Adapting Multiple Behavior Interventions That Effectively Improve Cancer Survivor Health Cancer Survivor Health

Participants completed two dietary recalls (one weekday and one weekend day) via telephone using a multipass method and the Nutrition Data Systems for Research (NDSR) software. The software averages the 2-day resulting data and calculates the Healthy Eating Index (HEI)-2015. The HEI indicates how closely someone's diet follows the Dietary Guidelines for Americans. The index range is 0 to 100 with an index closer to 100 indicating a healthier, well-balanced diet.

Participant body weight will be measured during an in-person or remote (Zoom) visit

Physical activity will be measured objectively via blank screen accelerometers which are small devices (1x2 inches) that will be worn at the waist during waking hours and switched to a wrist band during sleep for a 7-day period at each assessment point.

Waist circumference will be measured using unmarked tapes at the level of the umbilicus during the in-person or remote assessments.

Participants are provided with a 30 mg capsule of D3Cr and instructed to take the capsule 3 days prior to their assessment date. The night prior to assessment, they begin fasting and continue fasting until they produce the second urinary void of the day. During this void, a test strip is used. The strip is frozen (0 C or below) until analyzed. The outcome measure indicates kg of muscle mass.

Participants are provided with a 30 mg capsule of D3Cr and instructed to take the capsule 3 days prior to their assessment date. The night prior to assessment, they begin fasting and continue fasting until they produce the second urinary void of the day. During this void, a test strip is used. The strip is frozen (0 C or below) until analyzed. The outcome measure indicates percentage of body weight that is muscle mass.

In this physical performance test the participant is instructed to sit and stand as many times as they can while crossing their arms against their shoulders for 30 seconds. the outcomes measure is the number of times participants sit and stand in 30 seconds.

In this performance test we instruct participants to start from a seated position, cross their arms against their shoulder, then, when instructed, they stand walk around the cone and come back to a seated position. The outcome measure is the number of seconds from start to end of the walk

In this performance test, participants are instructed to step in place for 2 minutes. The outcomes measure is the number of steps within the two minutes that reach a certain height. This height is determined measuring first the distance from hip joint to top of knee, taking the half of that distance and applying it from the floor marking a that height on a wall or door frame with a sticker. Assessors spot and count steps that reach or exceed the sticker mark on the wall (every other step is counted)

This physical performance test is done as follows:

• Participant sits on the edge of a chair, with one leg is extended straight forward with the heel on the floor and ankle at ~90°.(The other leg remains bent with the foot flat on the floor).
• Participant's hands are placed one on top of the other, and participant slowly reaches forward toward the toes of the extended leg (the test is performed on both legs, and assessor selects the most flexible side)
• The outcome measure is the distance in cm from the closest finger and toe. 0 inches → fingertips touch the toe Negative (-) → Participant cannot reach toes Positive (+) → Participant reaches past toes

This physical performance test of flexibility is done as follows:

• Participant stands upright and reach one hand over the shoulder and the other up the middle of the back, attempting to touch or overlap middle fingers (both sides are tried - right over left, then left over right).

Outcome measure is the distance between the closest fingers (most flexible side is recorded)

Scoring:

0 inches → fingertips just touch Negative (-) → fingers do not touch (gap distance) Positive (+) → fingers overlap (amount of overlap)

This physical activity outcome is measured using the Godin Leisure Time Physical Activity Questionnaire which asks frequency and duration of various levels of physical activity in a week period.

The resulting outcome measure (minutes per week) is the Adjusted Godin Moderate-to-Vigorous Physical Activity (MVPA) score, calculated based on reported frequency and duration of moderate and strenuous (vigorous) leisure-time activities as follows:

Adjusted Godin MVPA= (frequency * duration of moderate activity) + 2 (frequency * duration of vigorous activity)

Quality of life - physical is assessed using the PROMIS global health subscales measuring self-reported overall physical health, including physical functioning, fatigue, pain, and general health perceptions. The outcome measure is the resulting T-scores, standardized to the U.S. general population Range: (0-100) Higher T-scores indicate better global physical health

The Global Physical Health score is calculated by combining responses from survey questionnaire -- raw scores are converted to T-scores via scoring manuals.

