Abstract P1-12-11: Exercise interventions for breast cancer (BC) patients in rural areas: The Northern New England (NNE) experience
Authors: Batukbhai B , Stannard MG , Donovan AM , Lyons KD , Dittus K , Stoedefalke K , Chamberlin MD 
Published: May 2019

Abstract
Background:
Women in rural areas are less likely to engage in physical activity (PA) compared with their urban counterparts. It can be even more challenging for BC patients due to the sequelae of their cancer and treatment. A quality improvement project in our cancer center evaluating leisure time activity among BC patients identified that about half the responders were sedentary or insufficiently active. Only one third were aware of the recommendation to achieve 150 active minutes per week while more than half reported not meeting the goal. Lack of motivation was quoted as the main reason for not meeting the goal by one-third of the responders. Goal setting has been an integral part of cardiac rehabilitation and behavior change techniques. It has shown to increase participation and motivation. We performed a combined analysis of collaborative interventions in NNE to identify if effective goal setting can overcome the barriers to PA among BC survivors.
Methods:
5 IRB-approved interventions promoting PA among BC patients across 3 states were included. Studies were stratified according to the stages of treatment, the types of intervention and whether goal-setting was used. Pooled effects were calculated using Comprehensive Meta-Analysis software and R package metafor (v.2.0.0) with the maximum-likelihood configuration. Subgroup analyses were conducted based on the goal-setting criteria.
Results:
The 5 studies examining 4 exercise interventions are shown in the table below.
The studies evaluating exercise interventions in BC patientsStudy nameIWEB/ W12051D12030D1032D12110UVM (STW)RegionVT/ MA/ NHVT/ NHVT/ NHVT/NHVTUrban/ Rural MixedMixedRuralRuralRuralUrbanRandomizedNoYesNoYesNoMeasurement Type of interventionIntermittent (Web-based)Pedometer Phone callSelf-reportedSelf-reportedSelf-reportedFinal goal defined as &gt;150 min of PA weeklyYesNoNoNoYesGoal-settingYesYesYesYesNoBMI eligibilityYesNoNoNoNoPA eligibilityNoYesNoNoNoEnrolled50282359407Completed intervention3441724279Completed/ Assigned to intervention (%)10014734168.6Completed + change PA (%)41.3100697580.4
D12030 included patients on chemotherapy with the aim to increase activity by 10MET/week, while the W12051, UVM, D1032 and D12110 studies included patients who were post-chemotherapy. Home-based programs were used in W12051 and D12030. Goal-setting was used in all the studies except for the UVM study which used a supervised program with self-reporting. Weighing by percentage of patients completing the program, the pooled change in PA was 56.6% (95% CI=24.2-89.1%). Pooled PA for the goal-setting subgroup was nearly twice as high as the without-goal-setting subgroup (74.3% and 39.5%, respectively).
Conclusion:
Cancer centers with large catchment areas need to design creative approaches to encourage PA among the BC survivors. With the lack of motivation as the most common barrier to achieving the recommended PA, goal-directed programs can be helpful by creating attainable targets as well as providing emotional and psychological support. In addition, geographical barriers need to be addressed through interventions like internet-based programs, personal tracking devices, and small-group social activities.
Citation Format: Batukbhai B, Stannard MG, Donovan AM, Lyons KD, Dittus K, Stoedefalke K, Chamberlin MD. Exercise interventions for breast cancer (BC) patients in rural areas: The Northern New England (NNE) experience [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-11.