Diet and Physical Activity Change or Usual Care in Improving Progression-Free Survival in Patients With Previously Treated Stage II, III, or IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
Diet and Physical Activity Change or Usual Care in Improving Progression-Free Survival in Patients With Previously Treated Stage II, III, or IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
This randomized phase III trial studies whether changes in diet and physical activity can
 increase the length of survival without the return of cancer (progression-free survival)
 compared with usual care in patients with previously treated stage II, III, or IV ovarian,
 fallopian tube, or primary peritoneal cancer. A healthy diet and physical activity program
 and counseling may help patients make healthier lifestyle choices. It is not yet known
 whether changes in diet and exercise may help increase progression-free survival in patients
 with previously treated cancer.
PRIMARY OBJECTIVES:

 I. To determine if women who are disease-free after successfully completing primary and
 potential consolidation/maintenance, therapy for stage II-IV ovarian, fallopian tube or
 primary peritoneal cancer and who are randomized to a healthy lifestyle intervention, will
 have significantly increased progression-free survival compared to similar women who are
 randomized to a usual care comparison group.

 SECONDARY OBJECTIVES:

 I. To determine if women who are randomized to the study intervention will have improved
 general quality of life as measured by the General Health subscale of Research and
 Development (RAND) 36-Item Health Survey (RAND-36).

 II. To determine if women who are randomized to the study intervention will have improved
 physical and bowel functioning as measured by the Physical Functioning subscale of RAND-36
 and the Gastrointestinal Symptom Rating Scale (GSRS)-Irritable Bowel Syndrome (IBS), compared
 to women who are randomized to usual care.

 TERTIARY OBJECTIVES:

 I. To assess patient compliance with the healthy lifestyle intervention by analyzing
 biomarkers (e.g., total carotenoid) at baseline, 6, 12, and 24 months.

 II. To explore the relationship between carotenoid exposure and progression free survival
 from ovarian cancer.

 III. To examine patient compliance with the healthy lifestyle intervention and to assess
 which types of patients are more likely to be compliant with the healthy lifestyle
 intervention and whether progression-free survival is better among compliant individuals.

 IV. To explore the impact of the intervention on other aspects of quality of life such as
 pain, role limitations due to physical health and emotional problems, mental health,
 vitality, and social functioning as measured by the corresponding subscales of the RAND-36.

 V. To explore the impact of the intervention on bowel functioning as measured with the
 GSRS-IBS subscales.

 VI. To assess the association between subjectively measured sleep duration/quality (using the
 Pittsburgh Sleep Quality Scale), anthropometric measurements, and self-reported dietary
 energy intake among women previously treated for stage II-IV ovarian or primary peritoneal
 cancer.

 VII. To assess and compare telomere length and rate of telomere shortening between ovarian
 cancer survivors randomized to lifestyle intervention versus standard of care.

 VIII. To assess effects of the intervention on biomarkers of metabolic health as measured by
 changes in circulating insulin and related insulin resistance, lipids and inflammation.

 IX. To determine if the intervention effect on the biomarkers listed above is modified by
 baseline central adiposity.

 X. To determine if the intervention effect on biomarkers listed above is mediated by change
 in central adiposity.

 XI. To evaluate changes in central adiposity using computerized tomography (CT) scan data
 from regularly scheduled, routine surveillance CT scans to determine if change in CT-specific
 visceral adiposity is associated with changes in biomarkers of metabolic deregulation and
 inflammation in a random subsample.

 OUTLINE: Participants are randomized to 1 of 2 groups.

 GROUP 1 (LIFESTYLE INTERVENTION): Participants receive a dietary intervention designed to
 promote increased levels of plasma carotenoids, control weight, and to ensure adequacy of
 micronutrient intake. Participants also undergo a physical activity intervention comprising a
 moderately low aerobic regimen to raise the usual activity level. Participants also undergo
 face-to-face counseling, receive educational materials and counseling focused on how to read
 food labels to estimate grams of fat per serving and serving size, and undergo telephone
 counseling by a lifestyle intervention counselor twice a week for 4 weeks, then weekly for 2
 weeks, twice a month for 5 months, monthly for the subsequent 6 months, and then once every
 other month for 12 months. Participants complete daily fat gram and step diaries at least
 three times per week.

 GROUP 2 (COMPARISON LIFESTYLE): Participants receive a study notebook containing general
 study-related information. Participants are not asked to record diet or physical activity but
 are provided a single sample diary in their study notebook. Participants receive telephone
 contact on a sliding scale similar to the intervention group, but at less frequent intervals
 (22 versus 33 calls over the course of the intervention).

