Ecological Momentary Assessment of Quality of Life in Metastatic Breast Cancer

项目总结

PROJECT SUMMARY Despite advances in breast cancer prevention and treatment, thousands of people are either newly-diagnosed with or progress to metastatic breast cancer (MBC). MBC can lead to significant decrements in quality of life (QoL), a multidimensional construct including physical and emotional well-being. Given the incurable nature of MBC, QoL is a critical outcome. Furthermore, data from our group and others demonstrate that individuals living with MBC have unmet needs related to QoL and desire MBC-specific QoL resources and interventions. However, little is known about changes in QoL over time in those with MBC. The longitudinal QoL data that do exist pri- marily come from pharmaceutical clinical trials, and have two key limitations. First, clinical trials may include selected, higher-functioning individuals with no significant comorbidities; thus, findings may not generalize to the broader MBC population. Second, clinical trials typically assess QoL at time points that align with treatment cycles. There is little data on changes in QoL between cycles of treatment. The proposed research addresses this gap in the literature by collecting longitudinal QoL data from people living with MBC. In-depth data on QoL concerns and intervention preferences of individuals with MBC will allow us to adapt and apply existing behav- ioral interventions to this group, who are often excluded from cancer survivorship studies. Our long-term goal is to support the experience of those living with MBC through behavioral interventions. However, additional data on QoL are needed in order to identify the optimal content and timing of such interventions. Thus, the overall objective of this application is to collect in-depth longitudinal, observational data on QoL in MBC. To achieve this objective, we will pursue two specific aims using mixed methods. In Aim 1, we will use an innovative ecological momentary assessment (EMA) measurement-burst protocol to collect QoL data in a sample of females with MBC (N=120). EMA involves repeated sampling of subjects’ current experiences in real time, in subjects’ natural environments. The measurement-burst design incorporates short periods (i.e., days) of intensive assessments that are repeated longitudinally over longer intervals (i.e., weeks). In the proposed study, participants will com- plete EMA bursts (3 prompts/day) once per week for four consecutive weeks. EMA bursts will assess overall QoL and symptom severity (anxiety, depression, fatigue, pain interference, and physical function). In Aim 2, we will conduct in-depth individual qualitative interviews with a convenience sample of Aim 1 participants (N=10) to assess participants’ experiences with the EMA protocol and their preferences for a future intervention. We will also explore the potential impact of self-monitoring on participants’ lived experiences with MBC. The proposed study will provide pilot data for a future trial to adapt an existing behavioral intervention targeting QoL among cancer survivors for metastatic breast cancer, and test the efficacy of the adapted intervention. This program of research has the potential to increase our understanding of QoL in this population, ultimately enabling us to identify targeted intervention strategies to improve QoL and reduce suffering.