Exercise Intervention for Lesbian, Gay, Bisexual, and Transgender Cancer Survivors

 描述(由申请人提供)：女同性恋者、男同性恋者、双性恋者和变性者(LGBT)的癌症患病率比异性恋者高2.1倍，但在美国的癌症研究中，LGBT癌症幸存者几乎是看不见的。这种隐形性，以及真实和预期的歧视，导致LGBT癌症患者和幸存者经历的心理痛苦比率是异性恋幸存者的1.7倍。鉴于这些痛苦的比率，作用于LGBT幸存者的独特的社会文化因素，以及痛苦与癌症相关的发病率和死亡率增加有关的事实，需要有针对性的干预措施来减少LGBT癌症幸存者的痛苦。我们的初步研究表明，LGBT幸存者的护理伙伴希望被包括在支持幸存者的干预措施中，而且社会支持与LGBT成年人的心理痛苦密切相关。我们的新型二元框架结合了护理伙伴的支持和标准化的运动干预，即癌症患者的锻炼(EXCAP(C)(R)，一项为期6周的居家渐进步行和阻力训练计划)，可能有效地减轻LGBT幸存者的痛苦。在这份K07职业发展奖申请书中，具有健康差异和二元干预研究背景的临床心理学家Charles Kamen博士建议对70名LGBT癌症幸存者(所有癌症类型，治疗后1-24个月)及其70名护理伙伴(广义)进行第二阶段随机对照试验，以：ARM 1，一种新颖的伙伴辅助版本的EXCAP(C)(R)(称为EXCAP-PA)，其中幸存者和护理伙伴将一起接受EXCAP(C)(R)材料和指导，或ARM 2，EXCAP(C)(R)的幸存者专用版本，只有LGBT癌症幸存者才会收到EXCAP(C)(R)材料。这项研究的总体假设是，在LGBT幸存者中，纳入护理伙伴支持的EXCAP-PA在改善痛苦的生物心理社会方面将比仅限幸存者的EXCAP(C)(R)更有效。在罗切斯特大学特殊的环境中，卡门博士是一名初级教员，处于有利地位。为了开始独立的研究生涯，他需要在三个核心能力领域进行额外的培训：1)LGBT健康的临床试验，2)生物终点的整合，3)运动干预的设计。他的导师有30多年进行癌症控制干预试验的经验，其中包括：匹克实验室主任兼运动肿瘤学专家Karen Mustian博士；癌症控制研究总监Gary Morrow博士；精神神经免疫学家Kathi Heffner博士；社区干预专家Deborah Bowen博士；肿瘤内科医生Supriya Mohile博士；二元干预专家James McMahon博士；以及生物统计学家Charles Heckler博士。该培训奖项提供的职业发展目标和受保护的时间将使卡门博士成为癌症相关健康差距和LGBT癌症幸存者和护理合作伙伴的二元干预方面的专家。此外，如果成功，这项研究将解决服务不足的LGBT幸存者群体中的一个严重差距(痛苦)。

 DESCRIPTION (provided by applicant): Prevalence of cancer is up to 2.1 times higher among lesbian, gay, bisexual, and transgender (LGBT) persons than heterosexuals, yet LGBT cancer survivors are virtually invisible in cancer research in the United States. This invisibility, as wel as real and expected discrimination, leads LGBT cancer patients and survivors to experience 1.7 times higher rates of psychological distress than heterosexual survivors. Given these rates of distress, the unique sociocultural factors acting on LGBT survivors, and the fact that distress is linked with increased cancer-related morbidity and mortality, tailored interventions to reduce distress among LGBT cancer survivors are needed. Our preliminary research shows that care partners of LGBT survivors want to be included in interventions to support survivors and that social support is strongly linked to psychological distress among LGBT adults. Our novel dyadic framework incorporates support from care partners and a standardized exercise intervention, Exercise for Cancer Patients (EXCAP(c)(r), a 6 week, home-based progressive walking and resistance training program), and may be effective in reducing distress among LGBT survivors. In this K07 Career Development Award application, Dr. Charles Kamen, a clinical psychologist with a background in health disparities and dyadic intervention research, proposes to conduct a Phase II RCT randomizing 70 LGBT cancer survivors (all cancer types, 1-24 months post treatment) plus their 70 care partners (broadly defined) to: Arm 1, a novel, partner-assisted version of EXCAP(c)(r) (called EXCAP-PA), in which both survivors and care partners will receive EXCAP(c)(r) materials and instruction together, or Arm 2, a survivor-only version of EXCAP(c)(r), i which only the LGBT cancer survivor will receive EXCAP(c)(r) materials. The overall hypothesis of this study is that among LGBT survivors, EXCAP-PA, incorporating care partner support, will be more efficacious than survivor-only EXCAP(c)(r) in improving biopsychosocial aspects of distress. Dr. Kamen is well positioned as a junior faculty member in an exceptional environment at the University of Rochester. He needs additional training in three core competency areas in order to launch an independent research career: 1) clinical trials for LGBT health, 2) integration of biological endpoints, and 3) design of exercise interventions. His mentors have over 30 years of experience conducting cancer control intervention trials and include: Dr. Karen Mustian, PEAK Lab Director and exercise oncology expert; Dr. Gary Morrow, Director of Cancer Control research; Dr. Kathi Heffner, psychoneuroimmunologist; Dr. Deborah Bowen, community intervention expert; and advisors Dr. Supriya Mohile, medical oncologist; Dr. James McMahon, dyadic intervention expert; and Dr. Charles Heckler, biostatistician. The career development goals and protected time provided by this training award will prepare Dr. Kamen to become an expert in cancer-related health disparities and dyadic interventions for LGBT cancer survivors and care partners. Further, if successful, this study will address a critical disparity (distress) n the underserved population of LGBT survivors.