Effectiveness of Active Living After Cancer (ALAC), a community-based physical activity program for underserved cancer survivors and their caregivers.
Authors: Mama Scherezade K. , Mitchell Stacy J , Tracy Patricia V. , Pena Luz Yadira , Moreno Carolina D , Valdes Adriana , Liao Yue , Lee Che Young , Servino Kendahl , McNeill Lorna H , Basen-Engquist Karen 
Published: June 2022

12013

Background: Physical activity (PA) improves physical functioning and quality of life in cancer survivors, yet few cancer survivors meet recommendations of ≥150 minutes/week of moderate intensity PA. Active Living After Cancer (ALAC) is a community-based program to improve the quality of life of cancer survivors by promoting PA and providing navigation services for survivorship issues. This study evaluates the impact of ALAC on PA, physical functioning, and quality of life in underserved cancer survivors who participated with and without a caregiver. Methods: Cancer survivors were recruited through community organizations to participate in ALAC, which consists of 12 weekly sessions, with or without a caregiver. Participants completed assessments of PA (Godin Leisure Time Exercise Questionnaire), physical functioning (30-sec sit-to-stand test), and quality of life (PROMIS physical and mental health) at baseline and follow-up. Paired samples t-tests were used to assess changes in physical activity, physical functioning and quality of life in cancer survivors and general linear models were used to compare changes between cancer survivors who participated with vs. without a caregiver. Results: Cancer survivors (N = 539; M age = 61.0±11.3 years) were mostly women (92.4%), Hispanic (57.3%) or non-Hispanic Black (21.5%), and medically underserved (85.3%). Most were breast cancer survivors (69.4%), diagnosed with Stage 0-III cancer (91.5%), and participated in ALAC without a caregiver (N = 463, 85.9%). From baseline to follow-up, the percent of cancer survivors meeting PA recommendations increased from 30.3% to 59.6% (Δ = 27.8 score, t= 16.4, p<.001), and the number of sit-to-stand repetitions in a 30-second period increased from 12.4 to 14.3 (Δ = 2.1, t= 8.6, p<.001). Cancer survivors also reported significant improvements in physical (Δ = 0.6, t= 2.4, p=.015) and mental (Δ = 1.0, t= 3.7, p<.001) health-related quality of life. Cancer survivors who participated with a caregiver reported improvements in physical (Δ = 0.7) and mental (Δ = 1.2) health-related quality of life, whereas those who participated without a caregiver reported slight decreases in physical (Δ = -0.2) and mental (Δ = -0.2) health-related quality of life. However, group x time interactions were not statistically significant [physical F(1,412) = 1.9, p=.168; mental F(1,412) = 49.2, p=.061]. Conclusions: Results confirm the effectiveness of ALAC among medically underserved cancer survivors for increasing PA and physical function and suggest that quality of life improvements may be enhanced by participating with a caregiver. Thus, community-based programs should encourage participation with a caregiver when possible to further increase PA, improve cancer survivorship, and reduce cancer health disparities among underserved cancer survivors.