The current offer of lifestyle behaviour change support to breast cancer survivors in England; to understand offer and uptake, barriers and facilitators (NIHR study 57719)

Introduction: Half of breast cancer survivors (BCS) are overweight/obese at diagnosis, and may have poorer treatment responses, increased recurrence, secondary cancers and increased overall and cancer-specific mortality than those with normal BMI. Multi-component lifestyle and behaviour change support (LBCS) comprising support for exercise, diet and psychological wellbeing has proven effective in reducing weight and improving quality of life, mental health, emotional and physical functioning. This study aimed to describe the current NHS LBCS offer and understand barriers/facilitators to offer and uptake.

Methods: National survey of healthcare practitioners (HCPs), BCS survey across four purposively sampled NHS Trusts, interviews with HCPs and BCS, stakeholder event to develop recommendations for practice.

Results: 144 HCP surveys were returned representing 47 NHS Trusts; 73% (n=105) were breast care nurses. Wellbeing support was most likely to be offered routinely (79.9%) with exercise (43.8%) and dietary support (47.2%) less likely. 304/965 (31.5%) BCS surveys were returned. Wellbeing support was most likely to have been offered (61.8%), exercise advice to 45.1%, dietary advice to only 14.1% with substantial variation between Trusts. 9% of responding patients were offered all three lifestyle support components. Primary interview (HCP n=10, BCS n=29) themes were service barriers: time, space and physical capacity, training and skills. Service enablers included dedicated clinics, reinforced messages, and individually-tailored support (See P145 Table 1).

Conclusions: Despite the effectiveness of multi-component LBCS, only 9% of BCS from participating Trusts reported receiving this support. Stakeholder workshop recommendations included need for dedicated guidelines, training to support provision and an LBCS framework to promote care equity.