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CANCER PREVENTION Seizing a Teachable Moment to Decrease Patients' Colorectal Cancer RiskHuman nature being what it is, it is not surprising that healthy people are not likely to change their bad health habits even when faced with compelling scientific evidence. But a brush with a life-threatening illness could provide the motivation for making lasting lifestyle changes. Next month, Project Prevent will begin testing this hypothesis in an innovative, collaborative study designed by HMS and HSPH researchers at the DanaFarber Cancer Institute and Harvard Pilgrim Health Care/Harvard Vanguard, with colleagues at the Duke Comprehensive Cancer Center.The study will randomize people who have recently been diagnosed with colon polyps--treatable precancerous lesions that increase the risk for developing colorectal cancer--to receive either usual care or tailored advice and self-help materials based on their risk factors. "Most trials tell people about all behaviors they should change, regardless of whether they have that risk factor to begin with," says Karen Emmons, principal investigator of Project Prevent and associate professor of health and social behavior at HSPH and the DanaFarber Cancer Institute. In addition, this study is innovative because it aims to maximize change across all of a patient's risk factors, rather than focusing on one at a time.
"If we are really to reduce colon cancer morbidity, it is important that these at-risk patients reduce their risk as much as possible, as quickly as possible," Emmons says. Her collaborators at Harvard Pilgrim/Harvard Vanguard include Frank Farraye, assistant professor of clinical medicine, and Robert Fletcher, professor of ambulatory care and prevention. About 13,000 patients will participate in Project Prevent, which will also evaluate the cost-effectiveness of such comprehensive, multiple risk factor interventions. Colorectal cancer is diagnosed in approximately 150,000 adults in the U.S. each year and is the second leading cause of cancer death after lung cancer. In the past five years, incidence rates have decreased only slightly among whites and have increased dramatically among African Americans. Risk factors for colorectal cancer include adenomatous polyps, physical inactivity, smoking, alcohol consumption, not taking multivitamins, and eating diets low in fruit and vegetables and high in red meat. Because people who develop colon polyps have a particularly high risk of developing colorectal cancer, it is especially important for them to reduce other risk factors. The U.S. Preventive Services Task Force recommends that people age 50 and older seek colorectal cancer screening, creating an opportunity to link behavior-change interventions to a "teachable moment" in a sizable at-risk group. In a pilot study of 204 people with colon polyps, the investigators found that participants had high levels of interest in making changes in their behavioral risk factors. Project Prevent participants who are randomized to the tailored intervention group will first receive standard written messages from their health care provider highlighting the importance of behavioral changes to reduce their risk of colorectal cancer, as well as other cancers and chronic illnesses. Then they will meet with a health educator to set personal goals for reducing risk behaviors. In addition, they will receive self-help materials addressing patient-specific barriers to change and tailored materials designed to help change target behaviors. Finally, they will receive up to five follow-up telephone counseling sessions over three months. Emmons and her colleagues hope these interventions will encourage patients to improve their health behaviors and ultimately reduce their risk for additional colon polyps and colorectal cancer. --Peta Gillyatt |
