Bridging the Gap: Evaluating why and how to implement lifestyle programs for cancer patients into routine clinical oncology care

弥合差距：评估为什么以及如何将癌症患者的生活方式计划纳入常规临床肿瘤护理

基本信息

批准号：
10537165
负责人：
Leah Puklin
金额：
$ 4.68万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-16 至 2024-09-15
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10537165
关键词：
Adherence Attention Base Ratios Behavior Behavior Therapy Behavioral Body Composition Body Weight Changes Body mass index Breast Cancer Model Breast Cancer Patient Breast Cancer Risk Factor Breast Cancer Treatment Breast Cancer survivor Cancer Center Cancer Control Cancer Hospital Cancer Patient Cancer Prevention Intervention Caring Clinical Oncology Cost Effectiveness Analysis Counseling Data Development Diagnosis Diet Dietary Intervention Dose Effectiveness Electronic Health Record Environment Ethnic Origin Exercise Funding Future Goals Growth Guidelines Healthcare Hospitals Inflammatory Intervention Interview Investments Life Style Maintenance Malignant Neoplasms Measures Mentorship Methodology Methods Modeling Motivation Newly Diagnosed Obesity Oncologist Oncology Outcome Patient Self-Report Patients Pattern Persons Physical activity Population Positioning Attribute Postdoctoral Fellow Public Health Schools Quality of life Race Randomized Controlled Trials Reach Effectiveness Adoption Implementation and Maintenance Recommendation Recurrence Reporting Research Research Personnel Research Support Resources Retrospective cohort Risk Role Serum Structure Surrogate Markers Survival Rate Survivors Thinness Time Training Translating Treatment Side Effects Tumor Tissue Weight Weight maintenance regimen Woman Work active method age difference base behavior change breast cancer diagnosis cancer prevention cancer therapy career chemotherapy clinical practice cost cost effective cost effectiveness cost estimate cost-effectiveness ratio design diet and exercise exercise intervention experience hazard health organization healthy lifestyle hormone therapy implementation science improved incremental cost-effectiveness insight lifestyle intervention malignant breast neoplasm medical schools mortality novel nutrition preference programs scale up therapy adherence tissue biomarkers treatment arm treatment as usual uptake usual care arm

Adherence Attention Base Ratios Behavior Behavior Therapy Behavioral Body Composition Body Weight Changes Body mass index Breast Cancer Model Breast Cancer Patient Breast Cancer Risk Factor Breast Cancer Treatment Breast Cancer survivor Cancer Center Cancer Control Cancer Hospital Cancer Patient Cancer Prevention Intervention Caring Clinical Oncology Cost Effectiveness Analysis Counseling Data Development Diagnosis Diet Dietary Intervention Dose Effectiveness Electronic Health Record Environment Ethnic Origin Exercise Funding Future Goals Growth Guidelines Healthcare Hospitals Inflammatory Intervention Interview Investments Life Style Maintenance Malignant Neoplasms Measures Mentorship Methodology Methods Modeling Motivation Newly Diagnosed Obesity Oncologist Oncology Outcome Patient Self-Report Patients Pattern Persons Physical activity Population Positioning Attribute Postdoctoral Fellow Public Health Schools Quality of life Race Randomized Controlled Trials Reach Effectiveness Adoption Implementation and Maintenance Recommendation Recurrence Reporting Research Research Personnel Research Support Resources Retrospective cohort Risk Role Serum Structure Surrogate Markers Survival Rate Survivors Thinness Time Training Translating Treatment Side Effects Tumor Tissue Weight Weight maintenance regimen Woman Work active method age difference base behavior change breast cancer diagnosis cancer prevention cancer therapy career chemotherapy clinical practice cost cost effective cost effectiveness cost estimate cost-effectiveness ratio design diet and exercise exercise intervention experience hazard health organization healthy lifestyle hormone therapy implementation science improved incremental cost-effectiveness insight lifestyle intervention malignant breast neoplasm medical schools mortality novel nutrition preference programs scale up therapy adherence tissue biomarkers treatment arm treatment as usual uptake usual care arm

