Group Phone-based Weight Control among Rural Breast Cancer Survivors

描述(申请人提供)：与体重正常的女性相比，在乳腺癌诊断时肥胖的女性复发和死亡的风险增加1.5到2.5倍。此外，确诊后体重增加和体力活动减少是很常见的，也增加了乳腺癌复发和死亡的可能性。农村妇女在乳腺癌诊断和治疗方面存在健康差距。与城市妇女相比，大多数农村县的妇女肥胖率也最高。为了解决这些差异，这项应用的首要目标是开发一种临床有效和成本效益高的战略，为农村乳腺癌幸存者提供体重控制干预。通过电话会议的集体电话治疗是一种新的治疗交付方法，我们已经证明，这种方法对农村乳腺癌幸存者的初始减肥有效，而且在农村妇女中比标准的个人电话治疗更有效。这种提供集体治疗的创新方法解决了农村地区的获取障碍，可能特别适合农村乳腺癌幸存者，因为它提供了社会支持，并提供了一定程度的匿名。农村乳腺癌幸存者更有可能被隔离，对隐私的担忧加剧，并报告难以适应乳腺癌。与此同时，他们获得专业支持服务的机会较少，因此更有可能在癌症和体重管理方面有未得到满足的支持需求。通过电话与其他幸存者一起改变生活方式的机会可能会在保密的环境中提供社会支持，同时它还可以改善饮食、体力活动、体重和生活质量。然而，在超过六个月的减肥维持延长护理期间，团体电话咨询的影响仍不清楚。当体重回升很常见时，减肥维持是治疗中更具挑战性的阶段，这种回升存在乳腺癌复发的潜在风险。这项随机对照试验将评估农村乳腺癌幸存者的团体电话减肥治疗的效果，并与已建立的基于邮件的教育比较条件相比较，在这两种情况下进行6个月的团体电话减肥阶段。除了干预对减肥维持的影响外，这项研究还将提供两种情况下每公斤减重的增量成本效益估计，以及对二次结果的影响，包括生活质量、乳腺癌风险生物标记物、饮食摄入量和体力活动。我们的目标是以一种具有成本效益的方式，生产长期的减肥维持、相关的生物标志物调节，并提高生活质量，可以推广到难以接触到的农村幸存者。

DESCRIPTION (provided by applicant): Women who are obese at breast cancer diagnosis have a 1.5 to 2.5 increased risk of recurrence and death compared to their normal weight counterparts. Moreover, weight gain and decreased physical activity are common after diagnosis and also increase the likelihood of breast cancer recurrence and death. Rural women suffer from health disparities in breast cancer diagnosis and treatment. Women of the most rural counties also have the highest prevalence of obesity compared to urban women. To address these disparities, the overarching objective of this application is to develop a clinically effective and cost efficient strategy for delivering a weight control intervention to rural breast cancer survivors. Group phone-based treatment via conference call is a novel treatment delivery approach that we have shown to be effective for initial weight loss among rural breast cancer survivors and more effective than the standard individual phone-based approach among rural women. This innovative method of providing group treatment addresses access barriers in rural areas and may be especially ideal for rural breast cancer survivors because it provides social support in conjunction with a level of anonymity. Rural breast cancer survivors are more likely to be isolated, to have heightened concerns about privacy, and to report difficulty adjusting to breast cancer. At the same time, they have less access to professional support services, and thus are more likely to have unmet support needs surrounding both cancer and weight management. The opportunity to engage in lifestyle change with other survivors by phone may provide social support in a confidential setting at the same time it enhances diet, physical activity, and weight, as well as quality of life. However, the impact of group phone counseling during extended care for weight loss maintenance beyond six months remains unknown. Weight loss maintenance is the more challenging phase of treatment when weight regain is common, and this regain presents a potential risk for breast cancer recurrence. This randomized controlled trial will evaluate the effects of group phone-based treatment for weight loss maintenance among rural breast cancer survivors, compared to an established mail- based education comparison condition, subsequent to a six month group phone-based weight loss phase for both conditions. In addition to the intervention impact on weight loss maintenance, the study will provide estimates of incremental cost-effectiveness per kg loss between the two conditions and the impact on secondary outcomes including quality of life, breast cancer risk biomarkers, dietary intake, and physical activity. We aim to produce long-term weight loss maintenance, associated biomarker modulation, and improved quality of life in a cost-effective way that can be extended to hard-to-reach rural survivors.