reducing chemotherapy toxicity. However, its effects across outcome domains have not been well-quantified. Methods: In line with PRISMA 2020 guidelines (PROSPERO: CRD420261296778), we searched PubMed, Embase, Web of Science, and CENTRAL from January 2015 through April 2026 for randomized or prospective comparative trials evaluating fasting during chemotherapy. Risk of bias was assessed using RoB 2 and criteria aligned with ROBINS-I. Standardized mean differences (Hedges’ g) and risk ratios (RRs) were pooled using three-level random-effects models. Results: Seven publications reporting six trials (268 participants) were included. The pooled estimate did not reach statistical significance (g = 0.21, 95% CI: −0.02–0.43, p = 0.064). Hematologic parameters (g = 0.11, 95% CI: −0.23–0.45) and quality of life (QoL) and patient-reported outcomes from one trial (g = 0.32, 95% CI: −0.03–0.66) did not differ significantly between groups. Adverse events also did not differ significantly (RR = 0.86, 95% CI: 0.55–1.36). Conclusions: Across six small trials, fasting during chemotherapy did not significantly affect hematologic parameters, QoL, or adverse events. However, it is worth nothing that point estimates generally favored fasting. Hence, a small benefit can neither be confirmed nor ruled out at this time. Adequately powered trials assessing patient-important outcomes and incorporating nutritional monitoring are needed before fasting can be recommended or ruled out.

Background: Web-based lifestyle interventions to promote healthy diet and physical activity among cancer survivors and their partners are recent developments; therefore, few studies have reported patterns of website use or associations with behavior change. Objective: The primary aim was to describe website use in the DUET (Daughters, Dudes, Mothers, and Others Together) trial and examine the associations between website use and changes in diet quality, moderate to vigorous physical activity (MVPA), and body weight. Methods: This secondary analysis used data from 28 survivor-partner dyads (BMI ≥25 kg/m2) randomized to the 6-month DUET web-based weight loss intervention, which released weekly e-learning sessions on diet and exercise. Website use was quantified as weeks of access, time spent, and frequency of page views. Diet quality was assessed using 2-day dietary recalls; MVPA was measured by the Godin Leisure-Time Exercise Questionnaire and accelerometry. Weight was measured on a scale. Website use was summarized descriptively, and associations were examined using Spearman partial correlations. Results: Participants had a mean age of 58 (SD 12.5) years; 78.6% (44/56) identified as female, 66.1% (37/56) were non-Hispanic White, and 86% (24/28) were breast cancer survivors. On average, participants viewed 11.2 (SD 7.4) weeks of the 24-week intervention, or a total of 312.9 (SD 255.7) minutes per participant. Sessions (n=2736), Home Page (n=975), and Tools (n=967) features showed the highest activity (5885 total page views). Website use was higher among adults aged 65 years and older than younger participants, showcased by duration of use (mean 14.4, SD 7.4 weeks vs mean 9.2, SD 6.8 weeks; P=.009), time spent per week (mean 17.0, SD 9.7 minutes vs mean 10.5, SD 10.6 minutes; P=.01), and total number of page views (mean 135.7, SD 90 vs mean 85.3, SD 111.9; P=.008); higher website use was also reported among women versus men in terms of duration of use (mean 12.8, SD 7.1 weeks vs mean 5.6, SD 5.9 weeks; P=.003), time spent per week (mean 14.6, SD 10.3 minutes vs mean 7.4, SD 10.3 minutes; P=.02), and total number of page views (mean 120, SD 110.2 vs mean 50.3, SD 64.4; P=.01). Diet quality was positively associated with website use (weeks: r=0.50; P<.001; time: r=0.45; P<.001; total page views: r=0.46; P<.001; and sessions page views: r=0.39; P=.005). Self-reported MVPA was also positively associated with website use (weeks r=0.37; P=.007; time: r=0.36; P=.009; total page views: r=0.36; P=.01; and sessions page views: r=0.35; P=.01). No significant associations were detected for accelerometry-measured MVPA or weight. Conclusions: Cancer survivors and their partners engaged with the DUET web-based platform to support diet and physical activity (with use particularly high among older adults and females). However, larger, more diverse dyadic web-based lifestyle interventions are needed to confirm these findings. Trial Registration: ClinicalTrials.gov NCT04132219; https://clinicaltrials.gov/study/NCT04132219