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项目摘要

Abstract Mounting evidence suggests that obesity at breast cancer diagnosis is associated with poorer survival. Far fewer studies have described weight patterns in the post-diagnosis period or explored how post-diagnosis weight patterns impact cancer outcomes. Those that have, had important limitations making it challenging to draw strong conclusions and direct resources to the most appropriate populations. However, the adverse role of obesity in breast cancer risk has driven the development of diet and exercise recommendations and lifestyle behavioral programs for cancer prevention and control. Studies have shown adherence to these recommendations can improve overall quality of life, body composition, and surrogate markers of mortality in women with breast cancer. Unfortunately, few breast cancer survivors currently meet the nutrition and physical activity guidelines or report discussing diet and exercise with their oncologist. This highlights an important evidence-practice gap which partially exists because research to date has focused on the efficacy of lifestyle interventions with less attention on how these interventions might be translated into clinical practice. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the goal of this application is to clarify the potential benefits of bringing behavioral lifestyle programming into routine oncology care and demonstrate how to do so in a scalable, sustainable, and cost-effective way using breast cancer as a model. First, we will describe weight patterns after breast cancer diagnosis by leveraging electronic health record data from a large, diverse healthcare network. We will apply novel longitudinal methods to define the population who could benefit from lifestyle counseling and to inform the most appropriate time to intervene. Second, we will conduct a mixed methods study to explore the experiences of women with breast cancer participating in a nutrition and exercise intervention during chemotherapy. From the patients' perspective, we aim to uncover motivations, preferences, and perceived barriers to and facilitators of adhering and sustaining a nutrition and exercise intervention during active cancer treatment. Lastly, we will estimate the cost-effectiveness of the same comprehensive nutrition and exercise intervention for breast cancer patients undergoing chemotherapy to provide critical data that can help inform the scaling-up of behavioral interventions in the oncology setting. An interdisciplinary team of renowned investigators was assembled from the Yale School of Public Health and the Yale School of Medicine to provide direct research support and professional development mentorship to the applicant. The proposed research and the collaborative training environment at Yale will enable the applicant to hone her existing skillsets and gain specialized expertise that will position her well for a competitive post-doctoral position and a long-term career as an independent investigator working to implement lifestyle behavioral counseling into the standard of oncology care.

抽象的越来越多的证据表明，乳腺癌诊断时的肥胖与生存率较差有关。较少的研究描述了诊断后期的体重模式或探索后诊断体重模式会影响癌症的结果。那些拥有重要限制的人，使其具有挑战性为最合适的人群得出强有力的结论和直接资源。但是，不利的角色乳腺癌风险中的肥胖促进了饮食和运动建议和生活方式的发展预防癌症和控制的行为计划。研究表明遵守这些建议可以改善整体生活质量，身体成分和死亡率的替代标记乳腺癌的妇女。不幸的是，目前很少有乳腺癌幸存者符合营养和身体活动指南或报告与肿瘤科医生讨论饮食和运动。这突出了一个重要的部分存在证据实践差距，因为迄今为止的研究集中在生活方式的效力上干预措施对如何将这些干预措施转化为临床实践的干预措施较少。在Re-Aim（触及，有效性，采用，实施和维护）框架的指导下，该应用程序的目的是阐明将行为生活方式编程带入的潜在好处常规肿瘤学护理并演示如何以可扩展，可持续和经济有效的方式使用乳腺癌作为模型。首先，我们将通过利用乳腺癌诊断后的体重模式电子健康记录数据来自大型，多样化的医疗网络。我们将应用新颖的纵向定义可以从生活方式咨询中受益并告知最合适的人口的方法是时候干预了。其次，我们将进行一项混合方法研究，以探索女性的经历在化学疗法期间，乳腺癌参加营养和运动干预。来自患者的观点，我们旨在揭示遵守和促进者的动机，偏好和感知的障碍并在主动癌症治疗期间维持营养和运动干预。最后，我们将估计乳腺癌患者相同全面营养和运动干预的成本效益接受化学疗法以提供关键数据，以帮助您进行行为扩展肿瘤学的干预措施。耶鲁大学公立学校组装了一个著名调查人员的跨学科团队健康和耶鲁大学医学院提供直接研究支持和专业发展向申请人进行指导。 YALE的拟议研究和协作培训环境将使申请人能够磨练她的现有技能并获得专业专业知识，这将使她良好地定位竞争性博士后职位和作为独立研究人员努力实施的长期职业生活方式的行为咨询成为肿瘤学护理的标准。