Abstract A068: Simulation modeling long-term outcomes associated with meeting aerobic activity guidelines among breast cancer survivors in the US

Abstract Background: Meeting aerobic activity (e.g., walking) guidelines may benefit breast cancer survivors; however, data on long-term outcomes considering survivors’ individual characteristics are limited. We evaluated the effects of meeting aerobic activity guidelines on life-years (LYs) and quality-adjusted life-years (QALYs) gained for breast cancer survivors in the U.S. Methods: We adapted an established discrete-event simulation model to estimate LYs and QALYs associated with meeting aerobic activity guidelines (≥150-minutes/week of moderate activity) (with or without muscle-strengthening activity (≥2-days/week)) (vs. no/minimal activity (<0.5 hours/week)) in a cohort of ∼20 million women diagnosed with stage I-III invasive breast cancer from ages 50-75 years. Model inputs were derived from trials, cohort studies, cancer registries, and national surveillance data. Model validation was conducted using publicly available data from the Women's Healthy Eating and Living (WHEL) study. We summarized LYs and QALYs for women stratified by age (50-59, 60-69, 70-75 years) and weight status (normal ≥18.5-<25kg/m2, overweight ≥25-<30kg/m2, obese ≥30kg/m2). QALYs were discounted at 3%. Results: Compared with no/minimal activity, meeting aerobic activity guidelines increased both QALYs and LYs. Overall, breast cancer survivors who met guidelines gained 485.3 QALYs and 1,088.6 LYs per 1,000 women compared to no/minimal activity. Considering age alone, the highest benefits were observed among survivors aged 60-69 years (1,139.7 LYs and 556.5 QALYs gained per 1,000 women). Gains were also observed for breast cancer survivors aged 50-59 years (844.3 LYs and 435.6 QALYs gained per 1,000 women); and 70-75 years (689.6 LYs and 468.7 QALYs gained per 1,000 women). Considering weight status alone, the highest benefits were observed among normal-weight survivors (1,205.6 LYs and 490.2 QALYs gained per 1,000 women). Gains were also observed for overweight breast cancer (916.5 LYs and 454.1 QALYs gained per 1,000 women); and obese (1024.6 LYs and 477.0 QALYs gained per 1,000 women). Considering both age and weight status, the greatest benefits were still observed among survivors aged 60-69 years. However, the relative ranking of gains by weight status changed, with obese survivors experiencing the highest gains (1,228.1 LYs and 583.2 QALYs gained per 1,000 women), followed by overweight survivors (1,148.0 LYs and 547.7 QALYs gained per 1,000 women), then normal-weight survivors (985.4 LYs and 509.1 QALYs gained per 1,000 women). The model closely replicated WHEL data for meeting aerobic activity guidelines (≥150-min/week) (e.g., 95% for 10-year all-cause survival rate). Conclusion: Meeting aerobic guidelines was associated with increased LYs and QALYs, with higher benefits seen among 60-69-year-old women with breast cancer. These findings indicate subgroups that may benefit most physical activity counseling and suggest a need for development of age- and weight-specific activity recommendations. Citation Format: Emma Tian, Oliver W.A. Wilson, Jacob Schneider, Jinani Jayasekera. Simulation modeling long-term outcomes associated with meeting aerobic activity guidelines among breast cancer survivors in the US [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A068.