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Breast cancer (BC) is an important health concern in the United States and is the most common cancer diagnosis among American women. An estimated 181,600 incident cases and 44,190 deaths due to BC are projected to occur in 1997. The incidence of BC in older women is 300 per 100,000, of approximately five times the incidence in younger women. For the increasing majority of women who survive their cancer, an important issue is successful readjustment and resumption of daily activities and quality of life. These challenges are greatest among older women who likely have experienced physical deconditioning and reductions in social supports with aging. Cancer and major malignancies are among the incident illnesses strongly associated with functional status and are associated with restricted activity days comparable in number to diabetes and osteoporosis. A key pathway for this decline appears to be periods of physical inactivity and emotional distr5ess from cancer or its treatment. The proposed intervention study is a controlled clinical trial (2X2 factorial design) which will test and compare the efficacy of two modalities in general rehabilitative medicine to enhance patient outcomes: patient education and support programs, and training to increase daily activity in the community. The study will enroll 212 women, 50 years of age and older, recently diagnosed with stage 0-2 BC and follow them for 18 months. The primary outcome measures are the 6-minutes walk (physical fitness) and the FACT-BC (comprehensive HRQL). In phase I, subjects will be randomized to 3 months of either enhanced usual care (patient information about existing support services, a patient newsletter and a monthly follow-up telephone contact) or a comprehensive psychoeducational program. In phase II, subjects will be re-randomized to exercise or to the usual care condition, and followed for 15 months. The primary aims of the study are to determine if: 1) A moderate exercise program, as compared to enhanced usual care (UC+), significantly improves the physical functioning and HRQL in older women with BC; and 2) A psychoeducational program, as compared to UC+, significantly improves physical functioning and HRQL in older women with BC.
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