JMIR Publications

ABSTRACT

Background:

The 5-year survival rate for breast cancer (BC) has increased in recent years. However, functional limitations associated with BC treatment (e.g., loss of strength, fatigue, lymphedema) often have far-reaching effects on survivors’ physical and mental health. Aerobic physical activity (PA) and muscle strengthening exercise (MSE) can reduce functional limitations, and occupational therapy (OT) can support these health-promoting behaviors after treatment. Yet, barriers to access among BC survivors (e.g., time burden, distance to OT clinic) limit access to OT programming. This is particularly true in Oklahoma, where 33% of residents live in rural counties. Digital technologies (e.g., telehealth) can help rural and urban BC survivors circumvent these barriers.

Objective:

We are investigating the feasibility of a novel OT program among rural and urban BC survivors that features 1) eight once-weekly telehealth OT sessions targeting constructs grounded in Self-Determination Theory (SDT), and 2) self-regulatory strategies known to support aerobic PA and MSE in BC survivors including self-monitoring via a wearable PA tracker, goal setting, and the provision of timely feedback.

Methods:

This is a single arm feasibility trial. We are recruiting 38 BC survivors from local organizations, community-based advertising, and via referral from a collaborating oncologist. Participants include individuals who have undergone breast conserving surgery or mastectomy for BC in the last 12 months and who do not meet recommended PA levels at the time of enrollment. We will assess self-reported program acceptability and feasibility via recruitment rates, study retention, and protocol adherence. Program safety will be assessed by tracking BC-related lymphedema events, musculoskeletal injuries, and other adverse events. Finally, we will assess changes in aerobic PA and MSE participation during the program period using self-report and objective measurement tools.

Results:

We received funding in March 2024 and Institutional Review Board approval in September 2024. We began recruiting in November 2024, and we anticipate completing data collection by November 2025. We hypothesize that the SDT-grounded OT program will be acceptable, feasible, and safe. We also expect pre- to post-program improvements in 1) SDT-informed determinants of PA; 2) levels of aerobic PA and MSE engagement; and 3) health-related quality of life.

Conclusions:

The novel OT program under investigation is designed to decrease barriers to engaging in aerobic PA and MSE among people who have undergone breast conserving surgery or mastectomy. The study is focused on the transition from active treatment to the post-treatment period. The program combines tailored exercise instruction, guided by a qualified professional, with the benefits of telehealth delivery and health behavior change theory to adapt, modify, and integrate PA into the daily routines of people transitioning to life beyond cancer. If shown to be acceptable and feasible, this program will be amenable to widescale dissemination.