Symptom Management and Transitioning to Engagement With Post-treatment Care for Adolescent and Young Adult Cancer Survivors
Overview
- Phase
- Not Applicable
- Intervention
- AYA Educational Information
- Conditions
- Cancer
- Sponsor
- Duke University
- Enrollment
- 260
- Locations
- 1
- Primary Endpoint
- Emotional distress as measured by PROMIS Anxiety Short Form
- Status
- Recruiting
- Last Updated
- 3 months ago
Overview
Brief Summary
The purpose of this study is to determine the effectiveness of a digital health program called AYA STEPS, which is designed to help adolescent and young adult (AYA) cancer survivors manage symptoms and engage in recommended follow-up care.
Detailed Description
The investigators have developed an accessible digital health intervention, AYA STEPS (Symptom Management and Transitioning to Engagement with Post-Treatment Care for AYA Survivors), designed to enhance adolescent and young adult (AYA) cancer survivors' abilities to manage their high symptom burden and engage in follow-up health care. Informed by the Obesity-Related Behavioral Intervention Trials (ORBIT) Model of intervention development, AYA STEPS has been systematically and rigorously developed and refined through the PI's prior work (K08CA245107). AYA STEPS is organized into six remotely delivered sessions providing cognitive-behavioral and patient activation theory-based skills expected to lead to lower symptom burden and increased health care engagement by improving AYAs' self-efficacy for symptom management and activation. The investigators propose a randomized controlled trial to examine the efficacy of AYA STEPS compared to AYA educational information for improving symptom burden and health care engagement for AYA survivors (N=260) who received cancer care in diverse health care settings (i.e., rural, urban, medically underserved areas) across North Carolina. Self-efficacy and patient activation will be examined as mediators of intervention effects. The planned study has the potential to produce clinically impactful health benefits for an underserved and understudied group of cancer survivors who have significant symptom burden, experience barriers to care engagement, and have limited access to AYA-specific behavioral interventions.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Diagnosed with one of the following cancers: 1) stage I-III breast cancer; 2) stage I-III colorectal cancer; 3) stage I-III sarcoma; 4) stage I-III Hodgkin or non-Hodgkin lymphoma; or 5) stage I-II testicular cancer
- •treated with curative intent and off therapy (with the exception of endocrine/hormonal therapy or oral targeted therapies used to prevent disease recurrence or progression) for the last three months
- •1 to 5 years post-diagnosis
- •Able to speak and read English
- •Able to give informed consent
Exclusion Criteria
- •moderate or severe cognitive impairment
- •severe untreated mental illness (e.g., schizophrenia, substance use disorder) that would interfere with providing meaningful consent/study participation
Arms & Interventions
Education Control
The education control condition will match AYA STEPS in delivery format \[videoconferencing, web-based platform, frequency (biweekly sessions)\], and session number (six) and length.
Intervention: AYA Educational Information
AYA STEPS
Participants will receive the AYA STEPS digital health intervention, which includes six sessions delivered remotely (i.e., videoconferencing) by a clinical psychologist with intervention content accessed using a web-based platform.
Intervention: AYA STEPS
Outcomes
Primary Outcomes
Emotional distress as measured by PROMIS Anxiety Short Form
Time Frame: Baseline, 3 Months, 6 Months, 12 Months
Symptoms of Anxiety will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety Short Form, an 8-item measure assessing symptoms of anxiety in the last week. Responses are on a 5-point scale from "never" (1) to "always" (5).
Symptom interference as measured by MD Anderson Symptom Inventory (MDASI) Symptom Interference
Time Frame: Baseline, 3 Months, 6 Months, 12 Months
The MDASI will be used to assess interference of symptoms in daily living (e.g., working, relations with other people, enjoyment of life) over the past month. The MDASI asks patients to rate the severity of 13 symptoms found frequently in patients with various cancers and treatment types on a scale from 0 (symptom "not present") to 10 (symptom "as bad as you can imagine"). This measure also includes 6 questions asking patients to rate the level of symptom interference in six domains (e.g., general activity, mood) on a scale from 0 (did not interfere) to 10 (interfered completely).
Pain severity and interference as measured by Brief Pain Inventory
Time Frame: Baseline, 3 Months, 6 Months, 12 Months
The Brief Pain Inventory will be used to assess pain severity and interference from pain across important life domains (e.g., general activity, work, relations with others). This measures includes a body map on which the patient can mark the location(s) in which they are experiencing pain, as well as 8 questions on a scale of 0 to 10 with higher scores indicating worse pain severity or pain interference.
Health care engagement as measured by Patient Participation Questionnaire
Time Frame: Baseline, 3 Months, 6 Months, 12 Months
The Patient Participation Questionnaire will be used to assess participants' health care participation and associated domains (i.e., receipt of information, communication, perceptions of their relationship with the medical team). Participants are asked to indicate their agreement with 17 items related to health care engagement on a 4 point scale: "to a great extent," "to some extent," "to a lesser extent," or "not at all." An additional item asks patients about their overall assessment of their involvement in their healthcare.
Patient self-assessment of communication competency with health care providers as measured by Medical Communication Competence Scale (MCCS) patient subscale
Time Frame: Baseline, 3 Months, 6 Months, 12 Months
The MCCS patient subscale will be used to assess survivors' perceptions of their competency for communicating and participating in health care. The patient subscale includes 39 items on a scale of 1 to 7, with higher scores reflecting self-perception of better medical communication competence.
Fatigue as measured by PROMIS Fatigue Scale
Time Frame: Baseline, 3 Months, 6 Months, 12 Months
Fatigue will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Scale, a 6-item self-report measure of fatigue. Participants are asked to think about the last week when responding to each item (e.g., "In the past 7 days, how run-down did you feel, on average?"), providing ratings on a scale from "not at all" (1) to "very much" (5).
Emotional distress as measured by PROMIS Depression Short Form
Time Frame: Baseline, 3 Months, 6 Months, 12 Months
Depressive symptoms will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Short Form, an 8-item measure assessing symptoms of depression in the last week. Responses are on a 5-point scale from "never" (1) to "always" (5).
Secondary Outcomes
- Patient self-efficacy for chronic disease coping as measured by Self-Efficacy for Managing Chronic Illness Scale(Baseline, 3 Months, 6 Months, 12 Months)
- Patient activation as measured by Patient Activation Measure (PAM)(Baseline, 3 Months, 6 Months, 12 Months)
- Patient self-efficacy for managing chronic conditions as measured by the PROMIS Self-Efficacy for Managing Symptoms Short Form(Baseline, 3 Months, 6 Months, 12 Months)
- General patient self-efficacy as measured by the PROMIS General Self-Efficacy Short Form(Baseline, 3 Months, 6 Months, 12 Months)