PATIENT-TAILORED PHYSICAL ACTIVITY INTERVENTION AMONG OLDER WOMEN WITH GYNECOLOGIC CANCERS UNDERGOING CHEMOTHERAPY (FIT4TREATMENT)

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PROJECT SUMMARY Older patients with gynecologic cancers have increased advanced stage at presentation, more aggressive histology and more commonly require adjuvant chemotherapy. This chemotherapy, as well as underlying cancer, cause accelerated aging and toxicity, leaving women vulnerable to functional decline, increased frailty, decreased health related quality of life. Physical activity has been shown to improve functional health, improve quality of life, slow aging, and decrease rates of frailty and sarcopenia. However, limitations exist in allowing older gynecologic cancer patients to access existing physical activity interventions, namely that many are delivered in person and do not account for the varied time course of symptoms related to chemotherapy. The use of remotely delivered mobile health (mHealth) technology-based physical activity interventions has been shown to increase physical activity in diverse populations including patients with metastatic cancer and older adults. The objective of this study is to use a multi-phase optimization strategy (MOST) clinical trial design to determine which components of an mHealth physical activity intervention (Fit4Treatment) delivered over 12 weeks with a 12 week follow-up meaningfully contribute to increasing physical activity of any intensity among older women with gynecologic cancer receiving chemotherapy. Participants will be randomly assigned to a combination of zero to four different intervention components using a full factorial design to estimate the effects of each component on increasing steps. The Fit4Treatment components include 1) symptom burden tailored goal setting 2) social support through an exercise care partner 3) treating oncology provider engagement and 4) coaching. We will also test how changes in physical activity improve patient-reported outcomes (physical function, fatigue, anxiety, quality of life), aging outcomes (frailty, functional performance) and cancer outcomes (chemotherapy delays, progression free survival). Finally, we will examine both mediators (adherence, self-efficacy) and moderators (age, treatment dose, cancer type) of the effects of the components of the Fit4Treatment on increasing physical activity. This research expands upon the robust work of our group examining the use of well-tested, patient-led, physical activity interventions to improve cancer patients’ health and survival, and is innovative in the use of an efficient MOST study design, examining a new high-risk population, and testing the effects of physical activity on aging and functional outcomes. This study will lead to an improved understanding of how to effectively increase physical activity among older patients with gynecologic cancers, a high-need and understudied population. Ultimately, these results will improve the health, quality of life and survival of older cancer survivors.