PROJECT SUMMARY
Cancer survivors have 1.7-18.5-fold increased risk, and 1.3-3.6-fold increased mortality of cardiovascular
disease (CVD). Physical activity has been shown to ameliorate risk, but survivors’ levels are far below the general
population. Due to this, provider physical activity recommendations and referrals are recommended by the
Institute of Medicine and the American Heart Association in survivorship care plans. In light of these
recommendations, barriers to physical activity participation among survivors exist at the provider, community,
and survivor levels. There is a critical need for implementation programs to connect these resources to increase
physical activity among survivors. To address this need, I developed, and beta tested a clinic-based eReferral
system referring patients to a nationwide community-based group program, LIVESTRONG at the Y, for survivors.
Due to COVID-19, we also referred to a virtual group program, Fit Cancer. The beta-test revealed the potential
of this approach; providers were engaged and referred survivors to the physical activity programs. It also
revealed the need for the eReferral to provide physical activity program choices, including a non-group self-
monitored digital health program. We, therefore, will build on the prior eReferral to develop and test
ActivityChoice in this 4-year proposal. ActivityChoice will include a patient narrative decision aid to support
choices to three evidence-based programs: LIVESTRONG (group in-person), Fit Cancer (group virtual), and
CareEvolution (Fitbit activity tracking and tailored messaging digital health). We found survivors prefer to hear
personal stories and support from other survivors to help support activity adoption, thus our decision aid will
include patient narrative stories to support program choices. In Aim 1, we will develop and test patient decision
aids to support choices with survivors and clinic staff and refine ActivityChoice. In Aim 2, we will conduct a
stepped wedge trial with clinic staff (n=8) at 3 UMass Cancer clinics sites, comparing an enhanced standard of
care control to the ActivityChoice implementation program in 70 patients with survivorship care planning visits.
We hypothesize ActivityChoice will have greater referral rates as compared to the enhanced standard of care
control. We will assess additional implementation outcomes, as well as exploratory physical activity and patient-
reported outcomes. In Aim 3, we will refine ActivityChoice and prepare for a multi-site trial through interviews
with stakeholders (survivors, clinic staff and administration) and potential future sites identified through our
collaborative networks. The refined program will be tested in a fully-powered effectiveness R01 trial submitted
in Year 4 of this project. To accomplish these aims, I will be guided by expert mentors and receive specialized
training in 1) Health and patient-provider communication, 2) Digital Health, 3) Advanced pragmatic clinical trials
and 4) Leadership and grant-development. This project will be conducted in collaboration with our clinical,
community and patient partners (Community Advisory Board) to guide the overall project design.
