PROJECT SUMMARY
Cancer survivors with overweight or obesity (ow/ob) display increased morbidity and mortality even after
amelioration of disease. Improvements in dietary and physical activity patterns can mitigate this risk and can be
supported through comprehensive, multiple health behavior change (MHBC) interventions. Yet, translation of
MHBC interventions to clinical practice is limited, in part because traditional “treatment package” approaches are
not optimized for real-world implementation. Integration of multi-omic data can capture lifestyle exposures and
biological responses, providing the potential to strengthen conclusions and overcome limitations of existing
assessment methods. This approach could elucidate the biological underpinnings of how changes in modifiable
behaviors influence individual phenotype during survivorship. Such knowledge would help to identify and tailor
interventions for incorporation into survivorship care. Yet, this has not been conducted, posing a critical research
gap. My goal is to create a sustainable and scalable MHBC program combining diet and exercise to support
survivors with ow/ob and improve health in survivorship. Thus, the overall objectives for this NCI early K99/R00
award are to: (1) develop a survivorship nutrition intervention, BfedBwell, for implementation within an existing
clinical exercise oncology program; and (2) determine the impact of the intervention on diet and health through
the integration of multi-omic approaches. In the K99 phase, I will utilize the Multiphase Optimization Strategy
(MOST) framework, an engineering-based approach to efficiently and systematically develop, optimize, and
evaluate behavioral interventions, to test three social cognitive theory-based components: (1) 1:1 counseling
with a registered dietitian, (2) behavioral skills development, and (3) group support for delivery alongside a core
nutrition education curriculum within a clinical exercise oncology program. Post-treatment survivors (n=80) with
ow/ob will complete a 12-week cluster-randomized 2^3 factorial trial to test candidate intervention components
for feasibility and acceptability and to identify a set of components that demonstrates patterns of efficacy for
increased adherence to lifestyle recommendations, weight loss, and improvements in cardiometabolic health. In
the R00 phase, I will utilize targeted metabolomics to measure changes in biomarkers of dietary exposure
through analysis of participant biospecimens collected before and after the intervention. I will then perform
integrated network analysis using multi-omics (metabolome, proteome, microbiome) to examine the effects of
the intervention on cardiometabolic health. My K99 mentorship and training plan will provide skills in behavioral
weight loss trials, MOST study design, and multi-omics integration in survivorship. The R00 phase will advance
my foundational knowledge as I become an expert in identifying and interpreting multi-omic findings and
integrating them into behavioral interventions to predict and evaluate individual response. Completion of these
aims will lay the groundwork for an R01-level optimization trial, leading to advances in care while spanning
behavioral and biological domains to develop precision oncology nutrition strategies for improved survivorship.
