Abstract P5-13-10: A patient centered intervention for adaptation of cancer risk reduction guidelines in breast cancer survivors
Authors: Thomas PS , Klimitchek A , Nelson B , Damani S , Bevers TB 
Published: March 2017

Background: Cancer survivors are susceptible to cancer recurrence and other cancers and this is an opportune time to focus on cancer prevention. The American Institute of Cancer Research (AICR) and the American Cancer Society estimate that modifications to the behaviors of diet and physical activity in addition to maintaining a normal body mass index (BMI) can help reduce cancer incidence by one third. The AICR and the American College of Sports Medicine (ACSM) have established guidelines on nutrition and physical activity respectively for cancer risk reduction. Cancer patients' transition to survivorship is an ideal time for them to make lifestyle modifications and adopt these guidelines. Although studies have evaluated structured exercise regimens and nutritional interventions, data is lacking on how to best achieve long term lifestyle changes in this population. By introducing a patient-centered intervention that utilizes motivational interviewing to our breast cancer survivors, we plan to increase the rate of adherence to the AICR and ACSM guidelines through tailored counseling focused on patient-driven lifestyle modifications.

Methods: Breast cancer survivors 5 years out from their diagnosis seen in the survivorship clinic were also scheduled to be seen by a health education specialist (HES) for a baseline visit. One year follow up visits were scheduled with the HES for reassessment of their nutrition and physical activity goals. All patients completed a survey of questions assessing their adherence to the nutritional and physical activity guidelines on cancer risk reduction at baseline and at 1 year follow up visit. Anthropometric measures including height, weight, BMI, pulse, respirations, and blood pressure were collected at each visit with their provider. Baseline demographic data was collected on all participants including age, race/ethnicity, cancer stage, previous cancer treatment(s), and comorbid conditions. Frequency of interactions (i.e clinic visit, telephone call, or secure message) with the HES were extracted from the medical record.

Results: From October 6, 2014 to May 31, 2016, 200 breast cancer survivors were seen in the survivorship clinic and by a HES. Fifty women who completed a baseline and 1 year follow up survey were selected to assess their adherence to the AICR and ACSM guidelines on cancer risk reduction. Sixty percent of patients decreased their BMI, 5% maintained their BMI, and 35% had an increase in BMI after one year follow up. There was an increase in the percentage of patients adhering to all of the guidelines after one year of follow up in comparison to baseline. There were notable increases in adherence to physical activity guidelines with 24% of survivors achieving at least 150 minutes of moderate exercise each week at baseline assessment and 34% of survivors meeting this guideline at the 1 year follow up visit.

Discussion: Through our intervention with a HES in our survivorship clinic, we were able to see trends toward increased adherence to the AICR and ACSM guidelines. Further analysis is ongoing to assess the frequency of interactions with the HES and their adherence to the guidelines. This analysis will give us a better understanding of the ideal target population for this intervention.

Citation Format: Thomas PS, Klimitchek A, Nelson B, Damani S, Bevers TB. A patient centered intervention for adaptation of cancer risk reduction guidelines in breast cancer survivors [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-10.