Grant Number:	5R01CA176838-05 Interpret this number
Primary Investigator:	Hudson, Shawna
Organization:	Rbhs-Robert Wood Johnson Medical School
Project Title:	Extended Cancer Education for Longer-Term Survivors (EXCELS) in Primary Care
Fiscal Year:	2017

There are 13.7 million cancer survivors in the United States. By 2050 the rate of growth for cancer survivors is expected to outpace the rate of growth for incident cancer cases. Approximately 70 percent of cancer survivors have co-morbid conditions that require a comprehensive approach to their medical care. Yet, cancer survivors do not receive recommended follow-up care at appropriate levels, with regard to both needed preventive care and chronic disease management. Survivors may benefit from psychosocial tools and support to help them cope with care transitions, to appropriately monitor their health, and to help them manage their interactions with members of the healthcare provider team. Unfortunately, there is currently a lack of psychosocial tools designed specifically to help survivors proactively manage their healthcare from the termination of treatment into extended survivorship. To fill this void, we draw on the social and behavioral science evidence base in social interaction and health communication to develop and test a highly innovative, self-management intervention: Extended Cancer Education for Longer-term Survivors (EXCELS). Based on health communication best practices, as well as on smart technology for ready access to patients, the EXCELS intervention will consist of (1) enhanced education and decision support materials delivered via mobile web and smart phone application and (2) health coaching engagement. The plan for intervention development involves three steps: first, during the formative phase, we will use qualitative methods (i.e., focus groups with survivors, depth interviews with primary care healthcare team members, user testing) to inform the design and iterative development of EXCELS. Second, we will pilot the intervention using a randomized controlled trial study design. Specifically, we will enroll 480 cancer survivors (breast, prostate, colorectal) who have completed active cancer treatment at least 2 years ago. The comprehensive EXCELS intervention consists of an ongoing 12 month intervention that entails (1) enhanced education and self-care support materials delivered via mobile web/smart phone application and (2) health coaching calls. A 2X2 factorial design will be used to test "proof of concept" or efficacy for the fully implemented EXCELS intervention compared with usual care so that the combined intervention - as well as each individual component - will be tested. The primary outcomes are use of preventive health services and tracking of cancer recurrence and late effects with patient coping as a secondary outcome. Outcomes will be assessed at baseline and at 6, 12, and 18 months by telephone interviews and chart audit by blinded research staff. Finally, a process evaluation of intervention implementation, as well as pilot data from this study, will be used to refine the intervention for testing in a larger implementation and dissemination research study.




User-Centered Development and Patient Acceptability Testing of a Health-Coaching Intervention to Enhance Cancer Survivorship Follow-up in Primary Care.
Authors: O'Malley D.M. , Davis S.N. , Amare R. , Sanabria B. , Sullivan B. , Devine K.A. , Ferrante J.M. , Findley P.A. , Miller S.M. , Hudson S.V. .
Source: Journal of cancer education : the official journal of the American Association for Cancer Education, 2022 Jun; 37(3), p. 788-797.
EPub date: 2020-10-07.
PMID: 33025453
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Correlates of Information Seeking Behaviors and Experiences Among Adult Cancer Survivors in the USA.
Authors: Davis S.N. , O'Malley D.M. , Bator A. , Ohman-Strickland P. , Hudson S.V. .
Source: Journal of cancer education : the official journal of the American Association for Cancer Education, 2021 Dec; 36(6), p. 1253-1260.
PMID: 32358717
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Development and usability testing of the e-EXCELS tool to guide cancer survivorship follow-up care.
Authors: O'Malley D.M. , Davis S.N. , Devine K.A. , Sullivan B. , Bator A. , Clemow L. , Ferrante J.M. , Findley P.A. , Miller S.M. , Hudson S.V. .
Source: Psycho-oncology, 2020 Jan; 29(1), p. 123-131.
EPub date: 2019-10-18.
