Whilst lifestyle interventions are important components of survivorship care, less is known about effectiveness in older people with cancer, and data varies according to intervention type. The aim of this umbrella review is to examine and synthesise the evidence supporting lifestyle interventions targeting physical activity(PA), diet, alcohol and smoking in older survivors.
We systematically searched six databases for systematic reviews investigating effectiveness of lifestyle interventions in survivors aged 65+. Outcomes included mortality, disease-progression, physical fitness/function, quality-of-life, hospital readmission and length of stay, anxiety/depression and fatigue. Two researchers performed independent screening, data extraction and quality appraisal.
After duplicate removal and title and abstract screening, 194 of 5,072 full-text articles were screened. Eleven systematic reviews met eligibility criteria, summarising 104 intervention studies involving 7,617 people with cancer, with large majority having prostate cancer (78%). Six studies were of high methodological quality, five were medium. Evidence varied across different intervention types, with majority summarising PA interventions (n=10), three diet and PA combined, two diet, and no smoking or alcohol; and outcome measures were limited in dietary reviews (i.e. only hospital length-of-stay(LoS)/readmission/complications and disease progression/mortality) All reviews reported at least one favourable outcome. Multiple PA reviews reported favourable impacts on physical fitness/function, quality-of-life (QoL), fatigue and (LoS)/readmission/complications, whilst two reviews reported associations between interventions targeting both diet and PA and physical fitness/function. All reviews investigating disease progression or mortality outcomes reported no association.
Whilst clinicians should feel confident to encourage PA in older survivors, further research is needed to understand the potential for diet, smoking and alcohol cessation interventions, and studies involving patients with non-prostate cancers are needed.