Rural breast cancer survivors see benefits from participating in research

October 17, 2011

By Cynthia Mines

A research project focusing on the health of rural Kansas breast cancer survivors has produced a lot more than data: participants lost weight and camaraderie has flourished among the women who became acquainted during conference-call sessions.

Obesity is a risk factor for breast cancer recurrence, and 35 women from Hays, Pittsburg, and Salina who
participated in a preliminary study lost an average of 25.2 pounds, or 12.7 percent of their starting weight. Rural women are also considered to be at a higher risk for obesity and to have less access to health care.

"Their dedication and commitment make them amazing women to work with," said Christie Befort, PhD,
study director and KU Medical Center Preventive Medicine assistant professor. "The average weight loss has been higher than we expected."

A counseling psychologist by training, Befort combined her early clinical training work with cancer patients with a focus on researching obesity and developing behavioral interventions she has had since joining KU Medical Center. The two interests evolved into research on weight management among breast cancer survivors.

A $3 million grant from the National Cancer Institute will enable Befort to expand her study statewide and include 208 breast cancer survivors in rural areas across Kansas. The two-year weight-loss maintenance intervention program began Aug. 1.

"Our retention in this study was 90 percent, and almost all of them were really super-engaged in supporting one another," Befort said. "They bond because they have all gone through the process of being diagnosed and treated for breast cancer and are working on lifestyle changes to improve survival. There is a bond there that happens that's even greater than when we do weightloss intervention with the general public."

The intervention addresses weight management and survivorship/quality of life with weekly group phone meetings for six months, then bi-weekly follow-up for another 12 months. The new study will be for two years to study maintenance since maximum weight loss tends to occur at six months and then weight
is regained, according to Befort.

"Most people know obesity is a risk factor for developing breast cancer in post-menopausal women, but it's also a factor in recurrence," she said. "Weight as well as physical activity is huge."

Women who are obese at breast cancer diagnosis have a 1.5 to 2.5 increased risk of recurrence and death compared to their normal weight counterparts, Befort said. In addition, weight gain and decreased physical activity are common after diagnosis, which increases the likelihood of breast cancer recurrence
and death. Women who live in the most rural counties also have the highest prevalence of obesity compared to urban women.

"At the same time, (rural women) have less access to professional support services, and are more likely to have unmet support needs surrounding both cancer and weight management," she said.

Rural women also tend to be diagnosed later and at more advanced stages of breast cancer and are less likely to receive radiation and breast-conserving surgery. There is also a greater time between surgery and beginning chemotherapy.

Befort's first study tested the delivery mechanism. "How were we going to get this intervention to rural
women who can't come in? We found using conference calls so women could get feedback and support from each other was more effective than individual calls," she said. "Groups were used for efficiency, but we were also interested in how the group dynamic can improve outcomes. More weight loss occurred in
the group."

"We're going to help them with sustaining a lifestyle change," she said. "We've all been impressed by the women. It makes the work fun and exciting and worthwhile."

To be eligible to participate in the study, women must be within three months to 10 years of breast cancer treatment, have a BMI between 25 and 45, and live in designated rural zip codes. Women interested in participating in the study should contact Heather Austin, MS, RD, at or 913-588-3030.

This story originally appeared in the Summer 2011 edition of Kansas Connections.

Last modified: Nov 09, 2011