IMPROVING EXERCISE AND DIET IN AFRICAN AMERICAN BREAST CANCER SURVIVORS

描述(由申请人提供)： 肥胖是一个重大的公共卫生问题，并与绝经后乳腺癌发病率和死亡率的增加有关。在癌症患者中，超重或肥胖与癌症复发风险增加和几种可能导致生存期缩短和健康相关生活质量(HRQOL)下降的共病相关。与白人乳腺癌幸存者相比，黑人乳腺癌幸存者更有可能在治疗过程中肥胖和体重增加。关于哪些策略可以帮助这些女性在乳腺癌治疗后达到或保持健康的体重，人们知之甚少。可能影响这一群体中肥胖率较高的因素包括态度(例如，对某些食物的偏好)、文化(例如，对食物的信念)、主观规范(例如，感知到的做出改变的支持)和感知到的控制力(例如，遵守生活方式指南的自我效能)，所有这些都可以通过适当的有针对性的干预来改变。此外，与癌症生存相关的因素，如对复发的恐惧，在采取健康的生活方式行为方面也可能很重要，但在黑人幸存者的体力活动或饮食干预中尚未得到解决。鉴于黑人幸存者的乳腺癌预后比白人幸存者更差，因此需要采取干预措施，促进这一群体的体重减轻。在计划行为理论(TPB)的指导下，我们建议对久坐超重和肥胖的黑人幸存者(治疗后6个月至5年)进行干预，以解决这些差距。我们将进行为期12周的双臂RCT试点，以教授行为技能，提供社会支持，并提高女性在执行推荐的身体活动和饮食行为方面的自我效能。在随机对照试验中，120名妇女将被随机分配到常规护理对照组(C；n=60)或干预组(I；n=60)。干预部门将接受计步器，参加6次小组会议，并接受由训练有素的同行(幸存者教练)进行的6次电话激励性面谈。在小组中，妇女将接受个人体育活动和饮食“处方”(例如，每天10,000步)，并参加集体活动(例如，集体散步、营养示范)。教练将根据幸存者的基本TPB原则(如态度、社会/文化规范)量身定做电话会议，并作为支持的来源。后续评估将在干预后6周和1个月进行。研究的目的是：1)检验以幸存者为中心的行为体重控制干预的可行性和可接受性；2)探讨干预对体重指数(BMI，kg/m2)、体力活动和饮食行为的主要影响；3)探讨干预对HRQOL评分的影响。这项建议符合缩小差距的国家目标，并侧重于服务不足的人口。如果前景看好，这些发现将被用来为旨在改善乳腺癌预后的更大规模的干预和纵向随机对照试验提供信息。 公共卫生相关性： 肥胖是一个重大的公共卫生问题，并与绝经后乳腺癌发病率和死亡率的增加有关。与白人乳腺癌幸存者相比，黑人乳腺癌幸存者更有可能在治疗过程中肥胖和体重增加。很少有研究记录在这一服务不足的群体中采取成功的策略。这项研究将评估改善超重和肥胖黑人乳腺癌幸存者的体力活动、饮食行为、身体质量指数和与健康相关的生活质量的干预措施的可行性和可接受性。如果成功，将进行一项更大规模的纵向研究，以评估干预措施在减少肥胖和乳腺癌预后方面的有效性。

DESCRIPTION (provided by applicant): Obesity is a significant public health problem and is associated with increased postmenopausal breast cancer incidence and mortality. Among cancer patients, being overweight or obese has been associated with an increased risk for cancer recurrence and several comorbid conditions that may contribute to shorter survival and decreased health-related quality of life (HRQOL). Compared to White breast cancer survivors, Black breast cancer survivors are more likely to be obese and gain weight during treatment. Little is known about which strategies can help these women achieve or maintain a healthy weight after breast cancer treatment. Factors that may influence higher obesity in this group include, attitudes (e.g., preferences for certain foods), culture (e.g., beliefs about food), subjective norms (e.g., perceived support to make changes), and perceived control (e.g., self-efficacy in adhering to lifestyle guidelines), all of which may be amenable to change through appropriately targeted interventions. Additionally, factors associated with cancer survivorship such as fear of recurrence may also be important in the adoption of healthy lifestyle behaviors but have not been addressed in physical activity or dietary interventions with Black survivors. Given that Black survivors experience worse breast cancer outcomes than their White counterparts, interventions that facilitate weight loss in this group are needed. Guided by tenets from the Theory of Planned Behavior (TPB), we propose to intervene with sedentary overweight and obese Black survivors (6 months to 5 years post treatment) to address these gaps. We will conduct a 12-week two-arm pilot RCT to teach behavioral skills, provide social support and increase women's self-efficacy in performing recommended physical activity and dietary behaviors. In the RCT, 120 women will be randomly assigned to either a usual care control (C; n = 60) or intervention (I; n=60) arm. The intervention arm will receive pedometers, attend 6 group sessions and receive 6 individual phone motivational interviewing sessions delivered by a trained peer (survivor coach). At the groups, women will receive individual physical activity and dietary "prescriptions" (e.g., 10,000 steps per day) and participate in group activities (e.g., group walks, nutrition demonstrations). Coaches will tailor phone sessions according to survivors' baseline TPB tenets (e.g., attitudes, social/cultural norms) and serve as a source of support. Follow-up assessments will occur at six weeks and one month after the intervention. Study aims are to: 1) examine the feasibility and acceptability of a survivor-focused behavioral weight control intervention; 2) explore intervention main effects on body mass index (BMI, kg/m2), physical activity, and dietary behaviors; and 3) explore the intervention's effect on ratings of HRQOL. This proposal meets national goals of reducing disparities and focuses on an underserved population. If promising, findings will be used to inform a larger intervention and a longitudinal RCT aimed at improving breast cancer outcomes. PUBLIC HEALTH RELEVANCE: Obesity is a significant public health problem and is associated with increased postmenopausal breast cancer incidence and mortality. Compared to White breast cancer survivors, Black breast cancer survivors are more likely to be obese and gain weight during treatment. Few studies have documented successful strategies in this underserved group. This study will assess the feasibility and acceptability of an intervention to improve physical activity, dietary behaviors, body mass index, and health-related quality of life in overweight and obese Black breast cancer survivors. If successful, a larger longitudinal study will be conducted to assess the effectiveness of the intervention on reducing obesity and breast cancer outcomes.