PAVING the path to wellness: Lifestyle medicine to improve outcomes in breast cancer survivors.
Authors: Lee Hannah , Smith Alexis , Abraham Elizabeth , Haggett Dana , Eisenstat Stephanie , Winters Loren , Sullivan Carol , Ryan Phoebe , Peppercorn Jeffrey M. , Warner Erica T. , Hall Daniel , Tollefson Michelle , Frates Beth , Comander Amy H. 
Published: June 2023

e24053

Background: Lifestyle medicine emphasizes the role of 6 pillars in preventing chronic disease and improving health: nutrition, physical activity, sleep, stress management, social connection, and avoiding risky substance use. While most oncologists are aware of the role of these factors in reducing risk of recurrence and improving outcomes, there are numerous barriers to addressing these lifestyle factors during clinic visits. The PAVING the Path to Wellness for Breast Cancer Survivors program (PAVING) is a 12-week lifestyle medicine group intervention designed to deliver lifestyle medicine guidelines and practices to cancer survivors in a supportive setting. This study assessed short-term impacts of PAVING on behavioral and psychological outcomes. Methods: 101 women who completed PAVING since 2019 were invited to complete a survey. Inclusion criteria were primary oncology treatment at Massachusetts General Hospital, age > 22, diagnosis of invasive breast cancer (Stages I-III) within past 5 years, ECOG score 0-1, and English fluency. 16 enrolled in the study, 13 of whom fully completed the survey. The REDCap survey included the REAP-S and EHQ nutrition scales, IPAQ-SQ physical activity measure, COPE Inventory for coping skills, Psychological Wellbeing Scale, PROMIS-QOL scale, and ratings of the impact of the program on well-being. Statistical analysis was completed in SPSS. Results: The participants, N = 16, were women above the age of 22 with a primary diagnosis of breast cancer. Analysis found while ASCO recommends a minimum of 150 min/week of moderate-vigorous exercise, PAVING participants achieved a median of 255 min/week (120 to 420). A Spearman’s rank correlation found a significant positive relationship between fruit intake and self-rated dietary improvement due to PAVING, r(13) = .764, p = .002. A significant positive relationship also existed between PAVING-attributed emotional well-being improvements and general mental health, r(13) = .615, p = .025. Participants strongly agreed PAVING improved their confidence in their ability to cope (M = 1.9, SD = .76) and set goals (M = 1.92, SD = .862). Participants agreed their quality of life (QOL) improved since completing PAVING (M = 2, SD = .816); QOL ratings (M = 1.69, SD = .751) reflect very good-to-excellent QOL in the average PAVING participant. Conclusions: PAVING Participants report positive lifestyle practices, many attributed to the program, supporting further investigation of this program for patients with cancer. Mental well-being, QOL, and fruit intake were all positively correlated with self-rated growth resulting from PAVING. Participants exceeded guidelines for physical activity, which has been shown to reduce risk of breast cancer recurrence. PAVING is an effective lifestyle-medicine intervention for breast cancer survivors, and expansion will enable a broader population to improve outcomes following diagnosis and treatment.