자료유형  

 학위논문

Control Number  

0017161085

International Standard Book Number  

9798383566015

Dewey Decimal Classification Number  

614.4

Main Entry-Personal Name  

Puklin, Leah Silverman.

Publication, Distribution, etc. (Imprint  

[S.l.] : Yale University., 2024

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2024

Physical Description  

160 p.

General Note  

Source: Dissertations Abstracts International, Volume: 86-02, Section: B.

General Note  

Advisor: Irwin, Melinda.

Dissertation Note  

Thesis (Ph.D.)--Yale University, 2024.

Summary, Etc.  

요약Background: Obesity, poor diet quality, and low levels of physical activity (PA) are increasingly prevalent public health challenges with important implications for breast cancer treatment adherence and survival. The field of energy balance and breast cancer survivorship has made significant advancements in recognizing the importance of integrating programs that promote positive lifestyle behavior change in oncology care. However, there remain significant gaps in translating research findings into routine clinical practice. These gaps include conflicting evidence surrounding who experiences weight change post breast cancer diagnosis and how post-diagnosis weight patterns impact survival; what aspects need to be addressed when designing and delivering interventions targeting lifestyle behavior change during and after chemotherapy; and how efficacious research interventions can be adapted and disseminated to reach broader populations of women with breast cancer.Methods: We sought to address several research gaps in the field of energy balance and breast cancer survivorship research via four projects that employed a range of study designs and analytical techniques. For the first study (Chapter 2), we assembled a retrospective cohort of women treated for stage I-III breast cancer (n=5,441) within the Smilow Cancer Hospital Network between 2013 and 2019. Individual-level repeated clinical weight measurements were extracted from the electronic health record and survival data from the Yale Tumor Registry and the Connecticut Tumor Registry. We assessed body weight trajectories over 5 years post-diagnosis and if baseline characteristics modified weight trajectories with non-linear multilevel mixed effect models. We also evaluated body mass index (BMI) at diagnosis and weight change 1-year post-diagnosis in relation to all-cause and breast cancer-specific mortality with Cox proportional hazard models. For the second study (Chapter 3), we conducted a secondary analysis of the Lifestyle, Exercise, and Nutrition Early after Diagnosis (LEANer) trial in which newly diagnosed breast cancer patients (n=173) undergoing chemotherapy were randomized to a yearlong nutrition and exercise intervention (n=87) or usual care (UC, n=86). We explored changes in PA and diet quality over the yearlong intervention period and evaluated baseline factors associated with behavior change. Mixed models compared changes in minutes/week of PA, dietary components measured via Food Frequency Questionnaire, and diet quality via the Healthy Eating Index (HEI)-2015 from baseline to one-year by study arm. Among the intervention group, we assessed baseline factors associated with one-year changes in PA and diet quality and participation in strength training at one-year with multivariable linear and logistic regression. For the third study (Chapter 4), we conducted semi-structured qualitative interviews with 29 women who completed the intervention arm of the LEANer trial to identify barriers to and facilitators of adopting healthy eating and exercise behaviors while undergoing active treatment for breast cancer. Stratified, purposeful sampling identified participants meeting both, one, or neither intervention goal at one-year: 1) 150 min/week moderate-to-vigorous intensity exercise via a self-report PA questionnaire; and 2) improving diet quality measured by the HEI-2015. Interviews were audio-recorded and transcribed verbatim. Thematic content analysis identified emerging themes. In the last study (Chapter 5), we conducted an analysis of the Lifestyle, Exercise, and Nutrition (LEAN) Self-Guided randomized controlled trial on the trial's primary outcome of weight loss. LEAN Self-Guided randomized breast cancer survivors with a BMI ≥ 25 kg/m2 to a 6-month lifestyle intervention (n=102) consisting of only printed and online materials or waitlist group (n=103). Effects of the intervention on self-reported body weight as well as the secondary outcomes of PA, diet quality (via HEI-2010), and quality of life were assessed using mixed model repeated measures analysis.Results: In Chapter 2, we found, on average, women experienced modest body weight change over 5 years post breast cancer diagnosis, (-0.80 kg (standard error [SE]=0.04)), yet post-diagnosis weight change differed significantly across several characteristics.

Summary, Etc.  

요약Assessing sociodemographic factors, patient reported outcomes, and baseline lifestyle behaviors as well as designing programs that address chemotherapy-related side effects and competing demands, may help future interventions achieve positive behavior change during chemotherapy. The LEAN Self-Guided trial demonstrated that providing tailored printed and online materials may be an effective strategy for promoting weight loss among breast cancer survivors who have completed active treatment. This type of program could be easily implemented across cancer centers and community clinics with minimal staff efforts and costs. Both the LEANer program and the LEAN Self-Guided facilitated lifestyle behavior change during and after breast cancer diagnosis; suggesting potential resources and programs to be tested in real-world effectiveness trials. Overall, the results of this dissertation provide critical evidence to support the integration of weight management, nutrition, and exercise-related supportive care services across the breast cancer care continuum.

Subject Added Entry-Topical Term  

Epidemiology.

Subject Added Entry-Topical Term  

Kinesiology.

Subject Added Entry-Topical Term  

Nutrition.

Subject Added Entry-Topical Term  

Oncology.

Index Term-Uncontrolled  

Breast cancer

Index Term-Uncontrolled  

Cancer survivorship

Index Term-Uncontrolled  

Interventions

Index Term-Uncontrolled  

Lifestyle

Index Term-Uncontrolled  

Physical activity

Added Entry-Corporate Name  

Yale University Epidemiology and Public Health

Host Item Entry  

Dissertations Abstracts International. 86-02B.

Electronic Location and Access  

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Control Number  

joongbu:655856