Digital Self-Management and Peer Mentoring Intervention to Improve the Transition from Pediatric to Adult Health Care for Childhood Cancer Survivors

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Project Summary/Abstract Childhood cancers require lifelong risk-based follow-up care tailored to their treatment exposures, including routine medical appointments, monitoring for late effects, and regular cancer screenings. Unfortunately, less than 1 in 5 adult survivors of childhood cancer obtain such risk-based follow-up care. The transition from pediatric to adult follow-up care for adolescent and young adult (AYA) survivors is a critical period when many survivors are lost to follow-up, particularly AYA survivors who identify as Hispanic or have low self-efficacy to manage their care. While the barriers to care are well-characterized, there are no efficacious interventions to help improve this transition for AYA survivors of childhood cancer. To address this gap, we developed Managing Your Health, a digital self-management and peer mentoring intervention to improve survivorship care self-management. It consists of six 1:1 virtual sessions with a peer mentor, another young adult survivor who independently manages their own care. Each session involves discussion of a complementary web-based self-management educational module. Peer mentors act as supportive accountability agents, providing specialized support based on shared experience and facilitating engagement with the modules. Our preliminary two-arm randomized feasibility trial showed that survivors found the intervention useful, were highly engaged, and reported significant improvements in self-management. Per participant feedback, we translated the web-based modules into a mobile app for easier accessibility. The goal of this project is to evaluate the efficacy of Managing Your Health (app + peer mentoring) compared with educational control in a two-arm randomized trial with 300 young adult survivors of childhood cancer currently aged 18-25 years. We will oversample for AYA survivors who identify as Hispanic given evidence of low self- efficacy and follow-up care in this group. Participants will complete outcome measures at baseline, 3 months, and 12 months post-randomization, with medical record abstraction for guideline-concordant care at 12 months. Specific aims will evaluate the efficacy of the intervention on self-management behaviors, quality of life, and adherence to guideline-concordant follow-up care, as well as mediators and moderators of treatment effects. The proposed research aligns with priorities detailed in the notice of special interest “Navigating Pediatric to Adult Health Care: Lost in Translation,” and seeks to address gaps in the long-term health care of childhood cancer survivors by evaluating an innovative theory-based intervention to facilitate the transition from pediatric to adult self-management of care.