 After completion of study, participants are followed up every 3 months for 2 years, every 6
 months for 3 years, and then annually thereafter.
Inclusion Criteria:

 -  Patients with a histological diagnosis of epithelial ovarian cancer, fallopian tube or
 primary peritoneal carcinoma, clinical stage II, III or IV at diagnosis

 -  Patients with the following histologic epithelial cell types are eligible: serous
 adenocarcinoma, endometrioid adenocarcinoma, mucinous adenocarcinoma, undifferentiated
 carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, transitional cell
 carcinoma, malignant Brenner?s tumor or adenocarcinoma not otherwise specified
 (N.O.S.); however, the histologic features of the tumor must be compatible with a
 primary M?llerian epithelial adenocarcinoma

 -  Patients must have completed all primary chemotherapy and consolidation therapy (if
 administered) at least 6 weeks, and no more than 6 months and 2 weeks, prior to
 enrollment and must be in complete remission; consolidation therapy is defined as any
 chemotherapy or biological therapy used for a patient who has completed at least four
 courses of primary chemotherapy and had documented complete remission prior to
 initiation of such chemotherapy (chemo) or biological therapy

 -  Patients must have achieved a documented complete response to treatment based on
 normal cancer antigen (CA)-125 (per the institution?s upper limit of normal) and
 computed tomography (CT) scan or magnetic resonance imaging (MRI) with contrast (i.e.
 there must be no clinical evidence of persistent or recurrent disease based on CA-125
 and CT scan or MRI with contrast)

 -  Patients must have a Gynecologic Oncology Group (GOG) performance grade of 0, 1, or 2

 -  Patients must not be currently enrolled in an ongoing (participating for 6 months or
 longer) medically prescribed diet or physical activity regimen

 -  Patients must have no other chronic disease that would preclude randomization into a
 lifestyle intervention trial; such diseases include recent myocardial infarction or
 unstable angina (in the previous 6 months), chronic hepatitis, rheumatoid disease,
 renal or hepatic disease/dysfunction and diabetics receiving insulin; or other
 clinical condition limiting ability to walk (recent leg fracture, significant
 osteoarthritis, related orthopedic conditions, degenerative neurological conditions,
 etc.)

 -  Patients must not have a serious psychiatric illness (e.g. lifetime bipolar disorder,
 schizophrenia or other psychosis, serious personality disorder, severe major
 depressive disorder or recent suicide or psychiatric hospitalization) (previous 12
 months), or a history of an eating disorder (anorexia nervosa or bulimia nervosa)

 -  Patients must complete all pre-entry assessments

 -  Patients must have signed an approved informed consent and authorization permitting
 release of personal health information

 -  Patients must be willing to provide name and appropriate telephone contact information
 and be willing to be contacted periodically via telephone by The University of Arizona
 Cancer Center (AZCC) staff for completion of individualized lifestyle intervention
 coaching, completion of the Pittsburgh Sleep Quality Index, and for clarification of
 patient-completed responses if necessary; patient must be willing to have Arizona Food
 Frequency Questionnaire (AFFQ), Arizona Physical Activity Questionnaire (APAQ),
 baseline questionnaire, and personal contact information sent to AZCC

 Exclusion Criteria:

 -  Patients with GOG performance grade of 3 or 4

 -  Patients may not have a history of other invasive malignancies within the last five
 years, with the exception of non-melanoma skin cancer or stage 1A endometrioid
 adenocarcinoma of the uterus

 -  Patients diagnosed with chronic disease/illness precluding their participation (i.e.,
 diabetics receiving insulin, myocardial infarction or unstable angina within previous
 6 months, chronic hepatitis, rheumatoid disease, renal or hepatic disease/dysfunction)

 -  Patients with a histological diagnosis of clinical stage I epithelial ovarian cancer,
 fallopian tube or primary peritoneal carcinoma

 -  Patients who are currently undergoing treatment (primary or consolidation) for stage
 II, III or IV ovarian, fallopian tube or primary peritoneal cancer or who completed
 treatment less than six weeks ago

 -  Patients with a life expectancy of less than one year

 -  Patients with body mass index (BMI) < 20 kg/m^2

 -  Vegan vegetarians

 -  Patients enrolled in a weight loss program or who are taking weight loss medications
 or dietary supplements and are unwilling to discontinue

 -  Patients who have participated in a marathon, triathlon, or other endurance-related
 physical activity within the previous 24 months

 -  Patients who have had surgery for weight loss

 -  Note: women will not be excluded if their baseline lifestyle assessment indicates
 a healthy eating and moderate physical activity with the exception of the
 exclusion criteria above