Telephone-Based Rehabilitation Intervention to Optimize Activity Participation After Breast Cancer
Authors: Lyons Kathleen Doyle , Wechsler Stephen B. , Ejem Deborah B. , Stevens Courtney J. , Azuero Andres , Khalidi Sarah , Hegel Mark T. , dos Anjos Sarah M. , Codini Megan E. , Chamberlin Mary D. , Morency Jamme L. , Coffee-Dunning Jazmine , Thorp Karen E. , Cloyd Danielle Z. , Goedeken Susan , Newman Robin , Muse Colleen , Rocque Gabrielle , Keene Kimberly , Pisu Maria , Echols Jennifer , Bakitas Marie A. 
Published: March 2024

Importance

Following treatment, breast cancer survivors face challenges participating in valued activities.

Objective

To determine whether a telephone-based coaching rehabilitation intervention enhances activity participation in the year following breast cancer treatment.

Design, Setting, and Participants

In this multisite, single-blind randomized clinical trial (Optimizing Functional Recovery of Breast Cancer Survivors), recruitment occurred between August 28, 2019, and April 30, 2022. Data collection was completed by April 1, 2023. Participants were recruited from 2 cancer centers (Dartmouth College and the University of Alabama at Birmingham) and via social media advertisements. Women aged 18 years or older who had completed primary treatment for stage I to III breast cancer within 1 year and reported participation restrictions were eligible to participate. Randomization was stratified by site, treatment, and time since treatment.

Interventions

The intervention, delivered via telephone over 9 sessions, used behavioral activation and problem-solving principles to promote activity participation. The education-based attention control condition was delivered via telephone at matched intervals.

Main Outcomes and Measures

The primary outcome was participation, assessed using 5 measures, including Patient-Reported Outcomes Measurement Information System (PROMIS) social participation-satisfaction measure. One individualized outcome allowed participants to specify activities for which they wanted to foster recovery. Outcomes were collected by telephone by blinded coordinators at baseline and at 8, 20, and 44 weeks. The individualized outcome was assessed at the first and last intervention and control session.

Results

Among 1996 patients identified, 303 were eligible and enrolled. Of these, 284 women (94%; mean [SD] age, 56.1 [10.2] years) completed baseline assessments and were randomized, and 81% or more of each group completed the final assessment with no adverse events. Of those who completed the final assessment, 118 of 144 (82%) were in the intervention group, and 113 of 140 (81%) were attention control participants. Between-group differences were not statistically significant for the main measures of PROMIS satisfaction (week 20: Cohen d, 0.1 [95% CI, −0.09 to 0.29] and week 44: Cohen d, −0.08 [95% CI, −0.27 to 0.11]) and ability (week 20: Cohen d, 0.15 [95% CI, −0.06 to 0.37] and week 44: Cohen d, −0.08 [95% CI, −0.27 to 0.11]). On the individualized outcome, intervention participants reported significantly greater improvements in activity satisfaction (Cohen d, 0.76 [95% CI, 0.48-1.02]) and performance (Cohen d, 0.60 [95% CI, 0.32-0.87]).

Conclusions and Relevance

In this randomized clinical trial, the intervention catalyzed greater improvements in self-selected activity participation and goal disengagement but did not otherwise accelerate recovery compared with the control condition. Future research should determine what intervention features may lead to the greatest reductions in participation restrictions and other measures that may detect functional recovery.

Trial Registration

ClinicalTrials.gov Identifier: NCT03915548