Development of a Cruciferous Vegetable Intervention to Prevent Cancer Recurrence in Non-Muscle Invasive Bladder Cancer Survivors (Preprint)

BACKGROUND Bladder cancer is one of the top 10 most common cancers in the US. Most bladder cancer (70-80%) is diagnosed at early stages as non-muscle invasive bladder cancer (NMIBC), which can be removed surgically. However, 50-80% of NMIBC recurs within 5 years, and 15-30% progresses with poor survival. Current treatment is limited and expensive. A wealth of preclinical and epidemiologic evidence suggests that dietary isothiocyanates (ITCs) in cruciferous vegetables (Cruciferae) could be a novel, non-invasive, and cost-effective strategy to control NMIBC recurrence and progression. Yet a scalable dietary intervention that increases ITC exposure through Cruciferae intake in NMIBC survivors has not been developed. OBJECTIVE This paper will describe a systematic process through which a dietary intervention for bladder cancer survivors was developed that can serve as a model for others who aim to develop evidence-based behavioral interventions for cancer prevention. METHODS We used a systematic process to adapt evidence-based dietary interventions into a Cruciferae intervention for NMIBC survivors. We 1) identified relevant factors, evidence-based behavioral techniques, and behavioral theory constructs used to increase cruciferae intake in NMIBC survivors; 2) used the PEN-3 model to review the intervention’s components (e.g. saliency of behavioral messages); 3) administered the revised intervention to community partners for their feedback; and 4) refined the intervention based on Step 3. RESULTS We developed a multi-component intervention for NMIBC survivors consisting of a magazine, tracking book, a live phone-call script, and interactive voice messages (IVR). Entitled “POW-R Health: Power to Redefine Your Health”, the intervention incorporated findings from our adaptation process to ensure saliency to NMIBC survivors. CONCLUSIONS This is the first evidence-based, theoretically grounded dietary intervention developed to reduce bladder recurrence in NMIBC survivors using a systematic process for community adaptation. This study provides a model for others who aim to develop behavioral, community-relevant interventions for cancer prevention/control, with the overall goal of wide-scale implementation and dissemination.