Grant Number:	6U01CA246659-02 Interpret this number
Primary Investigator:	Baker, Kevin
Organization:	Fred Hutchinson Cancer Center
Project Title:	An Interactive Survivorship Program to Improve Healthcare Resources [INSPIRE] for Adolescent and Young Adult (AYA) Cancer Survivors
Fiscal Year:	2020

PROJECT SUMMARY/ABSTRACT The proposed adolescent and young adult (AYA) mixed methods project will meet the goals and scientific scope of the U01 by refining and testing a scalable intervention to mitigate and manage adverse long-term outcomes in AYA cancer survivors. By improving access to survivorship resources, health literacy, self-management skills and support, the intervention is designed to improve adherence to AYA healthcare guidelines and reduce cancer- related distress. The project leverages an existing survivorship informatics infrastructure, an established multicenter survivorship research network, and our experiences with a randomized controlled trial (RCT) with AYAs and a digital and telehealth program initially developed for hematopoietic cell transplant survivors. This research fills a critical gap in care for AYA survivors by providing a novel, personalized, technology-based self- management program with stepped care telehealth. To be scalable, it uses a risk-based delivery model targeted to AYA survivors with demonstrated need. The two-arm RCT will test the AYA-adapted INSPIRE digital program, including an interactive mobile app/website and social media, adding stepped care telehealth for those with continued distress, lack of survivorship healthcare literacy, or who are not using the digital program at 1 month. In the active control arm, survivors receive access to a study website with existing AYA survivor resource links followed by delayed access to the INSPIRE program. Specific aims are: 1) Among AYA survivors with elevated cancer-related distress, determine the efficacy of a self-management program, INSPIRE, delivered by interactive digital cross-device options and stepped care telehealth coaching, compared to the active control arm. 2) Among AYA survivors with inadequate adherence to healthcare guidelines, determine the efficacy of the INSPIRE digital and telehealth self-management program in improving overall healthcare adherence and cardiometabolic or subsequent malignancy surveillance compared to the active control arm. 3) Examine mechanisms associated with intervention efficacy including engagement with the online program, use of telehealth contacts, and improved health self-efficacy, health literacy, AYA-specific impact of cancer, and barriers to healthcare; and examine moderators of intervention engagement or response including cancer clinical factors, health status, and sociodemographic and environmental factors. 4) Define costs of maintaining and delivering components of the INSPIRE program if delivered in a scaled-up model of care. An exploratory aim will assess dissemination potential and define risk models associated with distress, poorer health status or healthcare nonadherence. Aims will be accomplished with a two-arm, multicenter, risk-stratified RCT of N=980 AYA survivors of leukemia, lymphoma, colorectal cancer, melanoma, or sarcoma, age 18-39, and 1-5 years post-diagnosis. The primary outcome is reduced distress at 3 months; secondary outcomes are improved adherence and reduced distress at 12 months. If effective, the program is positioned for accelerated dissemination/implementation to improve care for AYA survivors by using a scalable informatics-based administration and largely digital intervention program.




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Health-Related Quality of Life in Young Adult Survivors of Hematopoietic Cell Transplantation.
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Prevalence of and Factors Associated with Marital Distress among Hematopoietic Cell Transplantation Survivors: Results from a Large Cross-Sectional Study.
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Biobehavioral Research and Hematopoietic Stem Cell Transplantation: Expert Review from the Biobehavioral Research Special Interest Group of the American Society for Transplantation and Cellular Therapy.
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Return to Work Among Young Adult Survivors of Allogeneic Hematopoietic Cell Transplantation in the United States.
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Feasibility of a behavioral intervention using mobile health applications to reduce cardiovascular risk factors in cancer survivors: a pilot randomized controlled trial.
Authors: Chow E.J. , Doody D.R. , Di C. , Armenian S.H. , Baker K.S. , Bricker J.B. , Gopal A.K. , Hagen A.M. , Ketterl T.G. , Lee S.J. , et al. .
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PMID: 33037989
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Home Spirometry Telemonitoring for Early Detection of Bronchiolitis Obliterans Syndrome in Patients with Chronic Graft-versus-Host Disease.
Authors: Turner J. , He Q. , Baker K. , Chung L. , Lazarevic-Fogelquist A. , Bethune D. , Hubbard J. , Guerriero M. , Sheshadri A. , Syrjala K.L. , et al. .
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PMID: 33781975
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Free of malignancy but not of fears: A closer look at Damocles syndrome in survivors of hematologic malignancies.
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Survivorship, Version 1.2021.
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Sexual Functioning in Long-Term Survivors of Hematopoietic Cell Transplantation.
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A theoretical model of financial burden after cancer diagnosis.
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Factors associated with social functioning among long-term cancer survivors treated with hematopoietic stem cell transplantation as adolescents or young adults.
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NCCN Guidelines Insights: Survivorship, Version 2.2020.
Authors: Denlinger C.S. , Sanft T. , Moslehi J.J. , Overholser L. , Armenian S. , Baker K.S. , Broderick G. , Demark-Wahnefried W. , Friedman D.L. , Goldman M. , et al. .
Source: Journal of the National Comprehensive Cancer Network : JNCCN, 2020 Aug; 18(8), p. 1016-1023.
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