Bridging the Gap: Evaluating why and how to implement lifestyle programs for cancer patients into routine clinical oncology care

摘要 越来越多的证据表明，乳腺癌确诊时肥胖与较差的存活率有关。 更少的研究描述了诊断后阶段的体重模式，或者探索了诊断后 体重模式会影响癌症的结果。那些有过的，有重要的限制，这使得它具有挑战性 得出强有力的结论，并将资源投向最合适的人群。然而，不利的作用是 肥胖与乳腺癌风险的关系推动了饮食和锻炼建议以及生活方式的发展 癌症预防和控制的行为计划。研究表明，这些都符合 建议可以改善总体生活质量、身体成分和死亡率的替代标记物 患有乳腺癌的女性。不幸的是，目前很少有乳腺癌幸存者在营养和身体方面达到 活动指南或报告与他们的肿瘤医生讨论饮食和锻炼。这突出了一个重要的 证据-实践差距的部分存在，因为到目前为止的研究主要集中在生活方式的有效性上 对如何将这些干预措施转化为临床实践的关注较少。 在RE-AIM(REACH、有效性、采用、实施和维护)框架的指导下， 本应用程序的目标是阐明将行为生活方式编程引入 常规肿瘤学护理，并演示如何以可扩展、可持续且经济高效的方式使用 以乳腺癌为模型。首先，我们将描述乳腺癌诊断后的体重模式 来自大型、多样化的医疗网络的电子健康记录数据。我们将应用新的纵向 确定可以从生活方式咨询中受益的人群的方法，并告知最合适的 是时候介入了。第二，我们将进行一项混合方法研究，以探索女性在 乳腺癌患者在化疗期间参加营养和运动干预。从病人的 从角度来看，我们的目标是揭示坚持的动机、偏好、感知到的障碍和促进者 以及在积极的癌症治疗期间维持营养和运动干预。最后，我们将估计 乳腺癌患者同样综合营养和运动干预的成本-效果分析 正在接受化疗，以提供关键数据，帮助扩大行为 肿瘤学环境中的干预措施。 耶鲁大学公共学院组建了一个由知名研究人员组成的跨学科团队 健康和耶鲁医学院提供直接的研究支持和专业发展 对申请者的指导。耶鲁大学拟议的研究和协作培训环境将 使申请人能够磨练她现有的技能，并获得专门的专业知识，这将使她在 具有竞争力的博士后职位和长期的独立研究员职业生涯，致力于实施 将生活方式行为咨询纳入肿瘤护理的标准。

Abstract Mounting evidence suggests that obesity at breast cancer diagnosis is associated with poorer survival. Far fewer studies have described weight patterns in the post-diagnosis period or explored how post-diagnosis weight patterns impact cancer outcomes. Those that have, had important limitations making it challenging to draw strong conclusions and direct resources to the most appropriate populations. However, the adverse role of obesity in breast cancer risk has driven the development of diet and exercise recommendations and lifestyle behavioral programs for cancer prevention and control. Studies have shown adherence to these recommendations can improve overall quality of life, body composition, and surrogate markers of mortality in women with breast cancer. Unfortunately, few breast cancer survivors currently meet the nutrition and physical activity guidelines or report discussing diet and exercise with their oncologist. This highlights an important evidence-practice gap which partially exists because research to date has focused on the efficacy of lifestyle interventions with less attention on how these interventions might be translated into clinical practice. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the goal of this application is to clarify the potential benefits of bringing behavioral lifestyle programming into routine oncology care and demonstrate how to do so in a scalable, sustainable, and cost-effective way using breast cancer as a model. First, we will describe weight patterns after breast cancer diagnosis by leveraging electronic health record data from a large, diverse healthcare network. We will apply novel longitudinal methods to define the population who could benefit from lifestyle counseling and to inform the most appropriate time to intervene. Second, we will conduct a mixed methods study to explore the experiences of women with breast cancer participating in a nutrition and exercise intervention during chemotherapy. From the patients' perspective, we aim to uncover motivations, preferences, and perceived barriers to and facilitators of adhering and sustaining a nutrition and exercise intervention during active cancer treatment. Lastly, we will estimate the cost-effectiveness of the same comprehensive nutrition and exercise intervention for breast cancer patients undergoing chemotherapy to provide critical data that can help inform the scaling-up of behavioral interventions in the oncology setting. An interdisciplinary team of renowned investigators was assembled from the Yale School of Public Health and the Yale School of Medicine to provide direct research support and professional development mentorship to the applicant. The proposed research and the collaborative training environment at Yale will enable the applicant to hone her existing skillsets and gain specialized expertise that will position her well for a competitive post-doctoral position and a long-term career as an independent investigator working to implement lifestyle behavioral counseling into the standard of oncology care.