PROJECT ABSTRACTThere are 13 cancer subtypes that are linked to obesity and these account for 40% of all cancers diagnosed inthe United States annually. American Indian/Alaska Native (AI/AN) populations are 1.6 times more likely to beobese than the general population. Many factors influence this elevated risk including poverty nontraditionalfoods related social determinants of health and physical inactivity. Furthermore AI/AN people have the worstcancer survival rates of any US racial group. Obesity-related inflammation likely drives cancer risk and adverseoutcomes and yet this is a reversible process. AI/AN are known to be underrepresented in clinical trials andresearch and even more importantly they have never been included in an intervention designed to modulateinflammation prior to cancer surgery. A small handful of studies in non-AI/AN featuring lifestyle interventionsfollowing diagnosis of obesity-related cancer and implemented during the short window of opportunity (WOO)before cancer surgery a strategy known as prehabilitation (prehab) have shown some significant findings.These include alterations in the expression levels of inflammatory markers in serum and the tumormicroenvironment (TME) factors that may influence carcinogenesis. Given the higher prevalence of obesityand worse cancer outcomes the AI/AN population may have the greatest gains from this line of research. Wehypothesize that a prehab intervention modeled after published literature then adapted with communitycollaboration for AI cancer patients will be feasible acceptable and successful at modulating inflammatorybiomarkers. The proposed project is to (1) complete the adaptation of a prehab intervention using thecandidates preliminary research (2) implement the prehab translational clinical trial for AI patients withobesity-related solid tumor cancer preparing for surgery and (3) measure inflammatory biomarkers pre andpost-intervention to assess responsiveness. Study outcomes include pre and post comparisons of serumbiomarkers (insulin leptin hsCRP IL-6 TNF cortisol AM prealbumin); tissue biomarkers (Ki67 insulinreceptor TNF NFB NOS2 cleaved caspase-3); anthropometric measurements (blood pressure weightwaist circumference); lifestyle behavioral measures (validated diet/exercise tools: REAPS IPAQ 6MWT STS).The proposed training plan builds on the applicants background in surgical oncology public health and AI/ANcancer disparities to include new training in (a) clinical trial design and implementation (b) biomarkermeasurement and (c) professional development. The rigorous research and training strategies will promote thecandidates goal of successfully transforming into an independent funded translational clinical trialist workingon behalf of AI/AN to narrow cancer disparities. This will be achieved with the support of a highly experiencedmentorship team and the well-resourced training environment of The University of Arizona an AI/AN-servinginstitution and home to the only NCI-designated Comprehensive Cancer Center in the state of Arizona.