Assessing and managing symptoms has a survival benefit for patients with advanced cancer. However, rural cancer patients have difficulty accessing services to address symptoms. Technology may offer one solution; however, little work has been done to specifically leverage technology-based solutions to deliver high quality supportive care in rural settings. Nurse AMIE (Addressing Malignancies in Individuals Everyday) is a 2-year, Phase III randomized controlled efficacy trial to investigate the use of a tablet-based symptom management and supportive care intervention to improve overall survival among 344 advanced cancer patients living in rural areas. Participants are randomized on a 1:1 basis to the Nurse AMIE intervention or a usual care group that receives a binder with written supportive care materials. Intervention participants are asked to access the Nurse AMIE application daily using the study-provided tablet to answer symptom questionnaires regarding their level of pain, fatigue, sleep, and distress. After receiving an empathic response from Nurse AMIE, participants are offered a guideline concordant self-care intervention to address their symptoms. The trial is powered to detect a 19 % difference in overall survival between groups at 2 years. Secondary outcomes include symptom severity, function, quality of life, patient-reported outcomes, and cost-effectiveness. Nurse AMIE is the first trial to apply and rigorously assess the effect of ongoing symptom assessment and management on overall survival among rural, advanced cancer patients. Results from the Nurse AMIE trial will provide evidence of the efficacy of delivering a high-quality, technology-based supportive care program among underserved rural populations. gov registration number NCT05221606.

Older women with breast cancer are more likely than younger women to experience dose-limiting toxicities with chemotherapy. This leads to dose reduction, treatment discontinuation, and inferior treatment outcomes. Older women are also at higher risk of long-term detrimental impacts of treatment on quality of life and physical function. The primary aim of the TeleHealth Resistance exercise Intervention to preserve dose intensity and Vitality in Elder breast cancer patients (THRIVE-65) trial is to assess the effects of an exercise and nutrition intervention on chemotherapy relative dose intensity among women aged ≥65 receiving chemotherapy for early-stage breast cancer. THRIVE-65 is a 2-arm parallel-group randomized controlled trial. The intervention includes two 30-45 min telehealth delivered resistance exercise sessions weekly, 90 min of unsupervised aerobic exercise weekly, and dietitian-guided high protein intake (1.2 g/kg/day)) delivered throughout the course of chemotherapy. The Health Education and Support control group receives a tablet with supportive care materials. Planned and observed chemotherapy dose and treatment schedule are recorded to assess relative dose intensity. Pre- and post- intervention assessments include patient reported outcomes, a geriatric assessment, dietary and physical activity measures, physical function and body composition. The THRIVE-65 trial is poised to answer a crucial scientific question: Can exercise and nutrition support improve chemotherapy tolerance among older breast cancer patients? Study results will inform clinical practice related to exercise and nutrition support for this population.

Background/Objectives: Obesity is a common comorbidity but there remains limited understanding on how higher obesity rates in rural areas may impact physical function decline and other health domains among cancer patients. This study addresses this gap by examining the association between body mass index (BMI) and physical function among a cohort of rural advanced cancer patients. Methods: This cross-sectional analysis uses baseline data from the Nurse AMIE trial (NCT04673019). Individuals were categorized as ‘normal weight’ (BMI ≤ 25 kg/m²), ‘overweight’ (BMI > 25 to 30 kg/m²), and ‘obese’ (BMI > 30 kg/m²). Objective physical function was measured by the Short Physical Performance Battery (SPPB) and subjective physical function and health domains were measured using surveys (PROMIS; SF-36). Results: Of 348 patients included, 88 (25.3%) were classified as ‘normal weight’, 107 (30.7%) as ‘overweight’, and 153 (44.0%) as ‘obese’. Average age was 64.8 years (SD = 12.2), 46% (n = 160) were female, 95% were white (n = 331), and 52% (n = 182) were Stage 4. Total SPPB scores revealed poorer functioning with higher BMI (M ± SD: BMI ≤ 25 kg/m²: 9.1 ± 2.3; BMI > 25–30 kg/m²: 8.3 ± 3.1; BMI > 30 kg/m²: 8.1 ± 2.8; p = 0.04). Similarly, scores from the SF-36 revealed subjective physical function was lower with higher BMI (BMI ≤ 25 kg/m²: 57.9 ± 29.1; BMI > 25–30 kg/m²: 53.7 ± 28.0; BMI > 30 kg/m²: 47.6 ± 27.6; p = 0.004). Participants reported lower levels of energy and greater fatigue with higher BMI (BMI ≤ 25 kg/m²: 49.8 ± 26.1; BMI > 25–30 kg/m²: 45.1 ± 24.6; BMI > 30 kg/m²: 40.7 ± 22.6; p = 0.01). Conclusions: Higher BMI is associated with poorer physical function and increased fatigue among rural advanced cancer patients, highlighting the need for supportive care related to physical function in this at-risk group.

