There are over a million cancer survivors in the state of Texas. It is estimated that one in three women and one in two men will be diagnosed with cancer in their lifetime, and the population of cancer survivors is expected to grow as survival rates improve and the population ages. Decreases in physical functioning after a cancer diagnosis are common and exceed what would be expected due to normal aging processes. Cancer survivors are also at increased risk for developing second cancers; between 15 and 20% of cancer diagnoses occur in people who have had a previous diagnosis. These functional deficits and increased risks of second cancers necessitate accessible and effective programs t...

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There are over a million cancer survivors in the state of Texas. It is estimated that one in three women and one in two men will be diagnosed with cancer in their lifetime, and the population of cancer survivors is expected to grow as survival rates improve and the population ages. Decreases in physical functioning after a cancer diagnosis are common and exceed what would be expected due to normal aging processes. Cancer survivors are also at increased risk for developing second cancers; between 15 and 20% of cancer diagnoses occur in people who have had a previous diagnosis. These functional deficits and increased risks of second cancers necessitate accessible and effective programs to help survivors improve their health and quality of life. Physical activity has been shown to improve quality of life and disease-free survival in people diagnosed with cancer, but programs to support survivors in being more active are not widely available or accessible. Overall project strategy: The goal of this dissemination project is to promote broader, sustainable adoption and implementation of the Active Living After Cancer (ALAC) program, an evidence-based intervention to improve cancer survivors' physical functioning and quality of life through increasing their physical activity. The ALAC program has been funded by CPRIT for the past 9 years and is currently offered to cancer survivors and their caregivers through partnerships with community organizations. With an implementation focus on minority and medically underserved populations, ALAC is available in both English and Spanish, and aims to teach cognitive and behavioral skills for increasing physical activity, provide opportunities to engage in different types of light to moderate physical activity, and deliver education content about survivorship concerns and services. It is delivered in 12 weekly sessions, offered either in-person or virtually. We propose to disseminate ALAC to community cancer centers in Texas, partnering with the Texas Society of Clinical Oncology (TxSCO; state affiliate of the Association of Community Cancer Centers), which will provide feedback on our dissemination process and promote the program to its members. We are focusing on community cancer centers because over 85% of cancer patients receive cancer care in the community, and thus these centers serve a broad cross-section of survivors. Specific goals: In order to effectively disseminate ALAC, we will develop an online implementation toolkit (Goal 1), which will include curriculum facilitator guide and PowerPoint presentations; and implementation guide that includes information on screening participants, developing a safety plan, and how to adapt the program to participant needs; participant recruitment materials; and program evaluation guide. We will also develop online training and a standardized Project ECHO curriculum for providing ongoing telementoring and technical assistance to implementers. These products will be shaped by interviews with current implementers and participants as well as potential implementers recruited from community cancer centers. We will identify two community cancer centers to pilot test the toolkit and provide feedback to refine it (Goal 2). After the toolkit has been revised based on feedback, we will implement strategies to disseminate ALAC to community cancer centers around the state (Goal 3). The dissemination strategies and materials will be shaped by the interviews conducted prior to the development of the toolkit and will employ strategies described in the Expert Recommendations for Implementing Change (ERIC) compilation. The evaluation of the dissemination will be guided by the RE-AIM framework, quantifying Research, Effectiveness, Adoption, Implementation, and Maintenance. Significance and Impact: Dissemination of the ALAC program will bring a significant and vital survivorship service to Texas cancer survivors. Physical activity has been shown to be associated with improved disease-free survival in people diagnosed with cancer. Additionally, randomized controlled trials support the benefits of exercise and physical activity for improving physical functioning, fatigue, psychological distress, and quality of life. Increasing physical activity after cancer can help survivors "get back to normal", enabling them to re-engage with valued roles such as family care, leisure activities, and employment. Improvement of physical functioning may help survivors address the accelerated aging and resulting disability that often occur after cancer diagnosis. Dissemination of ALAC to community cancer centers will increase program accessibility for Texas cancer survivors, particularly those living outside of the major metropolitan areas, and provide them with a path to improving their mental and physical health and well-being.

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