Developing a Stakeholder-Driven Cancer Rehabilitation Intervention for Older Adults with Breast Cancer

Abstract

The number of older adult breast cancer survivors is rapidly growing. Yet with survival, this population often experiences high, persistent rates of cancer-related disability. This disability manifests in the form of activity limitations or difficulties executing daily activities that older adult breast cancer survivors need or want to do. Despite efforts to improve detection of activity limitations and referral to rehabilitation services, cancer rehabilitation remains underutilized in this population. The focus of this dissertation was threefold. First, we examined the state of the science related to nonpharmacological interventions influencing activity limitations in older breast cancer survivors. We identified that existing interventions 1) are frequently complex in nature; 2) incorporate adaptive skills training, behavioral strategies, and exercise; 3) vary in delivery features; and 4) are associated with a wide range of effect sizes. The best combination of interventions and delivery features remain unclear. Second, we conducted semi-structured interviews with older breast cancer survivors to identify preferences for cancer rehabilitation interventions. We learned that the choice to pursue cancer rehabilitation is influenced by emerging awareness of disability, coping styles, comparisons with others, provider interactions, perceptions of cancer as a lifelong project, social support, and cost of rehabilitation. Participants’ preferences for intervention content varied but included some desire for interventions that provide peer support, healthy behavior training, and symptom management. Participants preferred interventions delivered in outpatient clinics or community-based settings. Third, we compiled findings from the scoping review and stakeholder interviews for expert panel review and consensus. Using a modified Delphi process, panelists rated intervention content and delivery features according to feasibility and prioritization. Our results revealed high consensus for intervention content including physical activity and adaptive skills training as well as interventions delivered in outpatient clinics or post-treatment, through a combination of in-person and virtual visits, lasting no more than 3 months, and occurring biweekly. Overall, these findings provide important evidence-based, stakeholder-informed directions for future intervention research in cancer rehabilitation. These findings can be used to inform the development, testing, and implementation of valued and accessible interventions to address activity limitations among older breast cancer survivors