Purpose: Women diagnosed with breast cancer who are affected by excess weight are at increased risk of recurrence and mortality. The Diabetes Remission Clinical Trial demonstrated that Total Diet Replacement (TDR) within a behavioural weight management programme could support people with type 2 diabetes to lose weight and achieve remission. In the UK, the National Health Service now offers primary care referrals to this programme for people with type 2 diabetes. If similar weight losses could be achieved for women with breast cancer affected by excess weight, it could mitigate breast cancer recurrence risk. However, definitive evidence is needed. We worked with a commercial provider to explore if this programme could be adapted for women diagnosed with breast cancer with a high body mass index (BMI ≥27) as part of the WE SURE CAN pilot trial.

Methods: During the trial set-up for WE SURE CAN a series of meetings were held with the commercial provider to identify where adaptations may be needed to ensure suitability for the target population. Input from the wider trial management group including patient representatives was provided as required. Key considerations included the safety of participants, referral to the programme outside of the primary care context, Covid-19, the geographical spread of potential participants, and staff knowledge around breast cancer.

Results: Several adaptations were made to the standard delivery of the weight management programme. These included 1) amended eligibility criteria, which were adapted as the trial progressed; 2) a two-stage screening process including communication with primary care to enable GPs to flag relevant concerns and support additional monitoring for pre-existing conditions; 3) remote delivery of the programme; and 4) development and provision of a brief training session on breast cancer for dietitians involved in the delivery of the intervention including information on common symptoms and red flags for recurrence.

Conclusions: It was possible to adapt a weight management programme incorporating TDR for women with breast cancer. Qualitative interviews are exploring experiences of delivering and receiving the programme. Pilot trial results will indicate adherence and if observed weight losses are similar to those in chronic-disease populations.

Purpose: Among individuals with a history of cancer, overweight and obesity (ow/ob) increases risk of recurrence, second primary cancers, and cardiometabolic disease. While multiple health behavior change interventions have demonstrated efficacy in improving lifestyle behaviors and achieving weight loss, the majority of survivorship programs focus on singular aspects of behavior change. Further, translation to clinical practice is sparse, and few individuals have access to survivorship programming as part of standard of care in real-world settings. Adapting existing programs to incorporate multiple health behaviors may be an effective strategy to increase access to sustainable comprehensive survivorship programs.

Methods: We partnered with potential program adopters from multiple levels to co-design a survivorship nutrition program, BfedBwell, for integration within an existing 12-week clinical exercise oncology program, BfitBwell. Co-designers included: (1) content experts with knowledge of survivorship guidelines and practices; (2) program delivery staff with experience providing nutrition and/or exercise interventions; and (3) individuals with a history of cancer and ow/ob. The Practical Robust Implementation and Sustainability Model framework guided intervention planning and evaluation. Semi-structured interview guides were created to collect information on factors affecting the organization and individuals to be served. One-on-one “think aloud” interviews were completed during several human-centered design cycles. Interviews were recorded for audio transcription, and rapid qualitative analysis was conducted to create a summary matrix to guide program development.

Results: Fifteen co-designers completed two rounds of interviews. Individuals identified key messaging and topics desired for inclusion in the program curriculum and provided feedback on mode of delivery, dose, frequency, wanted features, and perceived facilitators and barriers to participation and clinical implementation. Individuals requested content related to both nutrition (e.g., recipe development, label reading) and social/mental wellbeing (e.g., fostering resilience, acceptance of change, stress reduction). Most preferred weekly touchpoints delivered in a hybrid fashion combining remote and in-person sessions.

Conclusions: Rapid qualitative analysis informed intervention development, ensuring relevant content creation and encouraging co-designer buy-in. BfedBwell will undergo proof-of-concept testing to evaluate feasibility and acceptability of the integrated intervention. Results will inform delivery of a pilot trial to determine a set of optimal intervention components prior to advancing to efficacy testing.

Purpose: Rural-urban disparities exist in cancer-related outcomes across the United States. Central to many rural states’ community infrastructure is the Cooperative Extension Service (“Extension”), a long-standing conduit between agriculture experts and rural communities. This has been expanded via the Family and Consumer Sciences (FCS) arm of Extension (e.g., obesity and diabetes prevention). No current program exists for FCS to support individuals living with and beyond cancer (LWBC). The purpose of this study was to co-design a diet- and lifestyle-focused survivorship program for Extension, while identifying barriers to and facilitators of implementation.

Methods: Using purposive sampling, 10 post-active treatment adults LWBC and 10 FCS Oklahoma State Extension Educators were identified in counties within the top quartile of cancer incidence. Participants completed a survey and semi-structured interview to assess preferences and ideas for an Extension survivorship program. Survey data were analyzed using descriptive statistics. Interviews were transcribed verbatim, reviewed, and triangulated with evidence regarding the needs of survivors to identify program priorities. Deductive coding was done using the Consolidated Framework for Implementation Research (CFIR) to identify barriers to and facilitators of program implementation.

Results: Adults LWBC included 80% women and 20% men, aged 32-72 years. Extension Educators were all women across 10 counties, aged 30-67 years. Curriculum foci include diet, exercise, mental health, and social support; these are in line with current evidence focused on lifestyle (e.g., fruit/vegetable intake) and mental health (e.g., loneliness). Across CFIR domains, barriers identified by adults LWBC included scant familiarity with Extension and concerns regarding incompatibility of personal views with other community members’ (e.g., religion). Barriers per Extension Educators included disconnects between Extension and healthcare providers, and program attendance. Facilitators identified by adults LWBC included a desire for diet and exercise-related information and a current lack of support programs. Facilitators identified by Extension Educators included existing infrastructure and high-quality training to support implementation.

Conclusion: Adults LWBC reported a desire for continued support post-active treatment, emphasizing diet, exercise, and mental health. Extension Educators endorsed strong compatibility between the needs of adults LWBC and the infrastructure and expertise of Extension, with several opportunities to ensure effective implementation.