Mechanisms of substance use behaviors among young adult cancer survivors: A mixed-methods ecological momentary assessment approach - PROJECT SUMMARY As incidence rates of cancer among young adults (YA; age 18-39 years) keep rising, more YAs than ever before are impacted by cancer and, subsequently, cancer survivorship. Presently, there are over 2.1 million YA cancer survivors. Due to vulnerabilities associated with their life stage, YA cancer survivors are at high risk for compounding negative health and psychosocial consequences from cancer and its treatments, including substance use (SU). In fact, YA cancer survivors report higher rates of tobacco, alcohol, cannabis, and illicit drugs than non-cancer peers, and are four times more likely to develop long-term opioid use. Yet, there are no evidence-based SU interventions tailored for this population largely because the underlying mechanisms driving SU remain unknown. There is critical need to identify and intervene on SU as early as possible to mitigate harms including increased risk for cancer recurrence, overdose, psychosocial impairment, and exacerbation of late effects (i.e., pain). Existing data regarding SU in YA cancer survivors, along with lack of survivor and provider engagement in the research progress, has contributed to limited characterization of the underlying mechanisms of SU, which, per the National Institutes of Health Stage Model, is critical for behavioral intervention development. The proposed study addresses these gaps by partnering with YA cancer survivors and providers and utilizing an exploratory sequential mixed-methods design to gain an in-depth understanding of socioecological (e.g., motives, distress, late effects, social factors) drivers of SU and SU-related treatment needs in YA cancer survivors in early survivorship. In line with principles of patient engagement in research, the research team includes YA cancer survivors and providers who will be involved in all phases of research design and execution. Aim 1a seeks to identify and explore socioecological factors related to SU and SU treatment engagement among YAs with SU in early survivorship (N=15) via semi-structured qualitative interviews. Building upon insight from patients in Aim 1a, qualitative interviews will then be conducted with healthcare providers who work with YA cancer survivors to identify individual and systems-level barriers and facilitators to addressing SU in YAs in early cancer survivorship (Aim 1b). Finally, Aim 2 leverages a mixed-methods, longitudinal design to investigate real-time relations between SU and socioecological mechanisms among YA cancer survivors with SU (N=50), examining within- person dynamics, stability, and relationships among SU and socioecological factors via ecological momentary assessment paired with brief qualitative interviews. Using an EMA burst design along with qualitative feedback can assist in contextualizing within person associations observed in each burst. This foundational work is essential to facilitating development of patient-centered SU behavioral interventions that meet the unique needs of YA cancer survivors and are feasible for providers.
