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

弥合差距：评估为什么以及如何将癌症患者的生活方式计划纳入常规临床肿瘤护理

• 批准号: 10537165
• 负责人: Leah Puklin
• 金额: $ 4.68万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-16 至 2024-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10537165
• 关键词: Adherence; Attention; Base Ratios; Behavior; Behavior Therapy; Behavioral; Body Composition; Body Weight Changes; Body mass index; Breast Cancer Model; Breast Cancer Patient; Breast Cancer Risk Factor; Breast Cancer Treatment; Breast Cancer survivor; Cancer Center; Cancer Control; Cancer Hospital; Cancer Patient; Cancer Prevention Intervention; Caring; Clinical Oncology; Cost Effectiveness Analysis; Counseling; Data; Development; Diagnosis; Diet; Dietary Intervention; Dose; Effectiveness; Electronic Health Record; Environment; Ethnic Origin; Exercise; Funding; Future; Goals; Growth; Guidelines; Healthcare; Hospitals; Inflammatory; Intervention; Interview; Investments; Life Style; Maintenance; Malignant Neoplasms; Measures; Mentorship; Methodology; Methods; Modeling; Motivation; Newly Diagnosed; Obesity; Oncologist; Oncology; Outcome; Patient Self-Report; Patients; Pattern; Persons; Physical activity; Population; Positioning Attribute; Postdoctoral Fellow; Public Health Schools; Quality of life; Race; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Recurrence; Reporting; Research; Research Personnel; Research Support; Resources; Retrospective cohort; Risk; Role; Serum; Structure; Surrogate Markers; Survival Rate; Survivors; Thinness; Time; Training; Translating; Treatment Side Effects; Tumor Tissue; Weight; Weight maintenance regimen; Woman; Work; active method; age difference; base; behavior change; breast cancer diagnosis; cancer prevention; cancer therapy; career; chemotherapy; clinical practice; cost; cost effective; cost effectiveness; cost estimate; cost-effectiveness ratio; design; diet and exercise; exercise intervention; experience; hazard; health organization; healthy lifestyle; hormone therapy; implementation science; improved; incremental cost-effectiveness; insight; lifestyle intervention; malignant breast neoplasm; medical schools; mortality; novel; nutrition; preference; programs; scale up; therapy adherence; tissue biomarkers; treatment arm; treatment as usual; uptake; usual care arm

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.

摘要 越来越多的证据表明，乳腺癌诊断时肥胖与生存率降低有关。 很少有研究描述了诊断后时期的体重模式，或探讨了诊断后 体重模式影响癌症结果。那些有，有重要的限制，使其具有挑战性， 得出强有力的结论，并将资源导向最合适的人群。然而，负面作用 肥胖在乳腺癌风险中的作用推动了饮食和运动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， 建议可以改善患者的整体生活质量、身体成分和死亡率的替代指标， 患有乳腺癌的女性。不幸的是，目前很少有乳腺癌幸存者符合营养和身体条件。 活动指南或报告讨论饮食和运动与他们的肿瘤学家。这突出了一个重要的 证据-实践差距部分存在，因为迄今为止的研究集中在生活方式的功效上 这些干预措施较少关注如何将这些干预措施转化为临床实践。 在RE-AIM（Reach，Effectiveness，Adoption，Implementation and Maintenance）框架的指导下， 本申请的目的是阐明将行为生活方式规划纳入 常规肿瘤护理，并演示如何以可扩展、可持续和具有成本效益的方式使用 乳腺癌作为一个模型。首先，我们将描述乳腺癌诊断后的体重模式， 电子健康记录数据来自一个大型的、多样化的医疗保健网络。我们将采用新的纵向 方法来确定谁可以受益于生活方式咨询的人群，并告知最适当的 是时候介入了。第二，我们将进行一项混合方法研究，以探讨妇女的经验， 在化疗期间参与营养和运动干预的乳腺癌患者。从病人的 从这个角度来看，我们的目标是揭示动机，偏好，以及感知到的障碍和促进因素， 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 乳腺癌患者相同的综合营养和运动干预的成本效益 接受化疗，以提供关键数据，帮助扩大行为 在肿瘤学环境中的干预措施。 一个由耶鲁大学公共管理学院的著名调查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 对申请人的指导。拟议的研究和耶鲁大学的合作培训环境将 使申请人能够磨练她现有的技能，并获得专业知识，这将使她成为一个 具有竞争力的博士后职位和长期的职业生涯，作为一个独立的调查工作，以实现 生活方式行为咨询纳入肿瘤治疗标准。