Designing a Dyad-Based Digital Health Intervention to Reduce Sedentary Time in Black Breast Cancer Survivors and Their First-degree Relatives: Human-Centered Design Study

BACKGROUND

Breast cancer, the most commonly diagnosed cancer and second leading cause of cancer-related death in women in the United States, disproportionately affects women from minoritized or low socioeconomic backgrounds. The average woman has an approximately 12% lifetime risk of developing breast cancer. Lifetime risk nearly doubles if a woman has a first-degree relative with breast cancer, and the risk increases as multiple family members are affected. Decreasing sedentary behaviors through moving more and sitting less reduces breast cancer risk and improves outcomes for cancer survivors and healthy adults. Digital health solutions, such as mobile apps that are culturally appropriate, designed with input from the target audience, and include social support, are effective at improving health behaviors.

OBJECTIVE

This study aimed to develop and evaluate the usability and acceptability of a prototype app designed with a human-centered approach to promote moving more and sitting less in Black breast cancer survivors and their first-degree relatives (parent, child, or sibling).

METHODS

This 3-phase study consisted of app development, user testing, and evaluation of user engagement and usability. Key community stakeholders were engaged in the first 2 (qualitative) phases to provide input into developing the prototype app (MoveTogether). After development and user testing, a usability pilot was conducted. Participants were adult breast cancer survivors who identified as Black and agreed to participate with a relative. Participants used the app and a step-tracking watch for 4 weeks. App components included goal setting and reporting, reminders, dyad messaging, and educational resources. Usability and acceptability were assessed with a questionnaire that included the System Usability Scale (SUS) and semistructured interviews. Data were analyzed with descriptive statistics and content analysis.

RESULTS

Participants in the usability pilot (n=10) were aged 30 to 50 years (6/10, 60%), not married (8/10, 80%), and college graduates (5/10, 50%). The app was used on average 20.2 (SD 8.9) out of 28 days-SUS score of 72 (range 55-95)-and 70% (7/10) agreed that the app was acceptable, helpful, and gave them new ideas. Additionally, 90% (9/10) found the dyad component helpful and would recommend the app to friends. Qualitative findings suggest that the goal-setting feature was helpful and that the dyad partner (buddy) provided accountability. Participants were neutral regarding the cultural appropriateness of the app.

CONCLUSIONS

The MoveTogether app and related components were acceptable for promoting moving more in dyads of breast cancer survivors and their first-degree relatives. The human-centered approach, which involved engaging community members in the development, is a model for future technology development work. Future work should be done to further develop the intervention based on the findings and then test its efficacy to improve sedentary behavior while considering culturally informed strategies for adoption and implementation within the community.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05011279; https://clinicaltrials.gov/ct2/show/NCT05011279.

Approaches for Measuring Inclusive Demographics Across Youth Enjoy Science Cancer Research Training Programs

The National Cancer Institute's (NCI) Youth Enjoy Science Program (YES) funds initiatives to support the cancer research training and career ambitions of middle school through undergraduate students from populations underrepresented in the biomedical sciences. The program has funded 16 institutions nationally as of January 2022. Given the program's focus on increasing diversity within the cancer research workforce, demographic characteristics of YES trainees provide essential information about the populations being served and program effectiveness. Six programs formed an interest group focused on trainee demographics and surveyed all YES grantees about their demographic data practices. Fifteen programs (94%) completed the survey. Survey data were analyzed through descriptive statistics and thematic coding. Findings revealed considerable variability in programs' approach to demographic data, including which demographics were measured, how they were operationalized, and when and how the data were collected. Half of YES programs (53%) could report underrepresented populations in biomedical research among trainees using consistent definitions. Most programs described efforts to improve their demographic data practices; however, challenges remained for the vast majority. In consideration of these findings, we offer recommendations for inclusive demographic data practices to better define and retain underrepresented populations in biomedical sciences.

Best Practices to Support Early-Stage Career URM Students with Virtual Enhancements to In-Person Experiential Learning

STEM training of college-bound and college students has reliably employed hands-on experiential learning by placing students in on-campus research settings. Dana-Farber/Harvard Cancer Center's Young Empowered Scientists for ContinUed Research Engagement (DF/HCC's YES for CURE) program introduces Massachusetts high school and college students from underrepresented populations to cancer research by immersing them in scientific and nursing research environments. Amidst the COVID-19 pandemic, the 2020 summer program was re-designed and delivered virtually for 45 students. Because the program spans three years, we could evaluate the experiences of 18 students (cohort 2) who completed the 2019 (pre-pandemic) and 2020 (pandemic) summer programs. Analysis of cohort 2 data revealed three areas where students felt their competence improved with virtual programming (i.e., effective communication of ideas, access to high caliber speakers, engagement with program leaders) and two areas where it declined significantly (i.e., engaging other students, learning lab material). Additionally, student-reported competence to perform 21 scientific research and seven critical thinking processes were not negatively impacted by the virtual transition. Herein, we describe the adaptation of DF/HCC's YES for CURE program to a virtual format and the impact on students as a resource for institutions interested in enhancing their STEM training programs with virtual programming.

Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative

BACKGROUND

Racial and socioeconomic disparities in breast cancer mortality persist. In Boston, MA, Black, Non-Hispanic women and Medicaid-insured individuals are 2-3 times more likely to have delays in treatment compared to White or privately insured women. While evidence-based care coordination strategies for reducing delays exist, they are not systematically implemented across healthcare settings.

METHODS

Translating Research Into Practice (TRIP) utilizes community engaged research methods to address breast cancer care delivery disparities. Four Massachusetts Clinical and Translational Science Institute (CTSI) hubs collaborated with the Boston Breast Cancer Equity Coalition (The Coalition) to implement an evidence-based care coordination intervention for Boston residents at risk for delays in breast cancer care. The Coalition used a community-driven process to define the problem of care delivery disparities, identify the target population, and develop a rigorous pragmatic approach. We chose a cluster-randomized, stepped-wedge hybrid type I effectiveness-implementation study design. The intervention implements three evidence-based strategies: patient navigation services, a shared patient registry for use across academic medical centers, and a web-based social determinants of health platform to identify and address barriers to care. Primary clinical outcomes include time to first treatment and receipt of guideline-concordant treatment, which are captured through electronic health records abstraction. We will use mixed methods to collect the secondary implementation outcomes of acceptability, adoption/penetration, fidelity, sustainability and cost.

CONCLUSION

TRIP utilizes an innovative community-driven research strategy, focused on interdisciplinary collaborations, to design and implement a translational science study that aims to more efficiently integrate proven health services interventions into clinical practice.

Abstract IA16: Lessons learned from seventeen years of cancer research experiences program for under-represented high school and college students

Background/Purpose: Increasing participation of under-represented minorities (URMs) in cancer-related fields is critical for eliminating disparities in prevention, incidence, prevalence, detection, treatment, survival, and mortality. Early engagement in scientific research is linked to retention of students in STEM programs and careers. Dana-Farber/Harvard Cancer Center (DF/HCC) is one of the largest consortium comprehensive cancer centers in the world. As part of the mission to find new and innovative ways to combat cancer and eliminate cancer disparities in communities throughout the Northeast, we are shaping the development of a new, diverse, and educated workforce through the Continuing Umbrella of Research Experiences (CURE) program. CURE introduces high-school and college students from URM populations to the world of cancer research. The program aims to increase URMs successfully pursuing careers in biomedicine, cancer research, and/or health disparities, pursuing graduate degrees and/or professional training in these areas, and engaging in scholarly activity. Initially funded through a cancer center supplement, during the past two years DFHCC has expanded their programming by successfully obtaining two NCI R25 grants, Young Empowered Scientists for ContinUed Research Engagement (YES for CURE) Program (NCI CA221738) and Summer Program to Advance Research Careers (SPARC) Program (NCI CA214256).

Description: DF/HCC has engaged over 400 students in research experiences at its seven-member institutions. Building on a 17-year history of research training experience and a long-term partnership with the University of Massachusetts Boston (UMB), DF/HCC created programming that combines hands-on research experiences with professional development seminars, journal clubs, book clubs, social events, and individual project planning.

Evaluation: Students and mentors are surveyed each summer to identify opportunities for improvement. We also track academic and professional progress of our alumni annually.

Usefulness: Based on our 2017 survey with a 71% average response rate, 95% of our alumni have completed or are currently enrolled in post-secondary programs, with 72% completing college degrees so far. Of these, 83% graduated with STEM or health science degrees and 23% have additionally completed graduate degrees. Over two thirds of our alumni are currently working full- or part-time in STEM-related fields and almost 25% in cancer-related work. 15% are working in a health disparities-related field. Our alumni have coauthored more than 243 scientific publications. Our research education and training successfully engage the scientific curiosity and promote the academic success and future research careers of promising young URM scientists.

Learning Objectives: The participant shall be able to learn best practices for engaging high school and college students from under-represented backgrounds in hands-on cancer research.

References

E. De Chubin and AL DePass, editors. Understanding interventions that broaden participation in science careers. In Understanding Interventions, San Diego, CA, 2015.

K. Maton, T. Beason, S. Godsay, M. Sto. Domingo, T. Bailey, S. Sun and F. Hrabowski. Outcomes and processes in the Meyerhoff Scholars Research Program: STEM PhD Completion, Sense of Community, Perceived Program Benefit, Science Identity, and Research Self-Efficacy. CBE–Life Sciences Education 15: 3 (Ar48), 2016.

