PROJECT SUMMARY Sleep disturbance is one of the primary complaints of gynecologic cancer survivors with more than 80% ofsurvivors reporting sleep difficulties. Sleep disturbance also contributes to worsened health-related quality oflife (HRQOL) and increased symptom burden. Although non-pharmacological interventions for sleepdisturbance have been explored among cancer populations up to 50% of survivors do not adhere to treatmentrecommendations possibly due to the behaviorally labor-intensive nature thereof. Therefore there is a needfor more effective and acceptable approaches to improve sleep outcomes in cancer. This application proposesa career development plan to support Dr. Rina Fox in establishing an independent research program focusedon examining strategies to improve HRQOL and reduce symptom burden among cancer survivors withparticular consideration for the role of sleep and circadian rhythms in the overall disease experience. Hercareer development will be supported by a multidisciplinary group of researchers. Her mentors Drs. Ong Riniand Zee are recognized scholars in behavioral sleep medicine cancer control and survivorship and circadianrhythms and biology respectively. They have lengthy histories of federal funding multidisciplinarycollaboration and successful mentorship of trainees who go on to achieve independence. Dr. Foxs training willbe enhanced by expert consultants who will provide guidance in clinical gynecologic oncology (Dr. Tanner)biostatistics and optimization methodology (Dr. Siddique) qualitative research methods (Dr. Kaiser) circadianactivity rhythms and execution of sleep-focused research among cancer survivors (Dr. Ancoli-Israel) andbiobehavioral mechanisms of intervention efficacy and psychosocial intervention development specificallyamong gynecologic cancer survivors (Dr. Penedo). The aim of this application is to optimize a behavioralintervention to decrease sleep disturbance (primary outcome) and improve HRQOL and reduce symptomburden (secondary outcomes) among gynecologic cancer survivors. In Phase I 15 participants willsimultaneously receive three candidate intervention components known to reduce sleep disturbance (i.e. sleeprestriction stimulus control and bright light) and will subsequently complete semi-structured individualinterviews to provide feedback regarding barriers and facilitators to intervention adherence. In Phase II 80participants will be randomized to evaluate these intervention components within a 23 full factorial trial designas guided by the Multiphase Optimization Strategy (MOST) framework to identify the optimal combination ofcandidate intervention components enhanced to promote adherence that best affect the studys primary andsecondary outcomes. Sleep disturbance and circadian markers will also be evaluated as potential mechanismsunderlying the candidate intervention components effects on study outcomes. Results of this innovativeresearch will directly lead to an R01 application and an independent and programmatic line of research for Dr.Fox focused on HRQOL symptom burden and sleep and circadian disturbance among cancer survivors.