||5R37CA248774-03 Interpret this number
||Van Blarigan, Erin
||University Of California, San Francisco
||Optimization of a Remote Intervention to Improve Nutrition and Physical Activity in Colorectal Cancer Survivors
Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the United States. The American Cancer
Society (ACS) recommends normal body mass index (BMI), regular physical activity, and a healthy diet for
cancer survivors. In 2018, we estimated that 38% of deaths within 5 years of diagnosis could be prevented in
stage III colon cancer if all patients followed the ACS guidelines. Yet, <10% of CRC patients closely follow
these lifestyle guidelines. Investigators have yet to optimize a lifestyle intervention, capitalizing on effective
scalable components, to improve lifestyle behaviors in CRC survivors. Critical research gaps include: 1)
whether specific intervention components (e.g., text messaging, etc.) are effective, overall or in sub-groups
(men vs. women, etc.); 2) insufficient focus on improving diet; and 3) few studies with remote interventions
have measured biological outcomes. To address these gaps, we propose to use the multiphase optimization
strategy (MOST) framework to identify effective intervention components to increase the ACS guideline score
(a standardized measure of physical activity, diet, and body size) among CRC survivors. The MOST framework
is an engineering-based approach to efficiently optimize behavioral interventions while managing limited
resources. Our team at the University of California, San Francisco; Dana-Farber Cancer Institute; and
Northwestern University have strong expertise conducting lifestyle interventions in cancer survivors, including
using MOST. Building on this experience, we propose a 12-month (mo.) randomized factorial experiment
among 400 CRC survivors to determine the effect of 4 candidate intervention components [text messaging,
digital health tool kit (physical activity tracker, apps), health coaching, buddy training (e.g., friend, family)] on
change in the ACS guideline score from 0 to 12 mo. Changes in the ACS score (our primary outcome) have
high potential to impact CRC survival, and it is modifiable and measurable remotely. Our Specific Aims are to:
Aim 1) Identify which of 4 candidate intervention components increase the ACS guideline score at 12 mo.
among CRC survivors. We will determine the individual and interaction effects of each component.
Secondarily, we aim to: Aim 2) Examine mediators and moderators of the intervention components’ effects on
change in the ACS guideline score from 0 to 12 mo. We will examine social cognitive theory constructs as
primary target mediators and sociodemographic, clinical, and psychological/behavioral factors as potential
moderators. This aim will help us understand how and for whom the intervention components affect lifestyle
behaviors. Aim 3) Examine the ACS guideline score in relation to levels of fasting insulin, glucose, HOMA-IR
and inflammatory markers at enrollment and 12 mo. The data from all three aims of this proposal will guide our
next step to conduct a definitive randomized controlled trial to evaluate the effect of the optimized intervention
versus standard care on risk of CRC recurrence. Overall, this proposal is a critical step toward developing an
effective and scalable lifestyle intervention to reduce CRC mortality with potential for high public health impact.
Variety of Fruit and Vegetables and Alcohol Intake are Associated with Gut Microbial Species and Gene Abundance in Colorectal Cancer Survivors.
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