PMID: 31626397
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Rationale and design of extended cancer education for longer term survivors (EXCELS): a randomized control trial of 'high touch' vs. 'high tech' cancer survivorship self-management tools in primary care.
Authors: Davis S.N. , O'Malley D.M. , Bator A. , Ohman-Strickland P. , Clemow L. , Ferrante J.M. , Crabtree B.F. , Miller S.M. , Findley P. , Hudson S.V. .
Source: BMC cancer, 2019-04-11; 19(1), p. 340.
EPub date: 2019-04-11.
PMID: 30971205
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Determinants of patient activation in a community sample of breast and prostate cancer survivors.
Authors: O'Malley D. , Dewan A.A. , Ohman-Strickland P.A. , Gundersen D.A. , Miller S.M. , Hudson S.V. .
Source: Psycho-oncology, 2018 Jan; 27(1), p. 132-140.
EPub date: 2017-02-28.
PMID: 28133892
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Cardiovascular risk and communication among early stage breast cancer survivors.
Authors: Christian A.H. , O'Malley D. , Barac A. , Miller S.M. , Hudson S.V. .
Source: Patient education and counseling, 2017 Jul; 100(7), p. 1360-1366.
EPub date: 2017-02-10.
PMID: 28215826
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Perceptions of Cancer Risk: Differences by Weight Status.
Authors: Silverman K.R. , Ohman-Strickland P.A. , Christian A.H. .
Source: Journal of cancer education : the official journal of the American Association for Cancer Education, 2017 Jun; 32(2), p. 357-363.
PMID: 26553326
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Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.
Authors: O'Malley D. , Hudson S.V. , Nekhlyudov L. , Howard J. , Rubinstein E. , Lee H.S. , Overholser L.S. , Shaw A. , Givens S. , Burton J.S. , et al. .
Source: Journal of cancer survivorship : research and practice, 2017 Feb; 11(1), p. 13-23.
EPub date: 2016-06-08.
PMID: 27277895
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Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities.
Authors: Nekhlyudov L. , O'malley D.M. , Hudson S.V. .
Source: The Lancet. Oncology, 2017 Jan; 18(1), p. e30-e38.
PMID: 28049575
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Breast and prostate cancer survivors' experiences of patient-centered cancer follow-up care from primary care physicians and oncologists.
Authors: Hudson S.V. , Ohman-Strickland P.A. , Bator A. , O'Malley D. , Gundersen D. , Lee H.S. , Crabtree B.F. , Miller S.M. .
Source: Journal of cancer survivorship : research and practice, 2016 Oct; 10(5), p. 906-14.
EPub date: 2016-03-31.
PMID: 27034260
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Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance.
Authors: O'Malley D.M. , Hudson S.V. , Ohman-Strickland P.A. , Bator A. , Lee H.S. , Gundersen D.A. , Miller S.M. .
Source: Journal of cancer education : the official journal of the American Association for Cancer Education, 2016 Mar; 31(1), p. 63-9.
PMID: 25524391
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Development and preliminary testing of PROGRESS: a Web-based education program for prostate cancer survivors transitioning from active treatment.
Authors: Miller S.M. , Hudson S.V. , Hui S.K. , Diefenbach M.A. , Fleisher L. , Raivitch S. , Belton T. , Roy G. , Njoku A. , Scarpato J. , et al. .
Source: Journal of cancer survivorship : research and practice, 2015 Sep; 9(3), p. 541-53.
EPub date: 2015-02-20.
PMID: 25697335
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Perceptions of Primary Care Among Breast Cancer Survivors: The Effects of Weight Status.
Authors: Christian A. , Hudson S.V. , Miller S.M. , Bator A. , Ohman-Strickland P.A. , Somer R.A. , Ferrante J. .
Source: Health services research and managerial epidemiology, 2015 Jan-Dec; 2, .
PMID: 26120589
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Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes.
Authors: Hudson S.V. , O'Malley D.M. , Miller S.M. .
Source: Patient related outcome measures, 2015; 6, p. 75-90.
EPub date: 2015-03-19.
PMID: 25834471
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