Testing Counseling and Mobile Health Interventions to Improve Physical Activity and Diet Quality in Survivors of Childhood Cancer

Study Overview
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Brief Summary
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This clinical trial evaluates several behavioral interventions for the improvement of physical activity in cancer patients. Childhood and adolescent/young adult cancer survivors have been reported to have poor diet quality and rarely meet recommended physical activity guidelines. This trial aims to see whether a tailored intervention based on self-determination theory may help to improve physical activity and dietary change.

Detailed Description
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OUTLINE: Patients are randomized to Arms 1, 2, or 3. ARM 1: Patients receive a personalized clinician-led self-management telehealth session at baseline and 2 months. Patients with poor response at 3 months are randomized to Arm 2 or 4, otherwise patients receive the same telehealth session at months 4 and 6. Patients may receive 2 additional telehealth sessions after 12 months. ARM 2: Patients receive personalized goal setting for daily steps and activity (updated weekly) and 3 dietary goals (updated monthly) with social media peer support for 6 months. Patients with poor response at 3 months are randomized to Arms 1 or 4. Patients may receive personalized goal setting for daily steps and activity (updated monthly) and dietary goals (updated every 2 months) after 12 months. ARM 3: Patients receive no intervention for 12 months, and then receive their choice of intervention for up to 6 months. ARM 4: Patients receive remote sessions with a health coach every 1-2 weeks for 6 months. Patients may continue to receive remote sessions once a month after 12 months.

Official Title
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SALSA: Study of Active LifeStyle Activation

Conditions
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Hematopoietic and Lymphoid Cell Neoplasm, Malignant Solid Neoplasm

Intervention / Treatment
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* Behavioral: Behavioral Intervention
* Behavioral: Behavioral Intervention
* Behavioral: Behavioral Intervention
* Other: Survey Administration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Childhood Cancer Survivor Study (CCSS) participant who is between age 18 to < 55 years at time of initial consent Moderate to high CV risk status based on CCSS risk prediction models for cardiomyopathy and ischemic heart disease Able to read, write, and speak English Ability to understand and the willingness to provide informed consent At least one of the following: Less than 30 minutes/day of moderate to vigorous physical activity (MVPA) based on validated self-report instrument (Godin) Healthy Eating Index (HEI)-2015 score < 60 per study food frequency questionnaire (FFQ) Body mass index (BMI) >= 25 kg/m^2 per self-reported height and weight Be free of any known (self-reported) ischemic heart disease or cardiomyopathy Have internet access (can be via smartphone or computer; if neither device is available, the study can loan participants a Wi-Fi enabled device, but participant will need to have access to the internet) Exclusion Criteria: Individuals with known cardiomyopathy or ischemic heart disease based on prior CCSS surveys are excluded. While not likely to be common, participants who newly report in our study's screening questionnaire that they have newly diagnosed cardiomyopathy or ischemic heart disease will also be excluded Having any self-reported contraindication to walking or being physically active Not currently known to be pregnant; individuals known to be pregnant and otherwise eligible for the study can be enrolled once no longer known to be pregnant. Participants who report being pregnant after randomization can remain in the study Individuals receiving active cancer treatment. Participants who report starting active cancer treatment after randomization can remain in the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 54 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm 1 (personalized clinician-led self-management telehealth)<br>Patients receive a personalized clinician-led self-management telehealth session at baseline and 2 months. Patients with poor response at 3 months are randomized to Arm 2 or 4, otherwise patients receive the same telehealth session at months 4 and 6. Patients may receive 2 additional telehealth sessions after 12 months. | Behavioral: Behavioral Intervention<br>* Receive personalized clinician-led self-management telehealth sessions<br>* Other names: Behavioral Treatments;Other: Survey Administration<br>* Ancillary studies<br>|
| Experimental: Arm 2 (personalized goal setting)<br>Patients receive personalized goal setting for daily steps and activity (updated weekly) and 3 dietary goals (updated monthly) with social media peer support for 6 months. Patients with poor response at 3 months are randomized to Arms 1 or 4. Patients may receive personalized goal setting for daily steps and activity (updated monthly) and dietary goals (updated every 2 months) after 12 months. | Behavioral: Behavioral Intervention<br>* Receive personalized goal setting for daily steps and activity and dietary goals<br>* Other names: Behavioral Treatments;Other: Survey Administration<br>* Ancillary studies<br>|
| Active Comparator: Arm 3 (waitlist)<br>Patients receive no intervention for 12 months, and then receive their choice of intervention for up to 6 months. | Other: Survey Administration<br>* Ancillary studies<br>|
| Experimental: Arm 4 (remote sessions with a health coach)<br>Patients receive remote sessions with a health coach every 1-2 weeks for 6 months. Patients may continue to receive remote sessions once a month after 12 months. | Behavioral: Behavioral Intervention<br>* Remote sessions with a health coach<br>* Other names: Behavioral Treatments;Other: Survey Administration<br>* Ancillary studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sedentary time | <100 counts/minute as measured by research-grade accelerometry | Up to 12 months | 
| Healthy Eating Index (HEI)-2015 score | On a scale of 100 (perfect score) as measured by Food Frequency Questionnaire | Up to 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant engagement | As measured by: 1) response to clinician action plans [score of 0-10; 10 being most engaged]; 2) use of mHealth apps [e.g., number of days with daily steps ≥500; number of days with recorded calories ≥500; social media interactions counting viewing, liking, or posting comments]; and 3) number of sessions completed with lifestyle health coach and coach's rating of engagement [score of 0-10; 10 being most engaged] | Up to 12 months | 
| Health-related self-efficacy scale | Per Schwarzer R, et al. and converted to T-score (higher equaling greater self-efficacy) | Up to 12 months | 
| Multidimensional Health Locus of Control Scale | Per Wallston KA, et al. with 3 subscales: internal, chance, and powerful others (each scored from 6-36, with higher values indicating greater agreement with that subscale's locus on control beliefs) | Up to 12 months |