Approximately 20% of Americans live in rural communities. For several cancers, incidence rates for rural residents are over 8% higher than for urban residents. Increased physical activity (PA) can reduce risk for several cancers, but rural residents report lower PA than their urban counterparts. Multiple service delivery models have shown success with primary care providers (PCPs) promoting PA. We propose a cluster randomized controlled trial combining PCP PA counseling with telephone coaching to help rural adults increase their PA and reduce their cancer risk. 800-880 patients seeing 32-48 PCPs in 17 clinics will be enrolled in cohorts using a wait list control cluster parallel randomized design. Randomization occurs at the clinic level with the intervention offered either immediately or delayed until the final year of the study in a 1:1 ratio. PCPs receive training in evidence-based strategies through Project Extension for Community Healthcare Outcomes, a case-based learning model commonly used to deliver best practices to PCPs. After referral from PCPs, patients receive PA coaching from the MoveLine, a telephone-based coaching service grounded in evidence-based behavior change techniques. Feedback from MoveLine is provided to the PCP about patient progress through the program. An implementation evaluation occurs annually using rapid assessment procedures and qualitative interviews to suggest intervention delivery improvements. To examine contextual factors, clinic communities' PA environments and opportunities are assessed using established rural-specific methods. The PA Moves trial is a multilevel randomized trial to address rural health disparities by intervening on PA to reduce cancer risk. gov reference numbers: NCT05319821 and NCT05227105.

Nurse AMIE (Addressing Malignancies in Individuals Everyday) is a technology-enabled intervention developed to improve symptom self-management and quality of life in cancer patients. As the intervention was translated from earlier pilot trials for patients with metastatic breast cancer (NA-MBC) to a voice-activated version on Amazon Echo Show for women with metastatic breast cancer (NA-Echo), and finally to a rural advanced cancer population including all cancer types (NA-Rural), systematic documentation of adaptations was needed to ensure transparency and support future dissemination. To systematically describe and classify adaptations made in translating prior versions of Nurse AMIE using the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions (FRAME). A mixed-methods analysis was conducted documenting three Nurse AMIE iterations: NA-MBC, NA-Echo, and NA-Rural. Adaptations were documented from research team meeting notes, stakeholder interviews, protocol revisions, and prior trial usage data, then coded using FRAME domains. Nineteen planned adaptations were identified, all occurring during the pre-implementation phases of successive iterations. Adaptations were primarily contextual and content-related, targeting population eligibility, intervention duration, symptom assessment, interface design, and broader dissemination. Core intervention components were retained across all iterations. No training, evaluation, or fidelity-inconsistent adaptations were documented. FRAME-guided documentation revealed a coherent set of intentional, proactive adaptations that expanded Nurse AMIE's reach from metastatic breast cancer to rural adults with a broad range of advanced cancer types while preserving fidelity. Findings support informed scale-up and replication of the intervention in underserved oncology populations.