Episodic future thinking: A behavioral intervention to promote weight loss in breast cancer survivors.
Authors: Sukumar Jasmine S , Lustberg Maryam B. , Stein Jeffrey , Schnell Patrick , King Jenna , Schimming Denise , Hatfield Rachée , Quiroga Dionisia Marie , Pariser Ashley , Gatti-Mays Margaret E , Williams Nicole Olivia , Cherian Mathew Amprayil , Stover Daniel G. , Wesolowski Robert , Ramaswamy Bhuvaneswari , Tripathy Debashish , Basen-Engquist Karen , Vaughn Jennifer , Sardesai Sagar D. 
Published: June 2024

e22541

Background: Digital behavioral interventions are a scalable method to increase healthy lifestyle engagement. Episodic future thinking (EFT) is a behavior change method where participants mentally simulate positive, detailed, personal, and future-oriented events. EFT targets delay discounting (DD), a behavioral economic principle that measures valuation of long-term, future rewards. Higher DD correlates with bias of immediate gratification and maladaptive health behaviors. EFT can decrease impulsivity and improve body weight (BW) in those with obesity. However, EFT may impact cancer survivors differently. We report results from a phase II trial evaluating the feasibility of 12 week (wk) EFT in overweight/obese BC survivors. Methods: Eligibility included women with non-metastatic BC, BMI ≥ 25 kg/m2 and completion of BC treatment apart from endocrine therapy. All patients (pts) received lifestyle counseling, referral to nutritionist, and logged exercise/diet in MyFitnessPal. Pts were stratified by baseline DD and randomized 1:1 to 12-wk EFT vs control (Episodic Recent Thinking; ERT) in which pts imagine events in the past. Pts received text cues 3x/day during meals. The primary endpoint was adherence to EFT (percentage of smartphone prompts opened and attended to over 12 wk). Secondary endpoints were 12 wk change in BW and DD. A one-sample t-test evaluated adherence in pts regardless of drop-out and compared to an 80% target. A linear mixed effects model was used for secondary endpoints. Results: Pts were recruited from November 2021 - August 2023 (Table 1, n = 46) at The Ohio State University. In total, 17 (74%) in EFT and 19 (83%) in ERT completed the intervention. The average adherence was consistent with the 80% target (EFT 77%, 95% CI = 0.69 - 0.85; ERT 82%; 95% CI = 0.78 - 0.86). BW at 12 wk was available in 17 (74%) EFT and 19 (83%) ERT pts. There was a significant 12 wk change in BW in all pts (-4.0 lbs, 95% CI -6.08 - -1.79, p < 0.001; -2.03%, 95% CI -3.15 - -0.91, p < 0.001) but no significant difference between groups (lbs: -2.28 EFT vs -5.42 ERT, 95% CI -7.41 - 1.14, p = 0.1; %: -1.07 EFT vs -5.20 ERT, 95% CI -4.01 - 0.37, p = 0.1). There was no significant difference in 12 wk change in DD rate between EFT and ERT (ratio 1.56, 95% CI 0.19 - 12.95, p = 0.7). Conclusions: The high adherence supports the feasibility of implementing EFT and engaging digital health for remotely delivered weight loss in BC survivors. BW loss was globally observed, despite low baseline DD in the majority. Further investigation of EFT in combination with lifestyle intervention is needed to formally assess efficacy in this population. Clinical trial information: NCT05012176 . [Table: see text]