EMBRACE: Exploring Mindsets, Beliefs and Resilience Across the Cancer Experience

Anxiety will be measured using the 8 item Patient-Reported Outcomes Measurement Information System - Anxiety Short Form 8a (PROMIS-A). The PROMIS-A measures fear (fearfulness, panic), anxious misery (worry, dread), hyperarousal (tension, nervousness, restlessness), and somatic symptoms related to arousal (racing heart,dizziness). The items in the PROMIS negative affect banks use a 7-day time frame and a 5-point rating scale that ranges from 1 ("Never") to 5 ("Always"), with higher scores indicating greater severity of anxiety symptoms. The standardized T-Score for cancer patients reference population is 50 and the minimally clinically important difference (MCID) in T-scores is 3.0-4.5. Anxiety T-scores can be interpreted categorically as ≤55 = normal; 56-60 = mild; 61-70 = moderate; ≥71 = severe.

Depression will be measured using the 8 item the Patient-Reported Outcomes Measurement Information System - Depression Short Form 8b (PROMIS-D). The PROMIS-D content focuses on negative mood (sadness, guilt), views of self (self- criticism, worthlessness), and social cognition (loneliness, interpersonal alienation), as well as decreased positive affect and engagement (loss of interest, meaning, and purpose). The items in the PROMIS negative affect banks use a 7-day time frame and a 5-point rating scale that ranges from 1 ("Never") to 5 ("Always"), with higher scores indicating greater severity of depressive symptoms. The standardized T-Score for the cancer patient reference population is 50 and the minimally clinically important difference (MCID) in T-scores is 3.0-4.5. Depression T-Scores can be interpreted categorically as ≤55 = normal; 56-60 = mild; 61-70 = moderate; ≥71 = severe.

Positive and negative affect will be measured by the International version of the Positive and Negative Affect Schedule-Short Form (PANAS-SF). This is a cross-culturally validated version of the widely affect measure that consists of 10 items; 5 items measuring negative affect and 5 items measuring positive affect.

Sleep disturbance will be measured using the 8 item Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b (PROMIS-Sleep Disturbance). The PROMIS-Sleep Disturbance content focuses on perceptions of sleep quality, sleep depth, and restoration associated with sleep. Each item on the measure is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 8 to 40 with higher scores indicating greater severity of sleep disturbance.

Physical activity will be measured using the 8-tem Short Form of the International Physical Activity Questionnaire (IPAQ). The purpose of the questionnaire is to provide common instruments that can be used to obtain internationally comparable data on health-related physical activity by estimating the time spent performing physical activities (moderate to vigorous) and inactivity (time spent sitting).

Coping will be measured using the Cancer Behavior Inventory (CBI). The short version of the CBI is a 12-item measure of self-efficacy for coping with cancer. Items are rated on a 5-point Likert scale indicating confidence in a range of coping skills. The CBI yields a single summary score representing overall confidence in engaging in adaptive coping behaviors.

The Patient Activation Measure-Short Form (PAM-SF) is a 13-item measure that assesses patient knowledge, skill, and confidence for self-management.

Symptom distress will be measured using the 25 item physical symptom distress subscale of the Rotterdam Symptom Checklist (RSCL). All items are rated on a 4-point Likert scale ranging from (1) not at all to (4) very much. Higher scores (calculating by taking the sum of the items) are indicative of greater distress or impairment.

The Patient Global Impression of Change is a 3 item measure that assesses a patient's perceived improvement (since the start of the study) across 3 domains: Anxiety, Depression, and Global Wellbeing. Items are rated on a 7-point likert scale from 1 (Very much worse) to 7 (Very much improved).

Blood draws will be conducted using at-home blood device such as the Tasso-M20 self-administered home blood sampling method and multiomics testing. The Tasso-M20 device is CE marked and FDA registered. Using the provided kit instructions and contents, subjects will collect the Tasso-M20 blood sample in a self-administered, unsupervised manner which involves attaching the device on their arms for 5 minutes to collect 4 samples of 17.5μLof blood (dry blood spots) (visit Tasso for additional instructions and information) and then ship the device in a pre-labeled envelope back to Stanford where samples will be de-identified and stored in a -80 degree freezer. All de-identified samples will be assayed by the Stanford Human Immune Monitoring Lab (HIMC) using the MILLIPLEX Human 48-plex assay which identifies hormone biomarkers related inflammatory biology.