Facilitators and barriers to recruitment for an exercise and dietary intervention study in minority breast cancer survivors.
Authors: Greenlee H , Crew K , Ferguson K , McKinley P , Rundle A , Ogedegbe G , Matta J , Sandoval R , Hershman DL 
Published: December 2010

Abstract
Abstract #5077
Background: Hispanic and black women with breast cancer (BC) have poorer survival than non-Hispanic whites. Lean body mass, regular physical activity, and high intake of fruits/vegetables may improve survival. However, minority BC survivors are more likely to be obese and sedentary than non-Hispanic whites, which may contribute to poorer survival. We are conducting a randomized waitlist-controlled pilot study to test the effects of 6-months of the Curves® 30-minute circuit-based exercise and high-vegetable/low-fat nutrition program, on weight loss among Hispanic and black women, and now report facilitators and barriers to recruitment. Methods: Eligibility criteria: 21-70 yrs, Hispanic/black, BMI ≥25kg/m2, sedentary, stage 0-IIIa breast cancer, no evidence of recurrent/metastatic disease, radiation/chemotherapy completed ≥6 months prior, no uncontrolled comorbidities, and non-smoker. Participants were identified by physicians and referred for screening. Barriers to study participation were assessed, including work/family responsibilities, transportation, financial resources, and perceived risks/benefits of exercise and dietary change after cancer diagnosis. Results: To date, 96 women have been referred for screening and 50 (52%) completed screening questionnaires. Of those who completed questionnaires, 43/50 (86%) were eligible, and of those who were eligible, 37/43 (86%) chose to participate. Enrolled participants are 70% Hispanic, mean age 51yrs (range:32-69), mean BMI 33.2 (±5.8) kg/m2, 64% diagnosed as AJCC stage II/III, and 70% ≤ high school education. Reasons for ineligibility (n=53) include inability to recontact (46%), uncontrolled comorbidity (21%), too busy/not convenient (15%), still undergoing treatment (11%), currently smoking (4%), and not sedentary (2%). Eligible and ineligible women were not statistically different in terms of race, BMI, or stage at diagnosis. However, ineligible women were older (P&lt;0.01). Of the women who completed the screening questionnaire, women enrolled in the study (n=37), compared to women not enrolled (n=13), believed losing weight after cancer would prolong survival (P=0.01), making dietary changes would prevent recurrence (P=0.01), and that exercising would help them feel better (P=0.01), prevent recurrence (P=0.01), and prolong survival (P=0.046). Women not enrolled were more likely to report that exercising after a cancer diagnosis is dangerous (P=0.04). Conclusions: Recruitment of a multiethnic population to a Curves® based exercise intervention study was feasible. Patients who ultimately enrolled in this study believed that exercise and eating a healthy diet are beneficial to their health. Given that many overweight and sedentary women had pre-existing negative misconceptions about the benefits of exercise and dietary change after a BC diagnosis, and this was a key factor in predicting enrollment, educational efforts promoting healthy lifestyle behaviors should be further targeted towards this high-risk patient population.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5077.