This K07 proposal will provide me with the experience that I need to become a leading independent investigator of diet and cancer survival. My objective is to elucidate the role of diet after cancer diagnosis and develop interventions to improve cancer survivorship care. I have a solid foundation in nutrition and cancer epidemiology. My proposed 5-year training plan builds on this foundation and provides me with training in: 1) randomized controlled trial (RCT) design and management; 3) the biology, clinical management, and epidemiology of CRC; and 3) the use of mobile technology in lifestyle interventions. My proposed research will provide me with practical knowledge, skills, and experience in these areas, and fill important gaps in the scientific literature regarding the role of diet after CRC diagnosis. Over one million Americans are living with a diagnosis of CRC. While limited, data suggest that diet after CRC diagnosis impacts survival. Among stage III CRC survivors, a western dietary pattern was associated with a 3- fold increased risk of CRC recurrence or death. Based on this evidence of harm from a Western diet, there is a need for dietary interventions for CRC survivors. No study has pilot tested an intervention using mobile technology to improve diet after CRC. Thus, in Aim 1, I will conduct a pilot RCT to determine the feasibility and acceptability of a diet intervention targeted at reducing intake of a Western diet using mobile technology among CRC survivors. The intervention will target reduced intake of red and processed meat, alcohol, and sugar sweetened beverages and increased intake of whole grains, vegetables, and fruits. The results of this aim will provide preliminary data for an R01 application to conduct a definitive RCT testing the impact of improving diet on biological and clinical endpoints in CRC survivors. In addition, preclinical studies suggest that vegetable fats, which are not a characteristic of a Western diet, inhibit CRC progression. No prior study has examined vegetable fat intake after CRC diagnosis and survival in humans.
In Aim 2, I will use data from two RCTs of adjuvant chemotherapy among 2,372 CRC patients to determine whether consumption of vegetable fats after CRC diagnosis is associated with lower risk of CRC-specific and overall survival. I will apply the results of these analyses to refine the dietary intervention before moving forward to a large-scale RCT in my future work. My training and research plan incorporates coursework, mentoring, group meetings, seminars, journal clubs, conferences, and practical experience in a leading academic institution, the University of California, San Francisco. My research plan fits well in the program of my primary mentor, Dr. Alan Venook, who will oversee my training, research, and career development. I have assembled a strong mentoring team with expertise in RCTs, gastrointestinal oncology, the use of mobile technology in lifestyle interventions, and grant writing. This K07 proposal will accelerate my transition to an independent investigator dedicated to elucidating the role of diet in cancer survival.
This K07 application will provide me with the training and research experiences that I need to transition to a leading independent investigator of the role of diet in cancer survival. My proposed 5-year training and research plan build on my solid foundation in nutrition and cancer epidemiology and will provide me with training on: 1) randomized controlled trials; 2) the biology, clinical management, and epidemiology of colorectal cancer; and 3) the use of mobile technology in lifestyle interventions. In my proposed research, I will pilot test an intervention using mobile technology to improve the diet of colorectal cancer survivors and will examine the impact of vegetable fat intake after diagnosis of colorectal cancer on colorectal cancer-specific and overall survival; these projects will provide strong preliminary data for the development and funding of my future independent research program.
