Experimental 'urban garden' helps cancer survivors' lower risk for recurrence, chronic illness

There isn't something magical in the soil at the Garden of Hope, explains "Growing HOPE" project lead Colleen Spees, PhD, RDN, a researcher at Ohio State's School of Health and Rehabilitation Sciences and James Comprehensive Cancer Center. Instead, it's the combination of an evidence-based curriculum paired with novel technology and a spirit-nurturing environment that is literally changing the biology of the cancer survivors for the better.

"After four months in our program, our survivors decreased their weight, fasting glucose, non-HDL cholesterol, and increased physical activity and skin carotenoids. In addition, they improved overall adherence to anti-cancer dietary patterns," said Dr. Spees. "Not only do our survivors have weekly access to fresh fruits, herbs and vegetables, they learn why we recommend these cancer-fighting foods and how to safely prepare them. Participants also have access to nutrition experts both on and offsite that provide additional support and guidance."

There are currently more than 14.5 million cancer survivors in the U.S. and that number is expected to increase by 31% over the next 8 years. Cancer survivors are at increased risk for cancer recurrence and other chronic diseases. Lifestyle behaviors, such as diet and physical activity, are strongly linked to decreased risk of chronic disease and improved health outcomes, but very little research has been conducted specifically in this vulnerable population.

"We believe that our study is the first to implement and test an integrated approach to overall patterns of diet and physical activity while measuring the impact of adhering to evidence-based recommendations for cancer prevention and survivorship," said Dr. Spees.

Growing Hope

Dr. Spees' belief that modifiable lifestyle behaviors can play a significant role in reducing cancer is rooted firmly in her family's DNA. Literally. Her family is affected by an autosomal dominant gene mutation that disrupts a tumor suppressor gene that normally protects the body against cancer. After this mutation led to several deaths in her extended and immediate family, Dr. Spees, a registered dietitian, looked for information on dietary and behavioral interventions that could help her relatives and others improve their odds. She found little data that translated bench research discoveries to real world applications.

With the support of a TL1 training grant from Ohio State's Center for Clinical and Translational Science (CCTS), Spees went back to school to earn a PhD, focusing on cancer, nutritional genomics and lifestyle behaviors. Under the mentorship of Steve Clinton, MD, PhD, a researcher of cancer-fighting foods, her expertise and research interests led her to the Garden of Hope, where Spees saw an opportunity to conduct research and impact the lives of cancer survivors.

"Dr. Clinton, The James, and JamesCare for Life established the Garden of Hope in 2012 and began providing fresh produce to survivors. It was the perfect "stage," a living laboratory to engage survivors in new ways that could improve their long term health," said Dr. Spees. After conducting a pilot study with encouraging results, she received a grant from the American Cancer Society to see if she could expand the curriculum and experiences for cancer survivors -- and the seed for Growing HOPE took root.

Growing HOPE allows cancer survivors to visit the garden several times a week to harvest. The produce changes with the seasons, and survivors attend cooking demonstrations led by chefs and dietitians on how to prepare dishes using the foods that have just been harvested. Dietetic interns from Ohio State are on hand to support survivors, assist with harvesting, and answer questions. Cancer survivors participating in the program have access to an eHealth coach (a dietitian) via Skype, instant message, text, or email around the clock. Expert guest speakers regularly come to the garden and teach survivors about the current research, importance of anti-cancer dietary patterns, safe food handling, food preservation methods, and connections between the environment and illness.

Dr. Spees shared the positive results from Growing HOPE at Ohio State's recent BRUTx healthcare innovation meeting and at the national Academy of Nutrition and Dietetics Fall meeting, where she received the Award of Excellence in Oncology Nutrition Research.

"I don't think it's a surprise that when you give people information and empower them, you will see positive outcomes," said Dr. Clinton. "But what's hard to measure -- and as equally important -- is the experience that people have in the garden as the seasons change. The psychosocial experience of sharing, being outdoors, watching the sunset, hearing the birds, smelling the earth -- it's a reflection of the cycle of life that gives people solace."

Anne, a self-described foodie, Growing HOPE study participant and breast cancer survivor, agrees. She can tell you all about the creaminess of her butternut squash soup, the tart leaves of a rutabaga salad, the surprising sweetness of a fresh picked beet. But for her, it isn't just about the food.

"Having cancer brings everyone to the same place. The same fight. The Garden of Hope gives you a break from focusing on the fight. I get excited thinking about who I will see there, what vegetables are ripe, and what I'll learn how to cook that night. Nobody has a bad day in the Garden," said Anne.

What's Next on the Menu

With solid pilot data on hand, Spees is in the process of applying for grants and seeking funding that would allow her to conduct a large scale randomized controlled trial. She is hoping that she can take a closer look at the complex interactions between genes and the environment, along with evaluating additional biomarkers of health.

The Growing HOPE project is also developing new tools, videos and applications to help in assessment and feedback. Dr. Spees has partnered with software company Viocare, to create a secure web-based portal where participants can track progress and access the health coach, recipes, cooking videos, and evidence-based resources -- all data that she and team can track on the back end.

"We think this comprehensive approach is successful because it allows people to choose what components of the intervention are best for them, and the garden becomes their own "urban oasis." The garden is the glue that makes the pieces work together," said Spees. "And if this model works in cancer, it seems plausible that it could be replicated for other chronic diseases and populations. Growing HOPE could be the blueprint for other programs that combine team science and evidence-based medicine along with a nourishing environment and support network."