Exploring estrogen receptor(ER)+ve breast cancer survivors’ and health care professionals’ views and experiences of weight management(physical activity and nutrition) before, during and post treatment


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Katie Pickering1,Sarah Wane2,Helen Crank1,Annie Anderson3,Janet Brown4,Henry Cain5,Rob Copeland1,Kate Kendell5,Daniela Lee5,Peter McMeekin2,Richard McNally6,Laura Thomas7,Caroline Wilson8,John Saxton2
1Sheffield Hallam University,2Northumbria University,3University of Dundee,4University of Sheffield,5Newcastle Upon Tyne NHS Trust,6Newcastle University,7Liverpool John Moores University,8University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust

Abstract

Background

Excess body weight is associated with poorer ER+ve breast cancer (BC) survival outcomes, however, previous lifestyle interventions have frequently failed to produce clinically-important weight loss in this population. We aimed to co-design an intervention addressing the perceived challenges of weight loss (and maintenance), by building BC-survivors skills and confidence to engage in sustainable physical activity (PA) and healthy eating. Using established qualitative methods, we sought to understand ER+ve BC-survivors’ and health care professionals' (HCPs) experiences of weight management (WM) throughout the treatment pathway to inform intervention design for a randomised controlled trial.

Method

Focus groups were conducted with 16 BC-survivors and 21 HCPs from three NHS trusts in Yorkshire and the North East of England. Data were analysed using framework analysis. Two researchers independently coded data and agreed the thematic framework. Data were inductively themed under the main framework areas of PA, nutrition, WM and cancer journey/experience.

Results

BC-survivors reported the following key factors that negatively impact motivation for WM:

  • Treatment side-effects (particularly fatigue, lymphoedema concerns and weight gain)
  • Psychological uncertainty (of living with and beyond cancer)
  • Lack of credible information (from clinical and other sources)

HCPs reported the following as impeding clinical support for WM in BC-survivors:

  • Lack of knowledge (of best practice for WM in BC)
  • Availability of credible BC-specific support (routine practice sign-posts to external support but consistent infrastructure is lacking)
  • Prioritisation of medicalised treatment (no time to deliver WM support)

Conclusion

This study highlights 1) the complexity of WM for BC-survivors; 2) limited credible information available to BC-survivors and HCPs leads to insecurities about PA engagement and food choices. These findings are informing the co-design of an intervention to address these issues, embedding the behaviour change techniques needed to build the skills and confidence for clinically meaningful and sustainable weight loss in this population.