BACKGROUND Web-based lifestyle interventions to promote healthy diet and physical activity behaviors among cancer survivors and their partners are recent developments. Thus, few studies have reported patterns of website use, and whether it is associated with behavior change. OBJECTIVE The study’s primary aim was to describe website use in the DUET (Daughters, dUdes, mothers and othErs Together) trial and examine the associations between website use and changes in diet quality, moderate-to-vigorous physical activity (MVPA), and body weight. METHODS This secondary analysis utilized data from 28 survivor-partner dyads (with BMI ≥ 25) randomized to the 6-month DUET web-based weight loss intervention. The intervention released serialized e-learning sessions on diet and exercise each week. Website use was quantified as the number of weeks participants accessed the website, time spent on the website, and frequency of pageviews. Diet quality was assessed from 2-day dietary recalls, and MVPA from the Godin Leisure-Time Exercise Questionnaire and accelerometry. Weight was measured on a digital scale. Website use was summarized descriptively; associations were examined using Spearman partial correlations. RESULTS The study sample had a mean age of 58 (SD±12.5) years; 78.6% identified as female, 66.1% were non-Hispanic White, and 86% were breast cancer survivors. On average, participants viewed 11.2 weeks (SD±7.4) of the 24-week intervention, or a total of 312.9 (SD±255.7) minutes per participant. Sessions (2736), Home Page (975), and Tools (967) features showed the highest pageview activity (total of 5885 pageviews). Website use was significantly higher among adults aged 65 years or older compared to younger participants, showcased by duration of use (14.4 vs. 9.2 weeks), time spent per week (17.0 vs. 10.5 minutes), and total number of pageviews (135.7 vs. 85.3) (P <.05); higher website use was also reported among women versus men in terms of duration of use (12.8 vs. 5.6 weeks), time spent per week (14.6 vs. 7.4 minutes), and total number of pageviews (120 vs. 50.3) (P <.05). Diet quality was positively associated with website use: weeks (r = 0.50, P < .001), time (r = 0.45, P < .001), total pageviews (r = 0.46, P < .001), and sessions pageviews (r = 0.39, P =.005). Self-reported MVPA was also positively associated with website use: weeks (r = 0.37, P =.007), time (r = 0.36, P =.009), total pageviews (r = 0.36, P =.010), and sessions pageviews (r = 0.35, P =.01). However, no statistically significant associations were detected for accelerometry-measured MVPA or weight. CONCLUSIONS Findings suggest that cancer survivors and their partners engage with web-based lifestyle interventions that promote diet and physical activity behaviors (with use particularly high among older adults and females), and that website use was significantly associated with improvements in diet quality and self-reported MVPA. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04132219 INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.3390/nu13103472

PURPOSE: Financial barriers remain a critical issue for adolescent and young adults (AYAs, 18-39 years) with cancer, who face unique challenges because of their life stage and transitional care needs. Therefore, this study examined disparities in health care delays because of cost among AYA cancer survivors compared with older cancer survivors. METHODS: We used a nationally representative sample (taken from the National Health Interview Survey) contextualizing these trends within the evolving insurance landscape following the Affordable Care Act implementation. RESULTS: Despite an overall decline in delays across all age groups, AYAs consistently reported the highest rates of delays compared with middle-age (40-64 years) and older adult (65 years or older) survivors. Logistic regression analysis revealed that middle-age and older adults had lower odds of delays compared with AYAs (adjusted odds ratio [AOR], 0.53 [95% CI, 0.47 to 0.59], P < .0001; AOR, 0.15 [95% CI, 0.12 to 0.18], P < .0001), potentially because of their greater financial stability and insurance access, although cost-related barriers persisted for some. CONCLUSION: Our findings highlight persistent disparities in health care access because of cost among AYA cancer survivors compared with their older counterparts and emphasize the need for targeted interventions to reduce financial barriers to health care for AYAs.

Purpose: Parental or spousal cohabitating relationships are often targeted in behavioral interventions, but the contribution of cohabitation is poorly understood. This study explored whether cohabitation status moderated the impact of social cognitive theory constructs on adiposity, diet, and exercise in a dyadic, web-based weight loss intervention among cancer survivors and their chosen partners. Methods: The 24-week weight loss intervention was conducted among 56 dyads, comprised of a cancer survivor and their chosen partner (n = 112). Baseline and 6-month data on social cognitive theory constructs (self-efficacy, social support, and perceived barriers), and study outcomes of adiposity (weight and waist circumference), diet (calories and diet quality), and moderate-to-vigorous physical activity (MVPA) were used to perform moderated-mediation analyses among cohabitating (n = 25) versus non-cohabitating (n = 31) dyads. Results: The intervention was positively associated with dietary social support (path a₁: 0.36, 95% CI [0.083, 0.659]) and inversely associated with perceived dietary barriers (path a₁: − 10.57, 95% CI [− 19.109, − 3.091]) and perceived exercise barriers (path a₁: − 11.29, 95% CI [− 22.098, − 3.500]) among those who did not cohabitate (effects not observed among cohabitating pairs). The intervention’s mediating effects through perceived barriers on weight (indirect effect (ab): − 2.21, 95% CI [− 4.794, − 0.548]), waist circumference (ab: − 1.13, 95% CI [− 2.452, − 0.171]), caloric intake (ab: − 5.09 (2.86), 95% CI [− 12.602, − 0.709]), and self-reported MVPA (ab: 0.29 (0.18), 95% CI [0.019, 0.754]) also were stronger among non-cohabitating pairs. Conclusions: These findings suggest that social support partners outside the home substantially enhance intervention impact, though relationship quality and gender dynamics warrant further exploration. Trial registration: ClinicalTrials.gov Identifier: NCT04132219.

