Risk-stratified self-management care for colorectal cancer survivors: a new approach to increasing adherence to health behavior recommendations - PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) incidence and mortality are strongly linked to modifiable lifestyle factors, e.g., physical activity, alcohol intake, and diet. Importantly, adherence to health behavior recommendations (HBR) after CRC diagnosis improves physical function, quality of life, and is consistently associated with longer survival. However, <10% of CRC survivors adhere to health behavior recommendations (HBR) after diagnosis. Addressing low adherence to HBR in CRC survivors is therefore a clinically relevant unmet need. Low adherence to HBRs stems from a dearth of personally-tailored guidance about how to manage complex health behavior change. Personalized self-management training can remedy this issue by teaching CRC survivors the skills required to integrate health behavior recommendations into their unique life contexts. In non-cancer populations such as diabetes and spinal cord injury, personalized self-management training programs have been associated with increased adherence to health behavior recommendations when compared to standardized interventions. To date, a personalized approach to lifestyle self-management has not yet been tested in a cancer population. With strong evidence that post-diagnosis healthy lifestyle factors improve patient outcomes, CRC is an important population in which to study the impact of self-management training on HBR This five-year mentored research program for Dr. Alix Sleight aims to examine the effect of a personalized self- management training program on the uptake of HBRs in CRC survivors. A total of 120 stage I-III CRC patients diagnosed within 12 months will be recruited from the Cedars-Sinai Cancer Center and assessed using the standardized World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Health Behavior Adherence Scale. Patients with a WCRF/AICR score indicating low HBR adherence will be enrolled and randomized to: 1) a personalized self-management intervention with a focus on health behaviors or 2) a standardized health behavior education program. Each patient in the intervention group will receive content tailored to their unique areas of low HBR adherence on the WCRF/AIRC Scale. Our pilot study (n=30) demonstrated that a personalized self-management training intervention is feasible to implement, acceptable to cancer survivors, and has potential to impact adherence to HBR. We therefore expect that a larger systematic assessment of this intervention will show significant and clinically meaningful change in adherence to HBR. The proposed career development program was designed to expand Dr. Sleight’s skillset in 1) behavioral clinical trials, 2) biostatistics, and 3) implementation science. The training plan includes workshops and formal coursework alongside guidance from a network of diverse mentors. Together with a supportive institutional environment, this mentored research program will equip Dr. Sleight with the skills needed to develop and conduct large-scale randomized controlled trials of personalized self-management interventions for HBR adherence.
