There are ~680,000 adolescent and young adult cancer survivors (AYACS) in the U.S., and this number is likely
to grow as the incidence of cancer in this age-group is rising. AYACS experience significant disruptions to
achieving normative developmental milestones (e.g. completion of education, developing a career, dating,
marriage, child birth), which often results in elevated rates of depressive symptoms compared to healthy peers
and other cancer survivors. Among cancer survivors, depressive symptoms associated with poorer quality of life,
lower adherence to medical recommendations, increased healthcare utilization/costs, and elevated mortality risk.
Though psychosocial interventions for depression are efficacious in the general population, few have been
adapted for use with AYACS. Additionally, interventions to improve depressive symptoms have typically been
provided in-person, which has resulted in many barriers to participation (e.g., distance, limited clinician
availability “after hours”) that are problematic for AYACS who tend to have many competing commitments wuch
as school, work, and parenting. Therefore, it is critical to develop AYACS-targeted interventions that can be
delivered remotely and on-demand such as mobile health applications (mHealth apps). The objective of this
proposal is to prepare and optimize a mHealth app to promote self-management of depressive symptoms among
AYACS (iManageAYA), guided by the Multiphase Optimization Strategy (MOST) framework. MOST is a
framework adapted from engineering that uses highly efficient factorial experiments to evaluate individual and
combined effects of intervention components to determine which ones can be reduced, eliminated, or replaced
to improve efficiency. During the K99 phase, I propose using an iterative user-centered design process to prepare
a prototype of iManageAYA that is usable, acceptable, and feasible for AYACS. This intervention will consist of
a core application and four evidence-based components: 1) behavioral activation; 2) cognitive restructuring; 3)
mindfulness training; and 4) peer support. During the R00 phase, I will determine which intervention components
reduce depressive symptoms using a full factorial experiment. I will use the results of this experiment to develop
an intervention that only includes components that significantly contributed to reductions in depressive symptoms
among AYACS, minimizing participant burden. I plan to propose future studies will test the efficacy of this
optimized intervention, as well as strategies for its dissemination and implementation. In addition to the proposed
research, I will extend my knowledge and skills in: 1) user-centered design; 2) the MOST approach; 3) the
conduct of clinical trials with AYACS; 4) dissemination and implementation science and 5) professional
development. This K99/R00 award will enable my transition to an independent career conducting innovative
research to develop, evaluate, implement, and disseminate psychosocial interventions that address the unique
needs of AYACS. My mentoring team and collaborators have the necessary skills and resources to assist me in
achieving my goals and will ensure that I successfully transition to an independent investigator.
