Feasibility and Acceptability of a Web-Based Dietary Intervention with Text Messages for Colorectal Cancer: A Randomized Pilot Trial

Abstract

Background: Diet is associated with colorectal cancer survival. Yet, adherence to nutrition guidelines is low among colorectal cancer survivors.

Methods: We conducted a pilot trial among colorectal cancer survivors to evaluate a 12-week remote dietary intervention. Participants received print materials and were randomized (1:1) to intervention (website, text messages) or wait-list control. Primary outcomes included feasibility and acceptability. We also explored change in diet from 0 to 12 and 24 weeks and change from 0 to 12 weeks in anthropometry and circulating biomarkers (Trial Registration: NCT02965521).

Results: We randomized 50 colorectal cancer survivors (25 intervention, 25 control). Retention was 90% at 12 weeks and 84% at 24 weeks. Participants had a median age of 55 years and were 66% female, 70% non-Hispanic white, and 96% had a college degree. The intervention arm responded to a median 15 (71%) of 21 text messages that asked for a reply [interquartile range (IQR) = 8, 19] and visited the website a median of 13 (15%) days (IQR = 1, 33) of the 84 study days.

Conclusions: We developed a Web-based dietary intervention for colorectal cancer survivors. Our pilot results suggest that colorectal cancer survivors may engage more with text messages than a study website. Research to improve tailoring of text messages, while maintaining scalability, is needed.

Impact: Remote dietary interventions using text messages may be feasible for colorectal cancer survivors.See all articles in this CEBP Focus section, "Modernizing Population Science."

Figure 1.. CONSORT Flow Diagram.

Figure 1 shows the flow of participants from screening to end of study. Follow-up at 12 and 24 weeks was defined by completion of the 4-day diet record.

Figure 2.. Text message response rate and study website use during the 12-week intervention among the 25 people with colorectal cancer randomized to the intervention arm.

Figure 2 shows the percent of intervention arm (n=25) who responded to each text message that asked for a reply (A); visited the study website by study day (B); and had recorded food group intake on the study website, by study day (C). Participants could track intake of food groups for multiple days at one visit.

Figure 2.. Text message response rate and study website use during the 12-week intervention among the 25 people with colorectal cancer randomized to the intervention arm.

Figure 2 shows the percent of intervention arm (n=25) who responded to each text message that asked for a reply (A); visited the study website by study day (B); and had recorded food group intake on the study website, by study day (C). Participants could track intake of food groups for multiple days at one visit.

Figure 2.. Text message response rate and study website use during the 12-week intervention among the 25 people with colorectal cancer randomized to the intervention arm.

Figure 2 shows the percent of intervention arm (n=25) who responded to each text message that asked for a reply (A); visited the study website by study day (B); and had recorded food group intake on the study website, by study day (C). Participants could track intake of food groups for multiple days at one visit.

Figure 3.. Adherence to the target dietary recommendations among 50 people with colorectal cancer, by study arm and time point.

Figure 3 shows the percentage of participants who met the target intake of each of the six food groups at enrollment, 12, and 24 weeks. Light gray bars are for the intervention group and dark gray bars are for the control group. Slashed bars indicate post-intervention time points (12 and 24 weeks for the intervention arm and 24 weeks for the wait-list control arm).