Developing and testing weight management interventions to improve outcomes for seldom reached women affected by obesity and diagnosed with breast cancer - the FORALL study

Project Description

Background
Women and men living in the most deprived areas are more likely to be affected by obesity than those living in the least deprived areas, and experience poorer outcomes following a diagnosis of cancer. Obesity is linked to the risk of prostate and postmenopausal breast cancer. It is also associated with poorer survival outcomes for both prostate and breast cancer, increases risk of co-morbidities, and negatively affects psychosocial outcomes. Randomised controlled trials have demonstrated that weight management interventions can improve quality of life and have favourable cardio-metabolic effects in prostate and breast cancer patients. However, the majority of trials to date have included samples that are biased towards well-educated and white populations, and have not considered if interventions are supporting all groups of the population equally.

Aim:
To understand the barriers and enablers to engagement and to address major uncertainties in the design of interventions for overweight/obese people from socially deprived communities diagnosed with breast and prostate cancer.

Methods
We are aiming to apply for NIHR Programme Development Grant (PDG) funding to support two work packages, as follows:
Work package 1 (WP1)
The aim is to conduct the following formative work:
i) A rapid review of the recent literature, with a focus on:
a) recruiting individuals from socially disadvantaged groups to health behaviour change intervention studies.
b) supporting individuals from these groups with weight management
ii) Qualitative work with healthcare professionals:
To gain insight into their beliefs, attitudes and experiences of weight management, diet, and physical activity services, interventions and trials for overweight/obese people living with and beyond cancer, including perceived barriers to offering them to all, and perceived uptake across population groups. This qualitative work will also explore experiences of-, challenges, opportunities and successes of engaging cancer survivors from socially disadvantaged populations in treatment, support for health behaviour change, and long-term interactions.

Work package 2 (WP2)
This will include qualitative work with patients from the targeted populations to explore barriers and enablers to research participation and weight management behaviours (dietary behaviours and physical activity), including barriers and enablers to adherence and the use of digital technologies in this context. We will also explore acceptability of recruitment and intervention timings in relation to treatment modalities and stage of treatment within the care pathway.

Formative work from WP1 and WP2 will inform the development of a future NIHR Programme Grant application to develop (or adapt existing) intervention content and/or processes to increase engagement/recruitment amongst socially-disadvantaged groups, develop a protocol for delivery of a feasibility study, leading onto a definitive Randomized Control Trial (RCT). A key aim of the latter will be to demonstrate increased engagement in weight management health behaviours (i.e. recruitment, adherence, weight loss maintenance) amongst overweight/obese breast and prostate cancer patients from socially-deprived communities.