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

项目总结 当年轻人(YA)被诊断出患有癌症时，正常的生长和发育被扰乱， 脆弱人群的营养需求。尤其是西班牙裔和非裔美国人幸存者 由于他们在治疗前更有可能有较高的身体质量指数(BMI)，从而进一步增加了 癌症和合并症的后遗症风险。治疗后，YA幸存者报告生活质量下降 (QOL)和更严重的症状，包括疲倦、便秘、虚弱、肌肉萎缩、步行速度慢、 和65岁及以上的成年人类似的虚弱。作为治疗的结果，体重和 身体活动受限是30%-60%的幸存者的主要担忧。虽然有一些生活方式 干预措施已经公布，只有两项已发表的YA癌症幸存者研究纳入了饮食和 PA捆绑了健康行为方法。每项研究都遵循不同的饮食指南，两项研究都是 对可能因治疗和性别而有不同需求的YA乳腺癌幸存者进行了调查 不同之处。缺乏对来自种族/少数民族背景的YA的理解，因为 上述研究没有包括西班牙裔幸存者，只招募了一小部分非裔美国人 幸存者，这是我们计划在此应用程序中解决的一个重要差距。因此，健康的生活方式干预 包括饮食和体力活动(PA)，以防止肥胖相关的后遗症是有必要的。的目标是 目前的研究是采取一种顺序混合的方法来解决这一知识差距，以获得 基本的定量和定性信息，将作为我们下一步的框架；健康的 对不同种族、民族、性别、癌症诊断的YA癌症幸存者进行生活方式干预， 自诊断和治疗以来的时间。在目标1中，我们将招募目前YA癌症幸存者的不同样本 在20-30岁之间获得关于当前饮食质量的客观和主观生活方式行为数据，PA， 和生活质量。对于目标2，我们将招募目标1幸存者的子集来参与基于现象学的 社会认知理论指导下的半结构化访谈：(A)探索社会文化、环境、 和与生活方式行为相关的个人因素；(B)探索对ACS指南的认识，当前 实践和基本干预模块(例如，整合文化食品和偏好)，以告知 干预内容和方式。迫切需要为YA癌症制定健康行为干预措施 有效且易于传播的幸存者。这项研究的成功完成将提供 为我们提议的干预措施创建和增强框架所需的信息“培训师：个性化 在形式和模块方面对年轻的成年癌症幸存者进行辅导以鼓励健康的行为 内容，对社会文化和环境因素有令人满意的患者水平偏好。干预措施 在研究结束时创建的框架将很容易修改，以最适合个人的背景，采取 考虑到他们的世界观，增加了被广泛传播和有效的潜力。

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.