A Hope-Based Intervention to Address Disrupted Goal Pursuits and Quality of Life in Young Adult Cancer Survivors

CJ Berg, RC Vanderpool, B Getachew, MF Johnson, JB Payne, Y Sandridge, J Bierhoff, J Kelly, KE Effinger, WW Demark, S Duffy, A Mertens
2019 Cancer Epidemiology, Biomarkers and Prevention  
In this pilot study, we assessed feasibility and acceptability, and obtained efficacy parameters of an app based 8-week program focusing on a hope-based intervention to address the disruption of goal pursuits among young adult cancer survivors in order to ultimately increase quality of life. Methods: This 8-week appbased intervention program, known as AWAKE (Achieving Wellness After Kancer in Early Life), consists of educational videos, mood/activity tracking, and telephone-based coaching to
more » ... mote goal-oriented thinking and quality of life (QOL) in young adult cancer survivors (YACSs). Fifty-seven YACSs (18-40 years old), two years post treatment were recruited from two NCIdesignated cancer centers and randomly assigned to AWAKE (n ¼ 38) or an attention control (n ¼ 19). Both AWAKE and attention control group received weekly coaching calls. The app content for the AWAKE intervention group included 8 weekly modules specifically targeting the needs of young adult cancer survivors; the content delivered via text for those in attention control focused on personal finances. At weeks 0, 8, and 24, we assessed hope (via the Trait Hope Scale) and QOL (via the 36-Item Short Form Health Survey and Functional Assessment of Cancer Therapy-General). Results: The mean age was 32.2 years old, and 75.0% were female, 77.6% non-Hispanic White, 61.2% employed, and 67.3% married/stable union. Diagnoses included breast cancer (28.6%), hematologic malignancies (12.2%), and melanoma (12.2%). Weekly adherence to AWAKE averaged 86.1% (range: 100.0% at week 1 to 75.7% at week 8). Retention at end-of-treatment was 90.7%. Among AWAKE participants, 90.9% were satisfied with AWAKE and would recommend AWAKE to friends with cancer; >84.8% reported that AWAKE components were helpful. Despite being underpowered to detect efficacy, changes in hope and QOL outcomes trended in the hypothesized directions. Conclusion: AWAKE was a feasible and acceptable approach; changes in hope and some measures of QOL trended in the hypothesized direction. AWAKE has the potential to address disrupted goal pursuits and enhance QOL among YACSs. Future research is needed to examine AWAKE's efficacy in a larger RCT. Future research is needed to examine AWAKE's efficacy in a larger RCT. To confirm previous reports of increased non-Hodgkin lymphoma (NHL) risk with higher intake of dietary trans fatty acids (TFA), we conducted the first prospective study of prediagnosis red blood cell (RBC) TFA levels and risk of NHL and common NHL histologic subtypes (diffuse large-B cell lymphoma (DLBCL), follicular lymphoma, chronic lymphocytic lymphoma/small lymphocytic leukemia, other B-cell NHL, T-cell NHL). Methods: We conducted a nested case-control study in Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS) participants with archived RBC specimens and no history of cancer at sample collection (NHS: 1989-90; HPFS: 1994-5). We confirmed 583 NHL cases (332 women in NHS, 251 men in HPFS) and matched 583 controls by cohort (sex), age, race/ethnicity and blood draw date/time. We analyzed RBC TFAs using gas-liquid chromatography; individual TFA levels were expressed as a percentage of total fatty acids. We used unconditional logistic regression, adjusted for the matching factors, to estimate odds ratios (OR) and 95% confidence intervals (CI) for overall NHL risk per 1 standard deviation (SD) unit increase in TFA level. We fitted multivariate polytomous logistic regression models to assess associations for the specific subtypes listed above. Results: Total and individual RBC TFAs were not associated with overall NHL risk or risk of most histologic subtypes. However, we observed a positive association of total RBC TFA with DLBCL risk (n ¼ 86 cases; OR [95% CI] per 1 SD: 1.29 [1.02, 1.64]), driven primarily by 18:1 TFAs (1.35 [1.07, 1.72]). Among 18:1 TFA isomers, we found a positive association for trans 18:1 n-9 (elaidic acid; 1.33 [1.05, 1.68]) but not for other isomers. Conclusions: We observed significant positive associations for RBC TFA levels with DLBCL risk. These findings are consistent with published studies of self-reported TFA intake; further, previous studies have shown that TFA levelsparticularly trans 18:1n-9, which is industrially-derived are positively correlated with biomarkers of inflammation and immune activation, supporting the biologic plausibility of our findings. Food industry and public health measures to diminish TFA intake may help to reduce risk of NHL, and particularly of DLBCL. Screening programs based on fecal blood testing have been shown in randomized controlled trials to reduce colorectal cancer incidence and mortality. Professional organizations highly recommend screening average-risk patients with fecal immunochemical testing (FIT). Many patients find these stool tests more acceptable than colonoscopy and stool testing may be the preferred option for areas with limited endoscopic resources. However, the diagnostic performance of FIT testing, particularly for CLIA-waived point-of-care (POC) tests, has not been well studied. Purpose: We are comparing the diagnostic
doi:10.1158/1055-9965.epi-19-0087 fatcat:udw2yfpz3zbefmvuukvcl32g3e