Cancer-related cognitive impairment: Real-time evaluation and assessment of long-term impact of treatment on young adult survivors (CRCI REALITY)

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Project Summary/Abstract Of over 80,000 adolescents and young adults (AYA) diagnosed with cancer in the United States each year, 85% live for at least five years after their cancer diagnosis. Adolescence and early young adulthood is a critical period for frontal neurodevelopment, and cancer treatments potentially disrupt this neurodevelopment, leading to cognitive deficits known as cancer-related cognitive impairment (CRCI). An estimated 53% of these long-term early young adult (YA) survivors experience CRCI that interferes with their work and educational goals. However, sparse research using objective neuropsychological assessment does not detect CRCI as reported by YA survivors. Therefore, the goal of this K99/R00 application is to take the first step in an innovative program of research to characterize CRCI among this vulnerable survivorship population using ecologically valid assessments. Career Development Plan: The overall training objective is to provide Dr. Tometich with additional training and mentorship to become a highly qualified independent investigator with expertise in CRCI in the understudied population of AYA cancer survivors. Dr. Tometich’s training goals are to: 1) enhance her knowledge of cancer and cognition in AYAs, 2) acquire skills in cognitive and behavioral assessment methodologies, 3) develop proficiency in real-time longitudinal data analysis, and 4) continue professional development. During the K99 phase, Dr. Tometich will work under the primary mentorship of Dr. Heather Jim at Moffitt Cancer Center (an NCI-designated comprehensive cancer center) and co-mentorship of Dr. Brent Small. Experts in CRCI among AYA survivors are lacking nationally; therefore, a mentorship and advisory team will provide complementary expertise to address each aspect of the training and research content (additional advisors are Drs. Andrew Galligan, Martin Sliwinski, and Dinorah Martinez Tyson). Research Plan: The goal of this study is to evaluate long-term CRCI and potentially modifiable risk factors in YA survivors (i.e., age 18-30) using ecologically valid assessments. An existing cognitive ecological momentary assessment (EMA) has been developed and used by our research team in middle-aged breast cancer survivors, but it has not yet been applied in YA survivors. Furthermore, actigraphy can objectively measure two modifiable risk factors for CRCI (physical activity and sleep). In the K99 phase (i.e., Aims 1 and 2), we will use an iterative mixed-methods approach to tailor an EMA of CRCI and situational, behavioral, and contextual risk factors (SBCF) to the experience of YAs based on qualitative interviews with 20 YA survivors who report CRCI. We will then pilot the EMA and actigraphy in 25 YA survivors and make revisions as needed. In the R00 phase (i.e., Aim 3), we will recruit 150 YA survivors and 150 community controls matched on gender, age, and education for a cross-sectional study to evaluate CRCI and SBCF. Impact: The combined training and research plan will position Dr. Tometich to transition to independence as one of the few cancer control investigators specializing in CRCI in the vulnerable and unique population of AYA survivors.