Abstract P1-11-11: Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community
Authors: Zelek Laurent , Bodere Chloe , Bourlier Delphine , Festa Anne 
Published: May 2015

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. Median household income is 68% lower than in Paris (+68%), a gap growing with time. Whereas it is widely admitted in France that 25% of patients are faced with financial difficulties after breast cancer, this proportion reaches 40% in SSD. We present here intermediate 1-year results.
PATIENTS AND METHODS: Oncologie 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. Strictly speaking this score was aimed at measuring precarity, a concept referring to a social condition assumed to face worsening. 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. Between March 2013 and December 2013, 27 BCS were enrolled in a 3-month education program including 3 sessions of a professionally led support group (with dieticians and social workers). 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. Mean age was 52. Median vulnerability score was 51.8 (0-93.48) and 64% of patients had a score &gt;30. Dietary intakes were assessed at baseline, and 1 and 6 mos. after the last session. At baseline, although 13 BCS correctly answered the questionnaire, 17 BCS had difficulties to prepare meals and fatigue was the main reason for 10 of them; 4 BCS were lost for follow-up before the end of the program. At 1 mo. 15 BCS had knowledge of healthy dietary choices and 11 were ready to translate it into practice. Of note, 9 BCS decided to enroll in a tailored physical activity program or planned to do it. At 6 mos. only 10 BCS still had knowledge of healthy diet but all of them turned it into practice. Barriers were reported in 10 BCS and included anxiety or depression (n=8), family (n=6) and asthenia or other treatment side effects (n=5).
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, mainly related to psychosocial reasons. Furthermore, fatigue negatively influences the ability to prepare meals. A total of 100 BCS will be included over 3 years, and further studies will evaluate the impact of the vulnerability level and psychosocial comorbidities on BCS’ compliance.
Citation Format: Laurent Zelek, Chloe Bodere, Delphine Bourlier, Anne Festa. Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-11.