Clinical, demographic, and contextual determinants of older breast cancer survivors' reports of discussions about exercise with healthcare providers.

Abstract

e22549 Background: Exercise offers various benefits to older breast cancer survivors, but studies report that healthcare providers do not frequently engage in discussions about exercise in clinical practice. The purpose of this study was to evaluate the clinical, demographic, and contextual determinants of receiving exercise advice from healthcare providers among older breast cancer survivors in the U.S. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries linked to the Medicare Health Outcomes Survey (MHOS). Participants included women diagnosed with histologically confirmed invasive breast cancer from 2008-2015 who were 65+ years of age and had completed a MHOS survey at least two years after diagnosis. Descriptive statistics were calculated. We conducted a multivariable logistic regression analysis to identify clinical, demographic, and contextual variables associated with the likelihood of receiving exercise advice from a healthcare provider. Results: The sample of breast cancer survivors (n = 1,836) included 960 who received exercise advice and 876 who did not. The median age of the women in the sample was 76.2 years (range: 67.0-100.6). Survivors who were American Indian/Alaska Native/Asian or Pacific Islander (Odds Ratio (OR): 1.54; 95% Confidence Interval (CI): 1.09-2.18) or who had overweight (OR: 1.50; 95% CI: 1.17-1.91) or obesity (OR: 1.71; 95% CI: 1.31-2.23) were significantly more likely to receive exercise advice. In contrast, survivors who were never married (OR: 0.60; 95% CI: 0.37-0.96), had a high school degree (OR: 0.73; 95% CI: 0.58-0.92) or less (OR: 0.55; 95% CI: 0.42-0.73), were underweight (OR: 0.59; 95% CI: 0.36-0.95), or who were older (OR: 0.98; 95% CI: 0.96-0.99) had lower odds of receiving advice about exercise. The associations varied by type of comorbidity. Conclusions: Individual clinical and contextual characteristics of breast cancer survivors were associated with the likelihood of receiving exercise advice in a clinical setting. The consideration of the patients’ full range of circumstances when discussing and advising about exercise could potentially improve the overall quality of survivorship care. A personalized clinical decision tool could support individualized discussions about exercise in clinical settings.