Abstract
Introduction: The MEDEA (NCT04303924) RCT evaluated a phone-based educational and counselling intervention for weight loss (adapted from BWEL A011401) focused on calorie restriction and behavior change among overweight and obese survivors of BC in France. Patient’s acceptability and engagement with weight loss interventions can be influenced by cross-country cultural differences related to dietary, social and behavioral habits. We performed a qualitative study to explore these aspects and inform future implementation. Methods: 220 patients with stage I-III BC within 12 months of primary treatment and BMI ≥25 kg/m2 participated in the MEDEA trial and were randomized to receive the phone-based weight loss intervention delivered by dieticians through 24 semi-structured calls over 12 months vs. a standard health educational program. 20 patients in the intervention arm participated in focus groups to explore barriers and facilitators for uptake and engagement, as well as acceptability, satisfaction, and suggestions of improvement. A thematic content analysis was performed using Nvivo 12 software. Results: Four focus groups were conducted with patients from diverse sociodemographic and economic backgrounds. Patients had mostly positive representations. Several themes emerged:
1) Patients expressed satisfaction with the objective weight loss and improvement in symptom burden:
“I'm very satisfied with the weight loss, that's for sure.”
“My self-image improved, I find that I'm much more toned, I'm more energetic. I have less pain. I sleep better.”
2) Patients referred to the MEDEA intervention as a catalyzer to sustainable behavior change:
“It helped me a lot because it made me understand that I was eating too much of some food categories and not enough of others. It allowed me to balance my meals.”
“I didn't have motivation anymore and she really coached me, she taught me again to feel like exercise, to boost myself, to walk, and now I've become an addict, I do 2.5 hours of sport per day.”
3) Most of them stressed the convenience of remote intervention:
“It's much better over the phone because it would have been a constraint to free up time to go to in-person meetings.”
Nevertheless, patients highlighted some barriers to uptake and engagement and suggestions for improvement.
1) Need for tools to sustain engagement such as a follow-up call, psychological support and enabling/facilitating self-monitoring:
“If we had a call from the dietician six months after [the end of the intervention], it would help to keep the momentum on which we started.”
“I would have liked to have a summary of my weight loss. A small conclusion on a diagram to see the evolution.”
“I don't know if a psychologist could be included in MEDEA, but in any case it would be a good thing or that the coaches refer to psychologists.”
2) Need for culturally adapted content:
“Sometimes it was more like an American-style method, in terms of food. The menu planning, it's not very French.”
3) Patients advocated for a more patient-centered research ecosystem (e.g. selection of patient-reported outcomes measures, communication and community building):
“I think it would be interesting to have some of the results of the study.”
“I would have liked to meet the women who did the same program, to talk to them.”
“The food questionnaire is horrible to fill out! […] The last one I still haven’t filled it, because it annoys me so much that I forgot.”
Conclusions: The MEDEA intervention was deemed acceptable and positively experienced suggesting that a North American weight loss intervention was scalable and adaptable to a different language and cultural context. This qualitative analysis also informed refinements to optimize weight loss interventions in a European context.
Citation Format: Antonio Di Meglio, Laurence Vanlemmens, Carine Segura-Djezzar, Carole Bouleuc, Olivier Tredan, Barbara Pistilli, Tracy E. Crane, Davide Soldato, Cécile Charles, Aude Barbier, Bruno Raynard, Anthony Mangin, Bernadette Coquet, Guillemette Jacob, Julia Bonastre, Stefan Michiels, Dan Chaltiel, Fabrice André, Jennifer A. Ligibel, Ines Vaz-Luis, Maria Alice Franzoi. Experience and perceptions with a phone-based weight loss intervention among survivors of breast cancer (BC) in France: a qualitative study within a randomized clinical trial (RCT) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-05-12.