The 128,000 Texans diagnosed with cancer in 2021 will complete treatment and move into survivorship with an elevated risk for acquiring a second primary cancer, living with symptom burden, and diminished quality of life. This survivorship transition occurs in a window of heightened opportunity for encouragement toward preventive health behavior change. This window of opportunity, in which cancer survivors are primed to make health behavior changes that offer lifelong benefit, is not systematically capitalized upon in the cancer care continuum. In fact, few survivors meet the lifestyle behavior recommendations promoted by the American Cancer Society. LiveStrong Cancer Institutes and Texas Onc...

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The 128,000 Texans diagnosed with cancer in 2021 will complete treatment and move into survivorship with an elevated risk for acquiring a second primary cancer, living with symptom burden, and diminished quality of life. This survivorship transition occurs in a window of heightened opportunity for encouragement toward preventive health behavior change. This window of opportunity, in which cancer survivors are primed to make health behavior changes that offer lifelong benefit, is not systematically capitalized upon in the cancer care continuum. In fact, few survivors meet the lifestyle behavior recommendations promoted by the American Cancer Society. LiveStrong Cancer Institutes and Texas Oncology have partnered to propose the implementation and evaluation of a systematic approach to survivorship care that is focused on the delivery of evidence-based strategies in cancer prevention and control. Adherence to lifestyle behavior recommendations is associated with higher health related quality of life and correlated risk reduction for cancer survivors. Since 1991 the American Cancer Society has identified diet and exercise guidelines and encouraged oncology care teams to counsel survivors on lifestyle behavior recommendations. The importance of lifestyle behavior recommendations in the cancer survivorship space are reinforced by guidelines from both the American Society of Clinical Oncology and the National Comprehensive Cancer Network. Rural location is a recognized risk factor for health disparities - and rural cancer survivors are viewed as higher risk for lack of access to symptom management, psychosocial interventions, and behavioral intervention support. For example, only a third of overweight patients in the rural South reported counseling on weight loss, despite the clear links between obesity and the risk of a second primary cancer. The clear gaps in access to guideline adherent care present an opportunity to improve both quality of life and outcomes for rural Texans. The POSTCare Survivorship Care Process is a systematic clinical approach to survivorship care focused on the under-addressed preventive and psychosocial health needs of cancer survivors. We developed a patient-informed, theory driven, and highly innovative nurse-delivered survivorship care process. We demonstrated feasibility and a positive effect on quality of life and function in clinical trials. In this proposal we will adapt this evidence-based approach to rural survivors. Overall Project Strategy: In this proposal we seek to develop and implement an evidence-based platform for the delivery of guideline concordant survivorship care to cancer patients receiving treatment in rural clinics based in Paris, Mount Pleasant, and Greenville. We will partner with Texas Oncology and regional primary care physicians to identify patients completing active treatment and deliver guideline concordant prevention-focused survivorship care and promote healthy lifestyle discussions. We will build capacity for dissemination across other rural cancer treatment programs and have clear plans for sustainability and dissemination. Innovation: This proposal is innovative because it takes advantage of the "teachable moment" at the completion of active cancer treatment to engage rural cancer survivors in healthy lifestyle behaviors that reduce the risk of cancer recurrence, reduce the risk of second primary cancers, and improve quality of life. We will deliver this care via telehealth, in an innovative model that makes evidence-based cancer survivorship care available to Texans who are not located near large treatment centers where these services are available. Significance and Impact: This proposal targets high risk individuals at an optimal time to engage in lifestyle behavior change to reduce the risk of recurrent cancer or second cancers and reduce the impact of a cancer diagnosis on quality of life. This project has high potential for dissemination because the care delivery system is designed to deliver highly specialized care at an economy of scale.

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