Feasibility of nutrition counseling for breast cancer survivors: Results from the force trial.
Authors: Teplinsky Eleonora , Cording Jessica , Bessada Kasey , Christoudias Moira Katherine , Fishman Elena I , Gordon Catherine , Horowitz Elizabeth , Podolski Amanda , Rutledge John R. , Klein Laura 
Published: June 2023

e24054

Background: Certain dietary choices and body mass index (BMI) are associated with increased risk of breast cancer (BC) recurrence. Most patients (pts) consider nutrition very important but also report feeling confused about nutrition information. Many do not have access to a registered dietitian (RD) and nutrition education in medical schools is often lacking. Health coaching, education, goal-setting, and motivation are factors that can improve healthy habits and increase adherence to lifestyle modifications. We aimed to evaluate the feasibility of a 12-week (wk) pilot program of individualized nutrition counseling by a RD for BC survivors in a community oncology setting. Methods: We conducted a single-center, prospective, single arm trial to evaluate the feasibility of individualized nutrition counseling by a RD in pts with stage I-IV BC. Counseling focused on the American Cancer Society healthy eating pattern recommendations. Stage I-III BC pts must have completed all planned surgery, chemotherapy and radiation. Pts with stage IV/metastatic BC were eligible at any point during their treatment. Participants had three planned visits over a 12-week (wk) period: baseline, 4 wk follow-up visit, & 12 wk follow-up visit. Feasibility was measured by adherence to a three-visit protocol over a 12 wk period. Secondary objectives included effect of nutrition counseling on quality of life using Functional Assessment of Cancer Therapy-Breast (FACT-B) and on physical activity using Godin Leisure-Time Exercise Questionnaire (GLTEQ). Demographic and medical variables were collected. Results: N = 50 participants signed consent for the study, & all had baseline visits. Mean age 56 yrs (33-77). Pts: Stage I (N = 38); Stage II (N = 8); Stage III (N = 1); metastatic (N = 3). Mean BMI: 28.64 (17.7-48). Pts: ER+/HER2- (N = 37); ER+/HER2+ (N = 7); ER-/HER2+ (N = 2); ER-/HER2- (N = 4). 42 pts were on endocrine therapy during their participation on study. 36 pts (72%) completed the 12-wk program in its entirety. Average visit adherence for the whole cohort was 84.7%. Reasons for the 14 pts (28%) who did not complete the program included no virtual option available (N = 6); no time to attend (N = 2); not interested (N = 1) & unknown (N = 5). 9 only attended Visit 1 and 5 attended Visits 2 and 3. Pts who completed the program experienced an improvement in self-reported energy level (p = 0.01) as assessed in FACT-B from baseline to 12 wks. There was no significant difference in GLTEQ from baseline to 12 wks (p = 0.21). Remainder of QoL assessments to be presented. Conclusions: Individualized nutrition counseling in a community oncology program was feasible and led to improvement in self-reported energy levels. It is imperative to expand the reach and access of nutrition counseling to reach a more diverse patient population and maintain continuity. Future work will focus on testing this intervention in larger and more diverse populations of BC survivors and thrivers.