Geographic Recruitment of Breast Cancer Survivors into Community-Based Exercise Interventions
Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, USA. Medicine and science in sports and exercise
(Impact Factor: 3.98).
08/2009; 41(7):1413-20. DOI: 10.1249/MSS.0b013e31819af871
There is increased interest in developing and disseminating health behavior interventions for cancer survivors. Challenges in these efforts include participant burden in traveling to central intervention sites and sustainability. The purpose of this article is to report various methods used to recruit breast cancer survivors into an exercise intervention that attempts to address both of these challenges.
Letters were mailed within specific zip codes near community-based intervention sites in cooperation with state cancer registries. Additional recruitment methods included flyers at breast care clinics and support groups, mass media, and conferences.
Of the 3200 women who responded, 82% (n = 2625) identified having heard about the study through state or hospital registry and 8% (n = 243) through print and broadcast media. Thirty-five percent (n = 103) of randomized women self-identified as having a minority racial background and 31.9% (n = 94) self-identified as African American. Comparisons of participant age and racial distribution to state cancer registries indicate similar age distribution but greater racial diversity among participants.
These results support the use of population-based cancer registries to recruit survivors into community-based interventions and clinical trials.
Figures in this publication
Available from: Cynthia R Gross
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ABSTRACT: Lymphedema is a chronic and progressive long-term adverse effect of breast cancer treatment commonly defined by swelling of the affected arm. Current clinical guidelines indicate that women with and at risk for lymphedema should protect the affected arm from overuse. In clinical practice, this often translates into risk aversive guidance to avoid using the arm. This could lead to a disuse pattern that may increase the likelihood of injury from common activities of daily living. Further, such guidance poses an additional barrier to staying physically active, potentially translating to weight gain, which has been shown to be associated with worse clinical course for women with lymphedema. We hypothesize that a program of slowly progressive strength training with no upper limit on the amount of weight that may be lifted would gradually increase the physiologic capacity of the arm so that common activities represent a decreasing percentage of maximal capacity. Theoretically, this increased capacity should decrease the risk that daily activities put stress on the lymphatic system of the affected side. The Physical Activity and Lymphedema (PAL) Trial is a recently completed randomized controlled exercise intervention trial that recruited 295 breast cancer survivors (141 with lymphedema at study entry, 154 at risk for lymphedema at study entry). The purpose of this report is to provide detail regarding the study design, statistical design, and protocol of the PAL trial.
Contemporary clinical trials 02/2009; 30(3):233-45. DOI:10.1016/j.cct.2009.01.001 · 1.94 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the impact of a twice-weekly strength training intervention on perceptions of body image in 234 breast cancer survivors (112 with lymphedema) who participated in the Physical Activity and Lymphedema (PAL) trial. The study population included two hundred and thirty-four women randomly assigned to twice-weekly strength training or control group that completed the 32-item Body Image and Relationships Scale (BIRS) at baseline and 12 months. Percent change in baseline to 12-month BIRS total and subscale scores, upper and lower body strength, and general quality of life (QOL) were compared by intervention status. A series of multiple linear regression models including indicator variables for subgroups based on age, marital status, race, education, BMI, and strength change were used to examine differential intervention impact by subgroup. Strength and QOL variables were assessed as mediators of the intervention effect on BIRS. Results: Baseline BIRS scores were similar across intervention and lymphedema status. Significantly greater improvement in BIRS total score was observed from baseline to 12 months in treatment vs. control participants (12.0 vs. 2.0%; P < 0.0001). A differential impact of the intervention on the Strength and Health subscale was observed for older women (>50 years old) in the treatment group (P = 0.03). Significantly greater improvement was observed in bench and leg press among treatment group when compared to control group participants, regardless of lymphedema. Observed intervention effects were independent of observed strength and QOL changes. Twice-weekly strength training positively impacted self-perceptions of appearance, health, physical strength, sexuality, relationships, and social functioning. Evidence suggests the intervention was beneficial regardless of prior diagnosis of lymphedema. Strength and QOL improvements did not mediate the observed intervention effects.
Breast Cancer Research and Treatment 09/2009; 121(2):421-30. DOI:10.1007/s10549-009-0550-7 · 3.94 Impact Factor
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ABSTRACT: This report describes recruitment of minority cancer survivors for a randomized trial of I Can Cope, a support program of the American Cancer Society. Survivor Education and Evaluation (SURE), was designed to recruit patients, age 19 and older, with a primary cancer diagnosis. Recruitment was primarily carried out in a public hospital in Birmingham, Alabama. Of 373 patients approached, 226 were eligible for the study, 175 consented, and 140 were randomized during the 20-month recruitment period. Only 43 declined participation. This resulted in a 61.9% recruitment yield. The mean age of participants was 54.2 years (SD=10.9), 92 (65.7%) were female, and 111 (79.3%) were African American. Twenty-three different cancers were represented including breast (37.1%), colorectal (12.1%), hematologic (12.9%), and lung (7.1%). Over half (63%) had been diagnosed within 12 months. The experience of the SURE project provides evidence for optimism in recruiting racial minorities to cancer research studies.
Journal of Health Care for the Poor and Underserved 08/2011; 22(3):912-24. DOI:10.1353/hpu.2011.0069 · 1.10 Impact Factor
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