PREHABILITATION AND SUPPORTIVE CARE IN ONCOLOGY TREATMENT OF BREAST CANCER: PROACTIVE-B
Authors: Kay Dr Shelley , Grant Dr Suzanne , Lacey A/Prof Judith , Kumar Dr Sanjeev , Kerin-Ayres Ms Kim , Stehn Dr Justine , Gonzalez Dr Maria , Templeton Sandra , Heller Gillian , Wahlroos Sara , Malalasekera Ashanya , Mak Cindy , Seet-Lee Catherine , Bell Ainsley , Graham Susannah 
Published: May 2024

INTRODUCTION & AIMS
Neoadjuvant therapy has become standard treatment for patients with Stage II/III HER2 positive and triple negative breast cancer and in selected patients with locally advanced and borderline resectable high risk, luminal B breast cancer (1). Side effects such as fatigue, cardiotoxicity, neurotoxicity, anxiety, insomnia, vasomotor symptoms, gastrointestinal disturbance as well as a raft of immune-related adverse events, impact treatment tolerance, long term outcomes and quality of life. Post-treatment, many women increase body fat and decrease lean mass and develop metabolic syndrome (2) and accelerated cardiac aging (3). All of these are modifiable targets of exercise. The aim of this study was to determine if an early multi-modal supportive care program, designed through a qualitative study from consumers and healthcare professionals, can mitigate these side effects and improve chemotherapy completion, cardiometabolic, residual cancer burden (pCR) and surgical outcomes.

METHODS
This was a prospective, mixed-method, feasibility study that recruited 23 women receiving neoadjuvant therapy for breast cancer, combining qualitative and quantitative data collection and analysis. The supervised exercise intervention was designed to include aerobic interval, resistance and balance training twice/week, adapted for symptom burden in each session with relative training dose intensity calculated. An optional home program as also provided with therabands. Body composition, upper and lower body strength and cardiometabolic outcome measures were collected at baseline, end of first and second line of treatment and then 6 months post-surgery.

RESULTS
Full data will be completed in March 2024 to be presented. There was a high rate of complete pathological response (18/22). Currently, 13 participants have completed 6 month post-surgery assessments and preliminary analyses indicate increases in strength and maintenance of muscle mass during and after treatment. The program was found to be acceptable and feasible with high attendance and satisfaction ratings. The additional home program had poor uptake. Of interest to exercise physiologists was participant responses to cluster set training, how poorly rate of perceived exertion reflected training and strength testing loads, heart rate and blood pressure responses and treatment toxicities including cases of immunotherapy induced hepatitis. Many participants were stronger at the end of chemotherapy than before and reported that exercise gave them a sense of control.

CONCLUSION
Adapting exercise during neoadjuvant chemotherapy with additional supportive therapies for symptom management, improved physical and psychosocial functioning. The program was feasible and acceptable, with high satisfaction reported. Muscle mass can be maintained with supervised exercise training and maintained and 6 months after surgery.