Mechanisms that explain behavior change within web-based lifestyle interventions are not well-studied. This secondary analysis explores whether the effects of the DUET web-based lifestyle intervention on diet, physical activity, and/or adiposity are mediated through changes in self-efficacy, social support, and perceived barriers (key constructs of social cognitive theory). Data on mediators, diet quality, caloric intake, moderate-to-vigorous physical activity (MVPA), weight, and waist circumference (WC) were analyzed from 112 cancer survivors and their partners enrolled in the DUET intervention. Mediation analyses were performed using Mplus to execute regression analyses and determine associations. Mediation analyses supported an effect of the intervention on caloric intake (−3.52, 95% CI [−8.08 to −0.84]), weight (−1.60, CI [−3.84 to −0.47]), and WC (−0.83, CI [−1.77 to −0.18]), interpreting these negative associations as intervention induced reductions in dietary barriers. Higher social support was significantly and positively associated with, but not a mediator for, improvements in self-reported and accelerometry-measured MVPA (b = 0.69, CI [0.19, 1.24]) and (b = 0.55, CI [0.15, 1.00]), respectively. Self-efficacy did not appear to mediate the intervention’s effects. Findings suggest that the effects of the DUET intervention on diet and adiposity stem from reducing perceived barriers to a healthful, low-calorie diet.

(1) Background: A healthful diet, regular physical activity, and weight management are cornerstones for cancer prevention and control. Yet, adherence is low in cancer survivors and others, calling for innovative solutions. Daughters, dUdes, mothers, and othErs fighting cancer Together (DUET) is a 6-month, online, diet-and-exercise, weight-loss intervention to improve health behaviors and outcomes among cancer survivor-partner dyads. (2) Methods: DUET was tested in 56 dyads (survivors of obesity-related cancers and chosen partners) (n = 112), both with overweight/obesity, sedentary behavior, and suboptimal diets. After baseline assessment, dyads were randomized to DUET intervention or waitlist control arms; data were collected at 3- and 6-months and analyzed using chi-square, t-tests, and mixed linear models (α < 0.05). (3) Results: Retention was 89% and 100% in waitlisted and intervention arms, respectively. Dyad weight loss (primary outcome) averaged −1.1 (waitlist) vs. −2.8 kg (intervention) (p = 0.044/time-by-arm interaction p = 0.033). Caloric intake decreased significantly in DUET survivors versus controls (p = 0.027). Evidence of benefit was observed for physical activity and function, blood glucose, and c-reactive protein. Dyadic terms were significant across outcomes, suggesting that the partner-based approach contributed to intervention-associated improvements. (4) Conclusions: DUET represents a pioneering effort in scalable, multi-behavior weight management interventions to promote cancer prevention and control, calling for studies that are larger in size, scope, and duration.

Most Americans take dietary supplements (DSs) and use is even higher among cancer survivors. This secondary analysis seeks to identify types, reasons, and costs of supplements used by 367 older cancer survivors enrolled in the Harvest for Health vegetable gardening trial and evaluate associations between supplement intake and medical/socio-demographic factors. Descriptive statistics were used to identify supplement type and reasons for use. Average market price was used to estimate cost. Fifty-nine percent of the sample reported supplement use. Female (OR 2.11, 95% CI 1.35–3.30), non-Hispanic White (OR 1.77, 95% CI 1.05–3.0), and breast and gynecological survivors (OR 1.57, 1.03–2.38) were significantly more likely to report DS use compared to males, minorities, and survivors of other cancers. Use of vitamins (39%), multivitamins (23%), and minerals (12%) were the most prevalent. Commonly reported reasons for supplement use were to improve general health (47%) or treat medical conditions (39%) and cancer-related symptoms (12%). DSs daily costs ranged from USD 0.02 to 19.81, with a mean of USD 1.28 ± 1.74, a median of USD 0.78, and a mode of USD 0.34. DS use is prevalent among older cancer survivors, with overall health reported as the leading reason for use. Out-of-pocket recurrent costs can be substantial and underscore the need to promote a nutrient-rich diet whenever possible in this vulnerable population.