Candidate. My career goal is to reduce cancer health disparities in cancer survivorship by addressing sleep disturbance and other quality of life issues (e.g., distress, cognitive impairment, fear of cancer recurrence) in minority cancer populations. I received a solid foundation in observational cancer quality of life research, but my training has not provided the skills I need to develop mHealth behavioral interventions or the skills needed to reduce cancer health disparities. I look forward to taking the next steps in my career development, and the K01 provides an ideal opportunity to develop the necessary skills to achieve my career goal. This line of research has the potential to significantly improve cancer survivorship because of A) the large impact that sleep disturbance and other quality of life issues have on well-being, B) growing evidence of disparities in cancer survivorship, and C) the large and growing population of minority cancer survivors. Career Development Plan. My career development plan builds on my training in observational cancer quality of life research. I propose to develop the skills necessary to become a leader in the field of developing mHealth behavioral interventions for sleep disturbance and other quality of life issues in minority cancer survivors. Training will be obtained through participation in scientific conferences (mHealth, sleep medicine, behavioral medicine), methods workshops (designing mHealth interventions, health disparities research, clinical trial analyses), coursework (health disparities, qualitative methods, mobile app development), and structured mentorship from experts in intervention development (Dr. Sharon Manne), cancer health disparities (Dr. Elisa Bandera), sleep disturbance (Dr. Martica Hall), qualitative interviewing (Dr. Shawna Hudson), mHealth methodology (Dr. Lee Ritterband), developing culturally targeted interventions (Dr. Cathy Meade), and grant writing. This training will ensure that I achieve my goals, which are to: 1) Learn the health disparities research skills that will help me conceptualize and implement culturally targeted behavioral interventions for sleep disturbance and other quality of life issues, 2) acquire the skills necessary to develop and test behavioral interventions, including qualitative interviewing, mHealth methodology, and clinical trial analyses, and 3) Develop a deeper understanding of sleep disturbance and other quality of life issues in cancer survivors. Research Plan. We propose a sequential mixed methods approach to develop and pilot test a new mHealth behavioral intervention for cancer-related sleep disturbance that is culturally targeted to African American breast cancer survivors. We plan to take a holistic approach to cancer-related sleep disturbance as compared to standard treatment for primary insomnia, which is less effective in cancer survivors than in the general population. We will first identify predictors of cancer-related sleep disturbance in a unique cohort of African American breast cancer survivors as well as collect qualitative data on the barriers to standard treatment and opportunities for cultural targeting (Aim 1). Using data gathered in Aim 1, we will iteratively develop an mHealth intervention to address cancer-related sleep disturbance in African American breast cancer survivors (Aim 2). This intervention will address predictors of cancer- related sleep disturbance, reduce barriers to motivation and usage, and be culturally targeted to this population. It will also be tailored to patients' unique sleep patterns, adjusting recommendations based on automatically gathered objective sleep data via actigraphs (unobtrusive wrist-worn devices). Lastly, we will test this intervention for acceptability, feasibility, and preliminary efficacy (Aim 3). Thus, this project will address a health disparity for a distressing quality of life issue in a large and growing population. Mentorship Team. Each member of the mentorship team has external funding, including eight R01s between the five mentors. The team has excellent publication and mentorship track records. Collaborations with this esteemed mentorship team will result in 3-4 publications per year (2-3 first-authored). Environmental and Institutional Commitment. The research environment, facilities, and resources at the Rutgers Cancer Institute of New Jersey are ideal for career development in cancer survivorship disparities research. Numerous training opportunities are available across campus. I will carry out my K01 activities as a tenure-track Assistant Professor in the Division of Population Science with strong institutional commitment, including from Associate Director for Population Science Dr. Sharon Manne. Conclusions. Cancer-related sleep disturbance is a common and distressing survivorship issue. African American breast cancer survivors are at urgent need for a culturally targeted intervention that addresses the factors that make cancer-related sleep disturbance different from primary insomnia. In the proposed sequential mixed methods study, I will develop a new, tailored, mHealth, and culturally targeted intervention for cancer-related sleep disturbance in African American breast cancer survivors. The use of mHealth methods will ensure wide disseminability. The K01 award period will culminate in a R01 proposal. The K01 mentored career development award will support my transition to independence and position me as an expert in reducing cancer health disparities in cancer survivorship.
Cancer-related sleep disturbance is a common and distressing issue affecting breast cancer survivors, especially African American breast cancer survivors. To reduce this cancer health disparity and to improve on existing standard treatment, a new mHealth, culturally targeted, and tailored intervention will address risk factors for cancer-related sleep disturbance and barriers to treatment that are unique to African American breast cancer survivors. Given the high rates of mobile device ownership among older adults and the common reliance of mobile devices for health information among African Americans, this intervention shows great promise for reducing cancer-related sleep disturbance and thereby improving survivorship among African American breast cancer survivors.
