IMPACT Breast Cancer: Investigating Mental Health, Physical Activity & Cognition during Treatment for Breast Cancer

Elizabeth Salerno, PhD, MPH, Assistant Professor, Surgery

The time period after a diagnosis of breast cancer is overwhelming with tremendous treatment-related physical, mental, cognitive, and financial burden. Unsurprisingly, the prevalence of mood disorders (e.g., anxiety, depression) are high in the perioperative breast cancer setting. Physical activity (PA) improves these symptoms during and after treatment for breast cancer, and new evidence suggests that PA can also help prevent cancer-related cognitive decline. Early intervention with PA, or prehabilitation, can further reduce the severity of other treatment-related side effects, surgical complications, and cost of care, representing a proactive approach to improving mental and cognitive health in the perioperative phase. However, this setting is complex, with fluctuating symptoms and high frequency of clinic visits. Such an environment has important implications for prehabilitation uptake and efficacy; patients are less likely to enroll in and adhere to PA programs that do not consider the time of highest mental and cognitive burden. PA dose and timing during breast cancer treatment are also unclear, largely due to traditional methodologies that cannot capture dynamic, real-time symptoms in patients’ natural settings. Further characterizing the inter-related nature of PA, mental health, and cognitive function during the perioperative breast cancer setting is necessary and important to design PA interventions that can be successfully scaled and implemented into routine cancer care. For such interventions to persist beyond grant work, early stakeholder participation during developmental stages is critical. We therefore propose a pre- implementation study in the perioperative breast cancer setting to: 1) characterize the relationships between PA and anxiety, depression, and cognitive function across chemotherapy and in the days surrounding surgery; 2) systematically explore the infrastructure necessary to support the implementation of a healthcare-integrated prehabilitation PA intervention; and 3) identify patients at highest risk of mental and cognitive health and PA decline over time. Preliminary data collected during this study can provide key insights into how PA, mental health, and cognitive function change in the perioperative setting, as well as important facilitators and barriers to implementing a targeted lifestyle intervention for patients newly diagnosed with breast cancer. This study has the potential to shift the paradigm in the way we consider standard of care rehabilitation during cancer survivorship.