M. Ghee, M. Keels, D. Collins, C. Neal-Spence and E. Baker. Fine-tuning summer research programs to promote underrepresented students' persistence in the STEM pathway. CBE-Life Sciences Education 15: 3 (Ar28), 2016.

Citation Format: Karen Burns White, Emily McMains, Diedra Wrighting, Joan Becker, Kathynie Hinds. Lessons learned from seventeen years of cancer research experiences program for under-represented high school and college students [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA16.

Standardized activities for lay patient navigators in breast cancer care: Recommendations from a citywide implementation study

BACKGROUND

There is a need for guidelines on patient navigation activities to promote both the quality of patient navigation and the standards of reimbursement for these services because a lack of reimbursement is a major barrier to the implementation, maintenance, and sustainability of these programs.

METHODS

A broad community-based participatory research process was used to identify the needs of patients for navigation. A panel of stakeholders of clinical providers was convened to identify specific activities for navigators to address the needs of patients and providers with the explicit goal of reducing delays in the initiation of cancer treatment and improving adherence to the care plan.

RESULTS

Specific activities were identified that could be generalized to all patient navigation programs for care during active cancer management to address the needs of vulnerable communities.

CONCLUSIONS

Oncology programs that seek to implement lay patient navigation may benefit from the adoption of these activities for quality monitoring. Such activities are necessary as we consider reimbursement strategies for navigators without clinical training or licensure.

Cancer disparities: developing a multidisciplinary research agenda - preface

In this Special Issue, we present a series of papers concerned with developing a multidisciplinary research agenda to address social disparities in cancer. Motivating this Special Issue are two concerns: (1) despite major advances in knowledge during the 20th century about the extent, determinants, treatment, and prevention of cancer, social disparities in cancer, including within the United States, remain serious, persistent, and require redress; and (2) huge gaps in knowledge exist regarding the causes of and solutions to social disparities in cancer across the full cancer continuum, from prevention to occurrence to diagnosis to treatment and, all too often, to death. Consequently, critical research is critically needed, both to answer the unanswered questions and to ascertain why existing knowledge is not implemented to reduce and eliminate these disparities. To help advance work in this field, we share papers developed for a January 2004 workshop on cancer disparities held at the Dana Farber/Harvard Cancer Center (DF/HCC), in Boston, MA. Topics addressed include: the definition and magnitude of, and programmatic responses to, social disparities in cancer, plus development of a systematic approach to raising research questions to address cancer disparities, using the case examples of breast, cervix, colon, and prostate cancer.

Thrombin receptor (PAR-1) antagonists. Solid-phase synthesis of indole-based peptide mimetics by anchoring to a secondary amide

A novel, 10-step, solid-phase method, based on a secondary amide linker, was developed to construct a diverse library of indole-based SFLLR peptide mimetics as thrombin receptor (protease-activated receptor 1, PAR-1) antagonists. The key steps include stepwise reductive alkylation, urea formation, and Mannich reaction. Screening of the library led to a quick development of the SAR and the significant improvement of PAR-1 activity.

Design, synthesis, and biological characterization of a peptide-mimetic antagonist for a tethered-ligand receptor

Protease-activated receptors (PARs) represent a unique family of seven-transmembrane G protein-coupled receptors, which are enzymatically cleaved to expose a truncated extracellular N terminus that acts as a tethered activating ligand. PAR-1 is cleaved and activated by the serine protease alpha-thrombin, is expressed in various tissues (e.g., platelets and vascular cells), and is involved in cellular responses associated with hemostasis, proliferation, and tissue injury. We have discovered a series of potent peptide-mimetic antagonists of PAR-1, exemplified by RWJ-56110. Spatial relationships between important functional groups of the PAR-1 agonist peptide epitope SFLLRN were employed to design and synthesize candidate ligands with appropriate groups attached to a rigid molecular scaffold. Prototype RWJ-53052 was identified and optimized via solid-phase parallel synthesis of chemical libraries. RWJ-56110 emerged as a potent, selective PAR-1 antagonist, devoid of PAR-1 agonist and thrombin inhibitory activity. It binds to PAR-1, interferes with PAR-1 calcium mobilization and cellular function (platelet aggregation; cell proliferation), and has no effect on PAR-2, PAR-3, or PAR-4. By flow cytometry, RWJ-56110 was confirmed as a direct inhibitor of PAR-1 activation and internalization, without affecting N-terminal cleavage. At high concentrations of alpha-thrombin, RWJ-56110 fully blocked activation responses in human vascular cells, albeit not in human platelets; whereas, at high concentrations of SFLLRN-NH(2), RWJ-56110 blocked activation responses in both cell types. Thus, thrombin activates human platelets independently of PAR-1, i.e., through PAR-4, which we confirmed by PCR analysis. Selective PAR-1 antagonists, such as RWJ-56110, should serve as useful tools to study PARs and may have therapeutic potential for treating thrombosis and restenosis.