Quality of life - mental is assessed using the PROMIS global health subscales measuring self-reported overall mental health, including emotional distress, psychological well-being, social satisfaction, and quality of life perceptions. The outcome measure is the resulting T-score standardized to the U.S. general population Range: (0-100) Higher T-scores indicate better global mental health

Participants will complete a healthcare utilization survey to capture physician and emergency room visits, and hospitalizations.

Participants complete the 14-item Perceived Stress Scale (PSS-14), a validated self-report instrument that measures the degree to which individuals perceive their lives as unpredictable, uncontrollable, and overloaded over the past month.

Each item is rated on a 5-point scale (0 = never to 4 = very often). Positively stated items are reverse scored, and item responses are summed to generate a raw total score (range: 0 to 56).

The outcome measure is a T-score calculated using standard normalization procedures.

Range = 0 to 100. Higher T-scores indicate greater perceived stress (worse outcome).

Circulating cholesterol levels are assessed using dried blood spot (DBS) samples collected via fingerstick following a 12-hour fast. Blood spots are dried and stored according to standard protocols, and DBS eluents are batch-tested against known standards to determine cholesterol concentrations.

This outcome measure is the measure of mg/dl of total cholesterol

High-density lipoprotein (HDL) cholesterol will be assessed using dried blood spot (DBS) samples collected via fingerstick following a 12-hour fast. Blood spots will be dried and stored according to standard protocols, and DBS eluents will be batch-tested against known standards to determine HDL cholesterol.

Outcome measure is mg/dL of HDL Range (adults): typically, 20 to 100 mg/dL Higher HDL cholesterol indicates a better (protective) cardiovascular outcome.

Triglyceride levels are assessed using dried blood spot (DBS) samples collected via fingerstick following a 12-hour fast. Blood spots are dried and stored according to standard protocols, and DBS eluents will be batch-tested against known standards to determine triglyceride concentrations.

Outcome measure is mg/dL of triglyceride concentration Range:50 to 500 mg/dL (adults) Higher triglyceride levels indicate a worse (higher cardiovascular risk) outcome

Fasting glucose levels will be assessed using dried blood spot (DBS) samples collected via fingerstick following a 12-hour fast. Blood spots will be dried and stored according to standard protocols, and DBS eluents will be batch-tested against known standards to determine glucose concentrations.

Outcome measure is mg/dL of glucose concentration Range:70 to 200 mg/dL (adults) Higher fasting glucose levels indicate a worse metabolic outcome (greater risk of impaired glucose regulation or diabetes).

C-reactive protein (CRP) levels will be assessed using dried blood spot (DBS) samples collected via fingerstick following a 12-hour fast. Blood spots will be dried and stored according to standard protocols, and DBS eluents will be batch-tested against known standards to determine CRP concentrations.

Range: (0.1 to 10 mg/DL) in adults (higher values may occur with acute inflammation) Higher CRP levels indicate greater systemic inflammation and a worse health outcome

Quality of life is assessed using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L), a standardized instrument that measures health status across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

Each dimension is rated on 5 levels: No problems, Slight problems, Moderate problems, Severe problems and Extreme problems Responses are combined into a 5-digit health state, which is converted into a single summary index score.

EQ-5D Index range: 0 to 1. Higher scores indicate better quality of life

Cognitive Function is assessed using the PROMIS Cognitive Function Short Form 4a questionnaire, which evaluates memory, attention span, and concentration

Outcome measure is a T-score, standardized to the U.S. general population:

Range: (0-100) Higher T-scores indicate better cognitive function

Cognitive Ability is measured with PROMIS Cognitive Abilities - Short Form 8a, which evaluates perceived cognitive abilities, including memory, attention, concentration, and mental acuity.

Outcome measure is reported as T-scores, standardized to the U.S. general population:

Range: (0-100) Higher T-scores indicate better cognitive abilities