Abstract P5-13-13: Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community
Authors: Zelek L , Festa A , Bodere C , Morello S 
Published: March 2017

Abstract
BACKGROUND: To enhance compliance with national nutrition recommendations in breast cancer survivors (BCS), a 3-year program granted by the Regional Health Authority began in 2013 in an area (Seine-Saint-Denis, SSD) which is among the poorest in France.
PATIENTS AND METHODS: Ac'Santé 93 is a non-profit organization whose aim is to provide supportive care, health education and individualized assistance to patients and families, and to facilitate timely access to quality medical and psychosocial care. Vulnerability was evaluated using an 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score &gt;30 and considered as severe when &gt;40. Given the high level of poverty in the area and the incidence of financial difficulties in cancer survivors, a particular attention was paid to comparing the costs of different foods in order to promote affordable dietary changes. Between March 2013 and December 2015, 109 BCS were enrolled in a 3-month education program including 3 sessions of a professionally led support group (with dieticians and social workers).
RESULTS: Ten BCS were lost for follow-up before the end of the program; 54 BCS attended all the sessions. Mean age was 52. Median vulnerability score was 51.8 (0-93.48) and 59% of patients had a score &gt;30. Dietary intakes were assessed at baseline, and 1 and 6 mos. after the last session. At 1 mo. 65% BCS had knowledge of healthy dietary choices and 63% were ready to translate it into practice. Of note, 47% BCS decided to enroll in a tailored 1-year physical activity program or planned to do it, although it was not the aim of the study. At 6 mos. 52% of BCS still had knowledge of healthy diet and 49% of turned it into practice. However, only 12% were still practicing physical activity. Barriers were reported in 67% BCS and included asthenia or other treatment side effects (40%), anxiety or depression (27%), reluctance of relatives (20%), social isolation (20%) or cost (18%). Semi-directive interviews revealed unexpected benefits from this program such as empowerment, socialization or improvement of body image.
CONCLUSION: A short-term dietary intervention is feasible in vulnerable BCS living in an underserved area and improves adherence to higher quality diet in a meaningful number of patients. In spite of the attention paid to the affordability of dietary modifications, numerous barriers still exist in this population, the main one being treatment related side effects, including fatigue. Furthermore, compliance to a tailored physical activity program spontaneously decreases over time.
Citation Format: Zelek L, Festa A, Bodere C, Morello S. Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community [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 P5-13-13.