Obese breast cancer survivors have increased risk of recurrence and death compared to their normal weight counterparts. Rural women have significantly higher obesity rates, thus weight control intervention may be a key strategy for prevention of breast cancer recurrence in this population. This one arm treatment study examined the impact of a group-based weight control intervention delivered through conference call technology to obese breast cancer survivors living in remote rural locations. The intervention included a reduced calorie diet incorporating prepackaged entrees and shakes, physical activity gradually increased to 225 min/week of moderate intensity exercise, and weekly group phone sessions. Outcomes included anthropomorphic, diet, physical activity, serum biomarker, and quality of life changes. Ninety-one percent of participants (31 of 34) attended > 75% of intervention sessions and completed post-treatment data collection visits. At 6 months, significant changes were observed for weight (-12.5 ± 5.8 kg, 13.9% of baseline weight), waist circumference (-9.4 ± 6.3 cm), daily energy intake (-349 ± 550 kcal/day), fruits and vegetables (+3.7 ± 4.3 servings/day), percent kcal from fat (-12.6 ± 8.6%), physical activity (+1235 ± 832 kcal/week; all p’s < .001), as well as significant reductions in fasting insulin (16.7% reduction, p = .006) and leptin (37.1% reduction, p < .001). Significant improvements were also seen for quality of life domains including mood, body image, and sexuality. In conclusion, the intervention produced > 10% weight loss as well as significant improvements across multiple endpoints. The group phone-based treatment delivery approach may help disseminate effective weight control intervention to hard-to-reach breast cancer survivors.

Objective Rural women are understudied in research on weight control among breast cancer survivors despite having higher obesity rates than their urban counterparts placing them at higher risk for recurrence. The purpose of this survey study was to describe weight status and methods used for weight control in rural breast cancer survivors and to examine psychosocial factors in this population associated with weight change since breast cancer diagnosis. Methods Women treated for breast cancer within the past six years at one of three rural Cancer Centers were mailed a survey with a cover letter from their oncology provider. Results Survey respondents (n = 918, 83% response rate) were 96% White non-Hispanic, on average 3.2 years from treatment, and 11% reported metastatic disease. Among respondents without known metastatic disease, 68% were overweight or obese, 37% were obese, and 25% reported a weight gain exceeding 5 kg since diagnosis. Among the overweight/obese women, 61% were currently attempting weight loss, and the most common weight loss method was dieting on one’s own without assistance. Psychosocial factors associated with weight gain since diagnosis included depression, fear of cancer recurrence, diminished physical strength, body image concerns, relationship changes, and financial stressors. Conclusions The high response rate indicates a general interest in body weight issues among rural BrCa survivors, and the findings highlight the need for weight control programs in this population. Findings also indicate that factors related to poor adjustment to breast cancer is associated with weight gain among rural women.

This study used secondary analysis of data from two studies of expressive writing about stressful relational events to first describe the relations of word use to social-cognitive maturity of role-taking using Feffer’s Interpersonal Decentering scoring system and then to test hypotheses about active processing of relational information versus event closure. This scoring system for imaginative Thematic Apperception Test stories was adapted for expressive writing protocols and related to proportions of cognitive and emotional words used, relationship characteristics, and the subjective experience of writing. Relational events included relationship breakups (including divorce), loved one’s illness or death, and abuse. Decentering maturity was positively correlated with cognitive and insight words and with positive emotion words in both studies’ narratives, and also with self-rated experiences of emotional intensity in the low closure group only. Gender differences were consistent with gender theories applied to relational stressors.