Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

PROACTIVE-B: Lessons learned from conducting Exercise Oncology Research for Neoadjuvant Breast Cancer in a Hospital Supportive Care Department (#273)

Shelley Kay 1 , Suzanne J Grant 1 2 , Judith Lacey 1 2 , Sanjeev Kumar 3 , Kim Kerin-Ayres 1 , Justine Stehn 1 , Maria Gonzalez 1 2 , Katerina Zavitsanou 1 , Sandra Templeton 1 , Gillian Heller 4 , Jane Cockburn 5 , Ki Kwon 1 , Ainsley Bell 1 , Catherine Seet-Lee 1 , Susannah Graham 6
  1. Supportive Care and Integrative Oncology Department, Chris O’Brien Lifehouse Comprehensive Cancer Centre, Sydney, NSW, Australia
  2. NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
  3. Medical Oncology Department, Chris O’Brien Lifehouse, Sydney, Australia
  4. NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia
  5. Consumer, Australia
  6. Surgical Oncology Department, Chris O’Brien Lifehouse

Background: An exercise oncology clinic located within a hospital setting optimises access to supervised exercise during consecutive neoadjuvant systemic therapies (NAST) in women with high-risk, early breast cancer. Individualised exercise adapted to fluctuations in symptom burden over the treatment cycle can attenuate treatment-related toxicities. Other supportive care modalities provide additional and synergistic benefits for symptom control.

Objective: To assess the feasibility, acceptability, safety, and preliminary outcomes of a multimodal support program- PROActive-B - for women undergoing neoadjuvant systemic therapy for breast cancer.

Methods: This mixed-methods, pretest–post-test feasibility study was conducted at the Chris O’Brien Lifehouse, Sydney. Women receiving NAST participated in a 20-week program comprising: (1) supervised resistance-based exercise; (2) holistic nursing assessments; (3) symptom monitoring with stepped-care referrals (e.g., acupuncture, massage); and (4) education sessions. Primary outcomes were feasibility and acceptability (AIM, IAM, FIM). Secondary outcomes included physical function, body composition, self-efficacy (CBI-B), quality of life (FACT-B), surgical outcomes and cost.

Results: Thirty women were assessed, 23 enrolled (92%) and 21 completed the program (95% follow-up). Exercise adherence was 80% with no serious adverse events. Leg press strength increased from median 107.5 kg to 137.5 kg; 15 participants increased muscle mass during treatment. FACT-B scores declined during chemotherapy but exceeded baseline at six-month follow-up. Self-efficacy improved (CBI-B: 91 to 103), and distress scores decreased. Symptom monitoring led to 127 occasions of service for integrative therapies. Average program delivery cost was AUD3,600 per patient. Qualitative feedback supported the program’s individualisation and value.

Conclusion: Although there were higher demands on exercise physiology staff in conducting the exercise intervention along with supervision of non-research patients, intervention fidelity resulted in positive physiological and psychological outcomes. Data collection for exercise RDI was achieved but more challenging within the clinic setting. Flexible scheduling and social support from the staff and other patients were valued by patients. Supervised strength training as part of a multimodal, symptom-guided supportive care program during neoadjuvant therapy for breast cancer is feasible, safe, and well accepted with potential to improve treatment experience.

This work is part of the PROActive-B study (protocol published in BMJ Open [doi.org/10.1136/bmjopen-2023-080239]).