The COACH Study: A Framework for individualized COaching in young Adult Cancer survivors to encourage Healthy behaviors

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PROJECT SUMMARY When a young adult (YA) is diagnosed with cancer, normal growth and development is disrupted, heightening nutritional needs in a vulnerable population. YA Hispanic and African Americans survivors are particularly vulnerable as they are more likely to have a higher body mass index (BMI) pre-treatment, further increasing the risk of late effects of cancer and comorbidities. Following treatment, YA survivors report worse quality of life (QOL) and greater symptomatology, including fatigue, constipation, frailty, low muscle mass, slow walking speed, and weakness similar to adults aged 65 and older. As a result of treatment, changes in body weight and limitations in physical movement are a major concern in 30-60% of survivors. While a number of lifestyle interventions have been published, only two published YA cancer survivor studies have incorporated a diet and PA bundled health behavior approach. Each study followed different dietary guidelines and both studies were conducted in YA breast cancer survivors who may have different needs as a result of treatment and gender differences. There is a lack of understanding of YA from racial/ethnic minority backgrounds as the aforementioned studies did not include Hispanic survivors and recruited only a small handful of African American survivors, an important gap we plan to address in this application. Thus, healthy lifestyle interventions encompassing diet and physical activity (PA) to prevent obesity-related late effects are warranted. The goal of the current study is to take a sequential mixed methods approach addressing this knowledge gap to gain essential quantitative and qualitative information that will serve as the framework for our next steps; a healthy lifestyle intervention for YA cancer survivors that are diverse in terms of race, ethnicity, gender, cancer diagnosis, time since diagnosis, and treatment. In Aim 1, we will recruit a diverse sample of YA cancer survivors currently between 20-30 years of age to obtain objective and subjective lifestyle behavior data on current diet quality, PA, and quality of life. For Aim 2, we will recruit a subset of Aim 1 survivors to participate in phenomenological based semi-structured interviews guided by the Social Cognitive Theory to (a) explore sociocultural, environmental, and individual factors associated with lifestyle behaviors; (b) explore awareness of ACS guidelines, current practices, and essential intervention modules (e.g., integrating cultural foods and preferences) to inform intervention content and modality. There is an urgent need to develop health behavior interventions for YA cancer survivors that are effective and easily disseminated. Successful completion of this study will provide the information needed to create and enhance the framework for our proposed intervention “COACH: Individualized COaching in young Adult Cancer survivors to encourage Healthy behaviors” in terms of format and module content, with desirable patient-level preferences for sociocultural and environmental factors. The intervention framework created at the end of the study will be easily modified to best suit an individual’s background, taking into consideration their worldview, increasing the potential to be widely disseminated and effective.