Episodic Future Thinking: A Behavioral Intervention to Promote Weight Loss in Breast Cancer Survivors (Alliance A21-Pilot10).

PURPOSE: Obesity in breast cancer survivors (BCS) increases mortality, but lifestyle interventions have mixed outcomes. Episodic future thinking (EFT), in which individuals mentally simulate positive personal future-oriented events, has shown to reduce body weight (BW) and delay discounting (DD; the tendency to value delayed rewards less). How EFT affects BW reductions in BCS is unknown. This phase II trial evaluated the feasibility and preliminary efficacy of EFT in reducing BW in BCS with overweight/obesity.

METHODS

Women with nonmetastatic BC who completed treatment with a BMI ≥25 kg/m2 were enrolled. Patients were randomly assigned 1:1 to EFT or control (episodic recent thinking [ERT], where individuals mentally simulate positive personal recent events) and stratified by baseline DD; they received text message cues thrice daily for 12 weeks. The primary end point was EFT adherence. Secondary end points were changes in BW and DD.

RESULTS

We included 46 participants; 17/23 (74%) in EFT and 19/23 (83%) in ERT completed the intervention; 83% had low baseline DD (<0.0025). EFT adherence approached the 80% target to establish feasibility (EFT, 77% [95% CI, 0.69 to 0.85]). ERT had similarly high adherence (82% [95% CI, 78 to 86]). BW decreased overall (-2.01% [95% CI, -3.06 to -0.97]; P < .001) but did not differ between EFT and control. The 12-week change in DD did not significantly differ between groups.

CONCLUSION

A telehealth delivered behavioral intervention for weight loss is feasible in BCS, demonstrated by high participant adherence. Additional research is needed to elucidate EFT as well as ERT's comparable role in modulating DD and as an adjunct to lifestyle interventions for weight loss in BCS.