Moving Forward: A weight loss program for African-American breast cancer survivo

描述（由申请人提供）：即使在控制了年龄、社会经济地位、诊断时的肿瘤分期、激素受体状态、组织学和绝经状态后，非洲裔美国人（AA）女性的乳腺癌（BC）生存率明显低于欧美人（EA）女性。这种差异在芝加哥尤为明显，AA女性的死亡率比EA女性高出116%。AA型乳腺癌患者不仅比EA型乳腺癌患者更有可能死于癌症，而且更有可能死于合并症，包括糖尿病和高血压。不良饮食、缺乏身体活动和肥胖会导致乳腺癌的进展以及许多合并症的发生和恶化。迫切需要努力降低AA妇女患乳腺癌的高死亡率。解决不良饮食、缺乏体育活动和高肥胖率可能是近期内降低AA BC幸存者乳腺癌和全因死亡率的最佳机会。虽然有几项研究对EA BC幸存者进行了减肥干预，但没有专门针对AA BC幸存者开发的干预措施。Moving Forward是一项为期六个月的认知行为社区减肥干预，是与AA BC幸存者合作开发的。本申请提出了一项随机干预研究，以检验Moving Forward的效果，与与AA BC幸存者合作开发的为期六个月的认知行为社区减肥干预相比，对240名诊断为I， II或III期乳腺癌的AA肥胖妇女的BMI和行为，生物学和社会心理结果。我们与芝加哥公园区（CPD）合作，在六个以AA为主的芝加哥社区实施这项研究。除了拥有一个经验丰富的跨学科研究团队外，该项目还有其他几个优势，包括对AA BC幸存者减肥的创新；对AA BC幸存者中与乳腺癌和合并症相关的发病率和死亡率有积极影响的可能性；以及CPD社区项目的可持续发展潜力。

DESCRIPTION (provided by applicant): Breast cancer (BC) survival rates are significantly lower for African-American (AA) women compared to European American (EA) women even after controlling for age, SES, tumor stage at diagnosis, hormone receptor status, histology, and menopausal status. This disparity is particularly evident in Chicago where mortality rates for AA women exceed those for EA women by 116 percent. Not only are AA women with BC more likely than EA women to die from their cancer, they are also more likely to die from comorbid conditions including diabetes and hypertension. Poor diet, lack of physical activity, and obesity contribute to breast cancer progression and the development and exacerbation of many comorbid conditions. Efforts to reduce the high mortality rates observed in AA women with breast cancer are critically needed. Addressing poor diet, lack of physical activity, and high rates of obesity may provide the best near-term opportunity to decrease breast cancer and all-cause mortality among AA BC survivors. Although several studies have examined weight loss interventions among EA BC survivors, no interventions developed specifically for AA BC survivors have been examined. Moving Forward is a six-month cognitive-behavioral community-based weight loss intervention that was developed in collaboration with AA BC survivors. This application proposes a randomized intervention study to examine the effects of Moving Forward, compared to a six-month cognitive-behavioral community-based weight loss intervention that was developed in collaboration with AA BC survivors, on BMI and behavioral, biological, and psychosocial outcomes in 240 obese AA women diagnosed with Stage I, II, or III breast cancer. We have partnered with the Chicago Park District (CPD) to implement the study within six predominantly AA Chicago communities. In addition to having an experienced, interdisciplinary study team, this project has several other strengths including innovation in its focus on weight loss in AA BC survivors; the potential for having a positive impact on morbidity and mortality related to breast cancer and comorbid conditions among AA BC survivors; and the potential for sustainability within CPD community programs. PUBLIC HEALTH RELEVANCE: Breast cancer mortality rates are consistently higher for African-American women (AA) as compared to European American (EA) women. Furthermore, AA women with breast cancer are more likely than EA women with breast cancer to die from co-morbid conditions such as hypertension and diabetes. Obesity, poor diet and sedentary lifestyles may contribute to these disparities. Weight loss interventions, developed for AA breast cancer survivors, are needed. The proposed study will explore the efficacy of a weight loss intervention on BMI, biological markers of breast cancer progression and co-morbid conditions and psychosocial factors.