Adapting MultiPLe behavior Interventions that eFfectively Improve (AMPLIFI) Cancer Survivor Health

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Adapting MultiPLe behavior Interventions that eFfectively Improve (AMPLIFI) Cancer Survivor Health By 2020, the number of cancer survivors in the US will exceed 20 million due to trends toward aging, and improved cancer screening and treatment. Cancer survivorship is a victory, but it comes at a price. Once an individual is diagnosed with cancer, they are at much higher risk for second malignancies, cardiovascular disease, diabetes, osteoporosis, and functional decline (resulting in a loss of independence). Currently, the costs for these downstream effects are estimated to be at least $135 billion annually. Unhealthy lifestyle behaviors (e.g., a poor diet resulting in obesity and physical inactivity) associate with poorer outcomes after a cancer diagnosis. These behaviors also tend to cluster, i.e., people who practice one unhealthy behavior tend to practice another. It is hypothesized that cancer survivors may be able to improve their overall health and reduce comorbidity through lifestyle modification, particularly since estimates indicate that only 15-47% of cancer survivors adhere to national guidelines for weight status, diet and physical activity. While effective interventions in each of these domains exists, there has been little effort to disseminate these interventions broad scale and to survivors most in need (older, rural, minorities). Moreover, there is a relative dearth of research in determining optimal means of combining interventions, which is critical since many survivors practice more than one, or multiple suboptimal behaviors. The overarching aims AMPLIFI are to learn how to: 1) improve health behaviors in cancer survivors who practice multiple suboptimal health behaviors; and 2) adapt efficacious interventions to optimize their reach by the use of technology among cancer survivors, while also collecting data to inform the future dissemination and implementation (D&I) potential of these interventions. AMPLIFI involves 3 highly interrelated research projects supported by 4 highly integrated cores. It will enlist the efforts of 852 survivors of a broad array of cancers that have favorable 5-year cancer-free survival rates (oversampling those who are older, rural and minority) and gather the input of 48 key stakeholders to accomplish the following Specific Aims: 1) Understand how to adapt efficacious interventions for widespread dissemination through the use of technology, while maintaining the integrity of key components which drive behavior change; 2) Optimize acceptability and use of interventions (largely developed and tested in homogeneous samples of breast cancer survivors) to older, rural, minority survivors of many cancer types; 3) Test the efficacy of the adapted interventions delivered alone, in sequence, or combined; 4) Contribute to the science of D&I research by developing a new adaptation model; and 5) Determine factors that improve the D&I potential of distance-delivered health behavior change interventions by determining how they mediate behavior change and in whom they work best. Our ultimate goal is to improve the health of the highly vulnerable and ever increasing population of cancer survivors.