Project Summary/Abstract
Of over 80,000 adolescents and young adults (AYA) diagnosed with cancer in the United States each year, 85%
live for at least five years after their cancer diagnosis. Adolescence and early young adulthood is a critical period
for frontal neurodevelopment, and cancer treatments potentially disrupt this neurodevelopment, leading to
cognitive deficits known as cancer-related cognitive impairment (CRCI). An estimated 53% of these long-term
early young adult (YA) survivors experience CRCI that interferes with their work and educational goals. However,
sparse research using objective neuropsychological assessment does not detect CRCI as reported by YA
survivors. Therefore, the goal of this K99/R00 application is to take the first step in an innovative program of
research to characterize CRCI among this vulnerable survivorship population using ecologically valid
assessments. Career Development Plan: The overall training objective is to provide Dr. Tometich with additional
training and mentorship to become a highly qualified independent investigator with expertise in CRCI in the
understudied population of AYA cancer survivors. Dr. Tometich’s training goals are to: 1) enhance her knowledge
of cancer and cognition in AYAs, 2) acquire skills in cognitive and behavioral assessment methodologies, 3)
develop proficiency in real-time longitudinal data analysis, and 4) continue professional development. During the
K99 phase, Dr. Tometich will work under the primary mentorship of Dr. Heather Jim at Moffitt Cancer Center (an
NCI-designated comprehensive cancer center) and co-mentorship of Dr. Brent Small. Experts in CRCI among
AYA survivors are lacking nationally; therefore, a mentorship and advisory team will provide complementary
expertise to address each aspect of the training and research content (additional advisors are Drs. Andrew
Galligan, Martin Sliwinski, and Dinorah Martinez Tyson). Research Plan: The goal of this study is to evaluate
long-term CRCI and potentially modifiable risk factors in YA survivors (i.e., age 18-30) using ecologically valid
assessments. An existing cognitive ecological momentary assessment (EMA) has been developed and used by
our research team in middle-aged breast cancer survivors, but it has not yet been applied in YA survivors.
Furthermore, actigraphy can objectively measure two modifiable risk factors for CRCI (physical activity and
sleep). In the K99 phase (i.e., Aims 1 and 2), we will use an iterative mixed-methods approach to tailor an EMA
of CRCI and situational, behavioral, and contextual risk factors (SBCF) to the experience of YAs based on
qualitative interviews with 20 YA survivors who report CRCI. We will then pilot the EMA and actigraphy in 25 YA
survivors and make revisions as needed. In the R00 phase (i.e., Aim 3), we will recruit 150 YA survivors and 150
community controls matched on gender, age, and education for a cross-sectional study to evaluate CRCI and
SBCF. Impact: The combined training and research plan will position Dr. Tometich to transition to independence
as one of the few cancer control investigators specializing in CRCI in the vulnerable and unique population of
AYA survivors.
