Social Health, Activity Behaviors, and Quality of Life Among Young Adult Cancer Survivors

PRIMARY OBJECTIVES:

I. Characterize trajectories of social health over the course of cancer treatment and into early survivorship; II. Investigate longitudinal and potentially reciprocal associations between social health and activity behaviors (physical activity and sedentary time) and their relationship to quality of life; III. Examine whether gender, race/ethnicity, socioeconomic status, and symptom burden moderate these associations.

OUTLINE:

Patients complete surveys over 40 minutes and wear an actigraph GT3X-BT accelerometer continuously for 7 days at baseline, 3, 6, and 12 months.

• Medical Device Usage and Evaluation (Other): Wear an actigraph GT3X-BT accelerometer
• Quality-of-Life Assessment (Other), also known as Quality of Life Assessment: Complete survey
• Survey Administration (Other): Complete survey

Primary outcomes

• Change in social role functioning [Baseline up to 1 year]: Assessed using the PROMIS Ability to Participate in Social Roles and Activities Short Form 4a, which measures limitations in participation in usual social roles and activities due to health (higher scores indicate better participation).
• Change in perceived emotional support [Baseline up to 1 year]: Assessed using the PROMIS Emotional Support Short Form 4a, which measures perceived availability of people who provide emotional support, such as care, understanding, and someone to listen (higher scores indicate more emotional support).
• Change in perceived informational support [Baseline up to 1 year]: Assessed using the PROMIS Informational Support Short Form 4a, which measures perceived availability of people who provide advice, information, and guidance (higher scores indicate more informational support).
• Change in perceived instrumental support [Baseline up to 1 year]: Assessed using the PROMIS Instrumental Support Short Form 4a, which measures perceived availability of people who provide practical help and assistance with tasks (higher scores indicate more instrumental support).
• Change in loneliness score [Baseline up to 1 year]: Assessed using the UCLA Loneliness Scale short form, which measures subjective feelings of loneliness and social disconnection (higher scores indicate greater loneliness).
• Change in social anxiety symptoms [Baseline up to 1 year]: Assessed using the Mini Social Phobia Inventory (Mini SPIN), a brief validated measure of social anxiety and fear of social interactions (higher scores indicate greater social anxiety).
• Change in social network density [Baseline up to 1 year]: Assessed using a study developed egocentric social network questionnaire in which participants list up to 10 important adult social contacts and indicate which contacts know each other; density is calculated as the proportion of possible ties that are present (higher values indicate a more densely connected network).
• Change in proportion of supportive social ties [Baseline up to 1 year]: Assessed using a study developed egocentric social network questionnaire that measures whether each named social contact provides social support and encouragement for physical activity; the outcome is the proportion of social ties providing support (higher values indicate a more supportive network).
• Change in frequency of social contact [Baseline up to 1 year]: Assessed using a study developed egocentric social network questionnaire that captures how often participants interact with each named social contact; the outcome is the average reported frequency of contact across alters (higher values indicate more frequent social contact).
• Change in total daily physical activity [Baseline up to 1 year]: Assessed using a wrist worn ActiGraph GT3X BT accelerometer worn for 7 consecutive days at each time point. Raw data are converted to monitor independent movement summary (MIMS) units, and total daily physical activity is represented by average daily MIMS units across valid wear days (higher values indicate more physical activity).
• Change in total daily sedentary time [Baseline up to 1 year]: Assessed using a wrist worn ActiGraph GT3X BT accelerometer worn for 7 consecutive days at each time point. Sedentary time is calculated from accelerometer data as average minutes per day spent in sedentary behavior (e.g., low movement periods while awake) across valid wear days (higher values indicate more sedentary time).

Secondary outcomes

• Change in Quality of Life [Baseline up to 1 year]: Patient reported quality of life using Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10, assessed at baseline and 12 month follow up. This is a 10-item patient-reported questionnaire measuring general physical, mental, and social health. Most questions use a 1-to-5 point scale. Higher numerical values consistently represent better health or lower symptoms. The survey produces two separate scores: Global Physical Health (GPH) and Global Mental Health (GMH). Raw response values are summed and converted into standardized T-scores where a score of 50 represents the U.S. general population average (standard deviation of 10).
• Symptom Burden [Baseline up to 1 year]: Symptom burden assessed using the MD Anderson Symptom Inventory (MDASI) at all four timepoints. This survey is a multi-symptom patient-reported outcome (PRO) measure used to assess the severity of symptoms experienced by patients with cancer and the interference with daily living caused by these symptoms.

Sex: All, ages: 18 Years to 39 Years

Inclusion Criteria:

* Age 18-39 years at cancer diagnosis.
* Newly diagnosed (within past 3 months) with one of the following cancer types commonly seen in AYAs: testis, breast, thyroid, cervix, colorectal, brain/central nervous system, non Hodgkin lymphoma, uterine, melanoma, bones and joints, ovary, Hodgkin lymphoma, lung, or gastric cancer.
* Stage I-IV for solid tumors (AJCC 8th edition TNM staging) or I-IV for lymphomas (Ann Arbor staging).
* Receiving care at a participating USC affiliated hospital (USC Norris Comprehensive Cancer Center, Keck Hospital of USC, or Los Angeles General Medical Center) or MD Anderson Cancer Center.
* Clinician assessed expected survival greater than 12 months at time of diagnosis.
* Able to complete questionnaires and wear a wrist worn accelerometer.
* English or Spanish speaking.

Exclusion Criteria:

* Leukemia (excluded due to longer treatment duration and different care trajectory).
* Primary language other than English or Spanish.
* Cognitive or physical limitations that preclude completion of surveys or wearing an accelerometer.

• Kimberly Miller, PhD, Principal investigator, University of Southern California

NIH grants: P30CA014089, R37CA256867