PROJECT SUMMARY This K23 application support's the applicant's long-term goal to build an independent, sustained program of research leading patient-oriented research studies focused on improving medication adherence and health outcomes among socioeconomically diverse patients with cancer. Cancer treatment advances, including costly, long-term therapy with oral anticancer medication, have extended survival for patients with cancer, including those with multiple myeloma, a life-threatening blood cancer associated with significant pain and reduced quality of life. Improved knowledge of how oral anticancer medication adherence influences patient health outcomes over time and how financial hardship may affect these relationships will inform future large- scale studies aimed at developing timely, targeted interventions to improve adherence, reduce pain, and improve quality of life in patients with cancer. This career development award will support the applicant's training and research goals through focused, expert mentorship, coursework, and other training activities designed to 1) develop theoretical and measurement knowledge specific to medication adherence research; 2) develop statistical and qualitative methods expertise needed to conduct longitudinal, mixed method research; and 3) gain in-depth knowledge and research skills to conduct culturally-sensitive research with vulnerable populations. The proposed research project will generate knowledge about temporal relationships among adherence, financial hardship, pain, and quality of life in patients initiating long-term oral anticancer medication for multiple myeloma. Utilizing a longitudinal, mixed method design in a sample of 90 socioeconomically diverse patients newly prescribed oral anticancer maintenance therapy for multiple myeloma with repeated measure assessment at baseline, 3-months, and 6-months post therapy initiation, the study aims to 1) prospectively determine the influence of oral anticancer medication adherence on pain and quality of life; 2) determine whether financial hardship moderates the relationship between oral anticancer medication adherence and pain and quality of life over time; and 3) explore the patient experience of taking oral anticancer medication using qualitative methods in a subset of participants with differing adherence patterns. Descriptive statistics, mixed-effects modeling, and lagged value effects using Markov modeling will be used to achieve aims 1 and 2, respectively. Qualitative description and content analysis will be used to achieve aim 3. This proposal directly aligns with the National Institute of Nursing Research's mission to understand the behavioral aspects of symptoms to improve health outcomes and quality of life. Emory University's research environment provides strong resources that will facilitate Dr. Belcher's career development into an independent research scientist.