Project 3: Simultaneous Combined Or Sequential (S.O.S.) Approaches to Behavior Change for Survivors

越来越多的癌症幸存者的健康风险(不良饮食、超重、缺乏运动)代表着一种 严重的公共卫生问题，并可能导致二次初发和癌症复发以及其他 合并症和功能衰退。这一人群需要有效的行为干预。研究 到目前为止，主要是将个人的生活方式行为作为独立因素来处理，但通常有 多种健康风险，需要幸存者予以关注。因此，对多个可修改风险进行干预 影响公共健康的因素比干预单一行为的可能性要大得多。多重行为 改变干预措施在普通人群中取得了成功，在少数人中也取得了令人振奋的结果 癌症幸存者的现有研究。然而，这项研究中仍有几个空白。首先，没有 关于多重行为改变的最佳方法的共识以及少数几项比较 同时进行的多项行为干预与顺序进行的多项行为干预结果不一。澄清以下方面的最佳实践 多重行为改变具有重要的临床意义，并将是推动该领域向前发展的关键。 其次，这一研究尚未完全扩展到高危人群。正如所指出的，已经有 在癌症幸存者中进行了一些多项行为改变的研究，但没有一项同时进行检查 与序贯干预方法相比，大多数涉及受过良好教育的年轻白人 样本。国家癌症研究所呼吁在服务不足的人中进行多项行为改变研究 人口，即各种癌症的幸存者，也是农村人、老年人和少数群体。因此，拟议的 项目3建立在Amplifi的项目1-2的基础上，将测试同步与顺序的效果 以饮食、减肥和/或锻炼为目标的干预措施，探索哪种组合或顺序最好 最大限度地改变癌症幸存者的生活。这项研究将使用随机对照设计，研究对象为652例癌症 幸存者大多来自老年、农村和少数群体。主要目的包括确定相对疗效。 两种方法(同时和顺序)改变多种健康行为的方法中的哪一种，以及会议行为 目标(改善饮食质量，体重减轻3%，≥每周150分钟的≥中等强度体力活动) 干预后作为利益的终点。次要目标包括审查在6岁时保持收益 干预后几个月和手臂在身体活动和功能、瘦体重、生活质量、 以及成功衰老、免疫状态和全身炎症的生物标记物；识别潜在的介体 (SCT结构)和干预效果的调节因素(教育)；以及评估 循序渐进与同步的基于技术的干预。这将是有史以来规模最大的审判之一 比较顺序干预与同时干预。鉴于这一发现将对公众健康产生重大影响 患者群体的多样性和高危性。

Health risks (poor diet, excess weight, physical inactivity) in rising numbers of cancer survivors represent a substantial public health concern and can lead to second primaries and cancer recurrence, as well as other comorbidities and functional decline. Effective behavioral interventions are needed for this population. Studies to date have largely addressed individual lifestyle behaviors as independent factors, but there often are multiple health risks that require attention amongst survivors. Thus, intervening upon multiple modifiable risk factors is much more likely to impact public health than intervening on a single behavior. Multiple behavior change interventions have shown success in the general population, as well as promising results in the few available studies in cancer survivors. However, several gaps in this research remain. First, there is no consensus on the best approach to multiple behavior change and the few studies that have compared simultaneous vs. sequential multiple behavior interventions yielded mixed findings. Clarifying best practices for multiple behavior change has important clinical implications and will be key to moving the field forward. Second, this line of research has yet to be fully extended to at risk populations. As noted, there have been some multiple behavior change studies conducted in cancer survivors, but none have examined simultaneous vs. sequential intervention approaches and most involved predominantly younger, well-educated White samples. The National Cancer Institute has called for multiple behavior change research in underserved populations, i.e., survivors of various cancers who also are rural, older and minority. Thus, the proposed Project 3, which builds upon Projects 1-2 of AMPLIFI, will test the efficacy of simultaneous vs. sequential interventions targeting diet, weight loss, and/or exercise, and explore which combination or order is best to maximize change for cancer survivors. The study will use a randomized controlled design with 652 cancer survivors from mostly older, rural, and minority groups. Primary aims include determining the relative efficacy of two approaches (simultaneous vs. sequenced) to multiple health behavior change, with meeting behavioral goals (improved diet quality, 3% weight loss, ≥150 weekly minutes of ≥moderate intensity physical activity) post-intervention as endpoints of interest. Secondary aims include examining maintenance of gains at 6 months post-intervention and arm differences in physical activity and function, lean body mass, quality of life, and biomarkers of successful aging, immune status, and systemic inflammation; identifying potential mediators (SCT constructs) and moderators (education) of intervention efficacy; and evaluating the cost-effectiveness of sequenced vs. simultaneous technology-based interventions. This will be one of the largest trials ever to compare sequential vs. simultaneous interventions. Findings will be of high public health impact given the diversity and high risk nature of the patient population.