Practice Note Breast cancer survivors: Taking charge of lifestyle choices after treatment Linda Muraca a, * , Doris Leung b , Andrea Clark a , Mary Agnes Beduz a , Pamela Goodwin a a Marvelle Koffler Breast Centre, Mount Sinai Hospital, 600 University Avenue, Room 1285C, Toronto, Ontario M5G1X5, Canada b Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada Keywords: Breast neoplasms Cancer patients Obesity Overweight Body mass index Exercise therapy or exercise Group exercise Diet therapy Psychological model Transtheoretical model of change Introduction Improvements in cancer detection and breast cancer treatment have resulted in a growing population of breast cancer survivors (Hewitt et al., 2007). Canadian population-based studies indicate a higher prevalence of obesity and lower levels of physical activity among cancer survivors compared with the general population (Courneya and Friedenreich, 2007). Life expectancy for breast cancer survivors has been steadily increasing, however those with a higher body mass index (BMI) and low physical activity levels are not only at increased risk of cancer recurrence and arm lymphe- dema but they could also develop co-morbidities common to aging such as diabetes, hypertension, cardiovascular diseases and osteo- arthritis (Chlebowski et al., 2002; Goodwin et al., 1998). Unhealthy weight levels have been negatively associated with quality of life variables such as mood disturbances, sleep, fatigue and reduced overall physical functioning (Rooney and Wald, 2007). There is a significant need to develop effective interventions that will motivate women with early-stage breast cancer to manage their weight long-term by making better dietary choices and increasing their physical activity. There are several obstacles to weight loss and its maintenance and the diagnosis of breast cancer, itself, is not a significant moti- vator to lose weight. Health professionals are positioned to take advantage of the ‘‘teachable moment for making positive lifestyle changes’’ created by the diagnosis (Demark-Wahnefried et al., 2005). Health promotion experts suggest that the development of effective weight loss or maintenance programs should be guided by behavioural change theory. The use of theory can help program developers better understand why individuals change their behaviours and the underlying variables that may affect their choices (Pinto and Floyd, 2008), ultimately leading to the creation of more effective interventions. The Transtheoretical Model of Change (TTM) integrates several key constructs from various behavioural theories. Unlike other models, it focuses on individual decision-making and intention to change along with increasing self-efficacy or confidence (Prochaska et al., 1994). In the TTM model, behaviour change is a process wherein individuals move from one stage to another (Table 1). Completing one stage of change and moving to the next is deemed a success that can further motivate survivors to either maintain or achieve a healthy weight. The TTM model has been used with some success in a small number of health promotion interventions to improve diet and exercise in specific cancer populations (Pinto and Floyd, 2008). Program development The Marvelle Koffler Breast Centre at Mount Sinai Hospital in Toronto, Ontario provides a variety of services to women diagnosed with breast cancer. Many breast centre patients frequently request information about managing their weight and making healthy lifestyle choices. Oncologists in our centre support weight loss for their patients but often did not have effective strategies to offer them. To address this, the Centre’s medical director and advanced * Corresponding author. Tel.: þ1 416 586 4800x5190; fax: þ1 416 586 8659. E-mail address: lmuraca@mtsinai.on.ca (L. Muraca). Contents lists available at ScienceDirect European Journal of Oncology Nursing journal homepage: www.elsevier.com/locate/ejon 1462-3889/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejon.2009.12.001 European Journal of Oncology Nursing 15 (2011) 250–253