Prevalence of cancer is up to 2.1 times higher among lesbian, gay, bisexual, and transgender (LGBT) persons than heterosexuals, yet LGBT cancer survivors are virtually invisible in cancer research in the United States. This invisibility, as wel as real and expected discrimination, leads LGBT cancer patients and survivors to experience 1.7 times higher rates of psychological distress than heterosexual survivors. Given these rates of distress, the unique sociocultural factors acting on LGBT survivors, and the fact that distress is linked with increased cancer-related morbidity and mortality, tailored interventions to reduce distress among LGBT cancer survivors are needed. Our preliminary research shows that care partners of LGBT survivors want to be included in interventions to support survivors and that social support is strongly linked to psychological distress among LGBT adults. Our novel dyadic framework incorporates support from care partners and a standardized exercise intervention, Exercise for Cancer Patients (EXCAP(c)(r), a 6 week, home-based progressive walking and resistance training program), and may be effective in reducing distress among LGBT survivors. In this K07 Career Development Award application, Dr. Charles Kamen, a clinical psychologist with a background in health disparities and dyadic intervention research, proposes to conduct a Phase II RCT randomizing 70 LGBT cancer survivors (all cancer types, 1-24 months post treatment) plus their 70 care partners (broadly defined) to: Arm 1, a novel, partner-assisted version of EXCAP(c)(r) (called EXCAP-PA), in which both survivors and care partners will receive EXCAP(c)(r) materials and instruction together, or Arm 2, a survivor-only version of EXCAP(c)(r), i which only the LGBT cancer survivor will receive EXCAP(c)(r) materials. The overall hypothesis of this study is that among LGBT survivors, EXCAP-PA, incorporating care partner support, will be more efficacious than survivor-only EXCAP(c)(r) in improving biopsychosocial aspects of distress. Dr. Kamen is well positioned as a junior faculty member in an exceptional environment at the University of Rochester. He needs additional training in three core competency areas in order to launch an independent research career: 1) clinical trials for LGBT health, 2) integration of biological endpoints, and 3) design of exercise interventions. His mentors have over 30 years of experience conducting cancer control intervention trials and include: Dr. Karen Mustian, PEAK Lab Director and exercise oncology expert; Dr. Gary Morrow, Director of Cancer Control research; Dr. Kathi Heffner, psychoneuroimmunologist; Dr. Deborah Bowen, community intervention expert; and advisors Dr. Supriya Mohile, medical oncologist; Dr. James McMahon, dyadic intervention expert; and Dr. Charles Heckler, biostatistician. The career development goals and protected time provided by this training award will prepare Dr. Kamen to become an expert in cancer-related health disparities and dyadic interventions for LGBT cancer survivors and care partners. Further, if successful, this study will address a critical disparity (distress) n the underserved population of LGBT survivors.
Lesbian, gay, bisexual, and transgender (LGBT) cancer survivors experience more psychological distress than heterosexual survivors. Very few studies have examined this population and no treatments have been delivered to them specifically. This project will provide information about using exercise, along with support from care partners, to treat distress among LGBT cancer survivors, and will assess LGBT survivors' and their care partners' well-being after cancer diagnosis and treatment.
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