Abstract P2-13-07: A lifestyle intervention program for obese breast cancer survivors using shared appointments, technology, and community partners in an underserved area
Authors: Schlam Ilana , Alintah Princess , Gallagher Christopher , Boisvert Marc , Chitalia Ami , Tiwari Shruti , Martone Patrick , Dash Chiranjeev , Graves Kristi , Dilawari Asma 
Published: March 2020

Abstract
Introduction: Obesity is associated with a 41% increase in all-cause mortality in breast cancer survivors. The majority of patients treated for breast cancer at our center are obese and most patients are racial and ethnic minority women living in low-income neighborhoods. Numerous barriers exist for weight management and physical activity interventions in this patient population. We aimed to assess the feasibility of a lifestyle intervention in 30 obese breast cancer survivors using shared medical appointments and community partnerships. Methods: 30 patients with stage I-III breast cancer with a BMI ≥30 kg/m2 treated in the preceding 5 years were enrolled through medical oncology and breast surgery clinics. All participants were given a Fitbit® to monitor physical activity and a $25 grocery gift card for a shopping trip with a nutritionist. Participants were expected to attend at least 10 group shared medical appointments (SMA) offered weekly on-site. SMA included nutrition education, cooking instruction, exercise classes or survivorship lectures. We collected participant feedback on SMA. Initial study end points were feasibility of intervention delivery measured by number of SMA appointments and physical activity (steps) measured by Fitbit®. The study was divided in three phases. Phase I/II: patients were required to have baseline evaluations, attend 10 SMA, share Fitbit® information, and complete validated eating and health questionnaires (REAP-S and SF-36, respectively) at scheduled time intervals. In phase III, we provided participants with a binder with information on low-cost fitness and nutrition options in patient’s neighborhoods and awarded prizes for high-performing participants. Results: We enrolled 30/30 participants in less than 6 months from opening; 80% were African-American. Three enrolled subjects did not complete more than one SMA. Participants attended an average of 10.2 SMA; attendance ranged from 5-10 participants per session. 63% (n=19) of participants attended the required 10 or more of the required SMA sessions (average compliance with clinic appointments is 50-60%). Participants had an average of -0.18 kg weight loss; 43% (n=13) lost weight and 40% (n=12) gained weight during the intervention (5 participants lost to follow-up or did not have weight changes during intervention). The range of weight loss was 0.1 to 7 kg and weight gain 0.2 to 6.2 kg. Twenty-four participants had consistent Fitbit® steps recorded; 19 increased their average of daily steps and 7 decreased from baseline, however, the steps varied significantly week to week. At baseline, average daily steps was 3,977 (range 200 to 18,432; SD = 4,236 steps) and 5,526 (range 728 to 14,006; SD = 2437 steps) post- intervention. The number of participants who increased steps (n=19) was significantly greater than the number of participants who decreased steps (n=7; p=0.014). The total cost of the intervention was $150 per patient. Challenges to study implementation included collection of Fitbit® data at consistent intervals and the available times for offering SMA; these times precluded enrollment and compliance for patients who work during the day. Conclusions: Our pilot study of a low-cost lifestyle intervention program appears to be feasible and beneficial for obese patients in a largely underserved community. SMA contributed to compliance and had positive feedback; patients expressed high levels of interest and engagement in the intervention. After the intervention participants were motivated to continue with lifestyle modifications and formed a Facebook® page to maintain connections. In the future, the goal is to incorporate this program as part of our survivorship care and expand it to other malignancies and potentially to other sites.
Citation Format: Ilana Schlam, Princess Alintah, Christopher Gallagher, Marc Boisvert, Ami Chitalia, Shruti Tiwari, Patrick Martone, Chiranjeev Dash, Kristi Graves, Asma Dilawari. A lifestyle intervention program for obese breast cancer survivors using shared appointments, technology, and community partners in an underserved area [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-07.