A Biobehavioral Intervention to Reduce Adverse Outcomes in Young Adult Testicular Cancer Survivors

项目摘要 睾丸癌的诊断和治疗，特别是考虑到它对性健康和生殖健康的威胁， 在青壮年的形成期可能是令人痛苦的。队列研究显示， 睾丸癌的抑郁症状超过了普通人群。事实上，大多数年轻人 癌症幸存者将经历受损、痛苦和可改变的身体、行为和心理社会 在完成初级医疗后很长一段时间内仍存在的不良后果。这些措施包括 心理困扰，航行和追求生活目标的障碍，持续的副作用，升高 继发性恶性肿瘤和慢性病的风险，以及生物行为负担(例如，炎症加重， 调节失调的应激激素)，影响发病率和疾病相关的脆弱性。然而，几乎没有人 存在有针对性的、有效的干预措施，以帮助年轻幸存者重新谈判生活目标和规范 与癌症相关的情绪，没有一种侧重于通过生物行为机制减少发病率负担。 年轻或“初露头角”的成年期是以实现目标为标志的时期。慢性疾病被认为是“关闭” 在人的一生中，“时间”打断了对目标的追求，威胁着宝贵的人生方向。随着年轻人重返球门 追求，重新进入癌症后的生活可能是生存轨迹中的一个关键点。行为干预 在这个时候，它处于有利地位，可以产生更长期的影响。从我们小组的初步研究中脱颖而出，我们 目标聚焦情绪调节疗法(GET)作为一种新的行为疗法开发和试点测试 通过提高目标导航技能、提高目标感、 更好地调节患有睾丸癌的年轻人的情绪反应。GET是一种很有前途的 候选干预，以解决可能使癌症相关负担的解决复杂化的机制。 响应对可行、有效且可扩展的干预措施的需求，我们将随机分配300 青壮年(18-39岁)睾丸癌患者参加GET或ISL(个人支持)6次 倾听)，并评估基线、治疗后、3个月随访的主要和次要结果 6个月随访。我们预测GET将与更好的痛苦结局相关，并且相比较而言 不良生物行为指标(调节失调的昼夜应激激素，升高 炎症)，这些优势将在干预后的三个月和六个月内保持。这个 将通过视频会议进行干预，以增强访问能力。一个探索性的目标集中在 潜在的表观遗传脆弱性，以了解环境如何影响(通过DNA甲基化) 与压力和情绪调节有关的基因与癌症调节和干预反应有关。 这项研究利用了研究团队在生物行为肿瘤学和唾液方面的独特专业知识 为年轻的成年幸存者测试一种新的行为干预。它有可能理解如何 改变强调长期不良影响的近端行为、生物和心理因素。

Project Abstract Testicular cancer diagnosis and treatment, especially given its threat to sexuality and reproductive health, can be distressing in the formative period of young adulthood. Cohort studies reveal the prevalence of depressive symptoms in testicular cancer exceeds the general population. In fact, the majority of young adult cancer survivors will experience impairing, distressing, and modifiable physical, behavioral, and psychosocial adverse outcomes that persist long after the completion of primary medical treatment. These include psychological distress, impairment in the navigation and pursuit of life goals, persistent side effects, elevated risk of secondary malignancies and chronic illness, and biobehavioral burden (e.g., enhanced inflammation, dysregulated stress hormones) which influence morbidity and disease-related vulnerabilities. However, few targeted, effective interventions exist to assist young survivors in re-negotiating life goals and regulating cancer-related emotions and none focus on reducing the burden of morbidity via biobehavioral mechanisms. Young or “emerging” adulthood is a period marked by goal attainment. Chronic illness experienced as “off time” in the lifespan interrupts goal pursuits and threatens valued life directions. As young adults return to goal pursuits, re-entry to post-cancer life can be a critical point in the survivorship trajectory. Behavioral intervention at this time is well positioned to confer longer-term impact. Emergent from our group’s preliminary research, we developed and pilot-tested Goal-focused Emotion-Regulation Therapy (GET) as a novel behavioral intervention to enhance self-regulation through improved goal navigation skills, improved sense of purpose, and better ability to regulate emotional responses in young adults with testicular cancer. GET is a promising candidate intervention to address the mechanisms likely complicating the resolution of cancer-related burden. Responsive the need for feasible, effective, and scalable interventions, we will randomly allocate 300 young adult (ages 18-39) testicular cancer patients to 6 sessions of GET or ISL (individual supportive listening), and evaluate primary and secondary outcomes at baseline, post-treatment, 3-month follow-up, and 6-months follow-up. We predict that GET will be associated with superior distress outcomes and comparatively greater reductions in adverse biobehavioral indicators (dysregulated diurnal stress hormones, elevated inflammation), and these advantages will be maintained at three- and six-months following intervention. The intervention will be delivered via video conferencing to enhance access. An exploratory aim focuses on potential epigenetic vulnerabilities, to understand how environmental influences (via DNA methylation) on genes implicated in stress and mood regulation are related to cancer adjustment and intervention response. This study capitalizes on the study team’s unique expertise in biobehavioral oncology and salivary bioscience to test a novel behavioral intervention for young adult survivors. It has potential to understand how to alter proximal behavioral, biological, and psychological factors that underscore long term adverse effects.