R01CA255269

The ASPIRES Study: Activating Cancer Survivors and Their Primary Care Providers to Increase Colorectal Cancer Screening - Project Summary

Childhood cancer survivors treated with abdominal or pelvic radiotherapy (RT) are almost four times more likely to develop colorectal cancer (CRC) compared to the general population, with their elevated risk evident by the age of 30 years with no plateau. Since earlier detection of precancerous lesions (i.e., adenomas) or CRC is strongly associated with improved survival, screening with colonoscopy or multitarget stool DNA testing (MT-SDNA) with a colonoscopy after a positive test is recommended starting at age 30.

Unfortunately, the vast majority of survivors at high-risk for CRC are not adherent to recommended screening. Magnifying this problem, most childhood cancer survivors are no longer followed at a cancer center, are unaware of their risks, and are being followed by primary care providers (PCPs) who are not informed about the recommended follow-up care.

In order to improve adherence to CRC screening guidelines in high-risk childhood cancer survivors, we propose the ASPIRES (Activating Cancer Survivors and Their Primary Care Providers to Increase Colorectal Cancer Screening) study, which is the first known intervention to attempt to increase CRC screening rates in this population using a remote digital mHealth intervention. This is a 3-arm randomized controlled trial to evaluate the utility of patient activation with and without added PCP activation to increase CRC screening.

We propose to randomize 315 survivors, who are at least 30 years of age, with a history of abdominal or pelvic radiation for a childhood cancer and without a history of CRC. The primary outcome is obtaining CRC screening with colonoscopy or MT-SDNA during the 12-month study period. We will determine the comparative effectiveness of (1) a mHealth patient activation intervention and (2) patient activation plus PCP activation, compared to control.

Secondary aims include (1) conducting a multi-stakeholder mixed-methods Consolidated Framework for Implementation Research (CFIR)-informed evaluation to understand patient, provider, and system factors associated with uptake of the intervention, to explore enablers and barriers to uptake of CRC screening, and to generate recommendations for future adaptation, scalability, and sustainability; (2) identify potential moderators and mediators of uptake of CRC screening; and (2) estimate the cost-effectiveness of the intervention.

The proposed ASPIRES study brings together a research team with necessary expertise and experience in survivorship, CRC screening, dissemination and implementation, and mHealth intervention research with the unique resource of the 31-institution Childhood Cancer Survivor Study (CCSS). Notably, the CCSS represents the single largest cohort of survivors in the target population and the infrastructure to conduct the proposed study.

Results from this intervention will have important implications for patients at high-risk for CRC, and we expect that findings from this study will provide the evidence for implementation and dissemination of our CRC screening interventions targeting these populations.

University Of Chicago

TO IDENTIFY CANCER RISKS AND RISK REDUCTION STRATEGIES, TO IDENTIFY FACTORS THAT CAUSE CANCER IN HUMANS, AND TO DISCOVER AND DEVELOP MECHANISMS FOR CANCER PREVENTION AND PREVENTIVE INTERVENTIONS IN HUMANS. RESEARCH PROGRAMS INCLUDE: (1) CHEMICAL, PHYSICAL AND MOLECULAR CARCINOGENESIS, (2) SCREENING, EARLY DETECTION AND RISK ASSESSMENT, INCLUDING BIOMARKER DISCOVERY, DEVELOPMENT AND VALIDATION, (3) EPIDEMIOLOGY, (4) NUTRITION AND BIOACTIVE FOOD COMPONENTS, (5) IMMUNOLOGY AND VACCINES, (6) FIELD STUDIES AND STATISTICS, (7) CANCER CHEMOPREVENTION AND INTERCEPTION, (8) PRE-CLINICAL AND CLINICAL AGENT DEVELOPMENT, (9) ORGAN SITE STUDIES AND CLINICAL TRIALS, (10) HEALTH-RELATED QUALITY OF LIFE AND PATIENT-CENTERED OUTCOMES, AND (11) SUPPORTIVE CARE AND MANAGEMENT OF SYMPTOMS AND TOXICITIES. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO STIMULATE TECHNICAL INNOVATION, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, AND FOSTER PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS.

93.393 - Cancer Cause and Prevention Research

National Cancer Institute (NCI) [HHS - NIH]

Chicago, Illinois 606375418 United States

Single Zip Code

Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required) (PAR-18-559)

Amendment Since initial award the total obligations have increased 344% from $741,537 to $3,293,294.