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. 2025 Feb;19(1):253-269.
doi: 10.1007/s11764-023-01464-4. Epub 2023 Sep 28.

Characterization and efficacy of lifestyle behavior change interventions among adult rural cancer survivors: a systematic review

Samantha J Werts  1   2 , Rogelio Robles-Morales  3   4 , Jennifer W Bea  5   3 , Cynthia A Thomson  5   3
Affiliations

Characterization and efficacy of lifestyle behavior change interventions among adult rural cancer survivors: a systematic review

Samantha J Werts et al. J Cancer Surviv. 2025 Feb.

Abstract

Purpose: Little is known about the intersection between age and rurality as characteristics that impact lifestyle behavior change for cancer survivors. This review aims to summarize the current literature on lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors.

Methods: A systematic search of five databases identified randomized controlled trials and controlled clinical trials that targeted diet, physical activity, alcohol consumption, or tobacco use change in adult cancer survivors living in rural areas of the world.

Results: Eight studies met the inclusion criteria. Most studies were conducted in either Australia or the USA, included survivors at least 6 weeks post-treatment, and half included only breast cancer survivors, while the other four included a mix of cancer types. All but one had a physical activity component. No articles addressed changes in alcohol or tobacco behavior. Seven (87.5%) had a fully remote or hybrid delivery model. Most of the physical activity interventions showed significant changes in physical activity outcomes, while the dietary interventions showed changes of clinical but not statistical significance.

Conclusions: Few studies have been conducted to implement and evaluate the effectiveness of lifestyle behavior change interventions among older rural survivors of cancer. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with this population.

Implications for cancer survivors: Effective diet and physical activity interventions exist, albeit limited in terms of effective lifestyle behavior change intervention tailored to older, rural survivors of cancer, particularly in relation to alcohol and tobacco behaviors.

Keywords: Cancer; Lifestyle; Older adults; Rural population; Survivorship.

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Conflict of interest statement

Declarations. Competing interests: The authors have no relevant financial or non-financial interests to disclose. Conflict of interest: None

Figures

Fig. 1
Fig. 1
PRISMA flow diagram. Modified from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71
Fig. 2
Fig. 2
Risk of bias summary diagram
See this image and copyright information in PMC

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