Implementation and Effectiveness Trial of HN-STAR
- Conditions
- Head and Neck Cancer
- Interventions
- Other: HN-STAR Intervention
- Registration Number
- NCT04208490
- Lead Sponsor
- Wake Forest University Health Sciences
- Brief Summary
People who have been treated for head and neck cancer (HNC survivors) can experience serious consequences from their cancer and its treatment, ongoing risks of new cancers, and other unrelated illnesses. These concerns pose challenges to the provision of comprehensive care to HNC survivors. We created HN-STAR to facilitate and tailor the ongoing care of HNC survivors. Survivors use HN-STAR on a computer or tablet to answer questions about symptoms and health concerns before a routine visit with a cancer care provider. During the clinic visit, the provider uses HN-STAR to see evidence-based recommendations for managing each concern reported by the survivor. The provider and survivor discuss recommendations and select appropriate actions (e.g., testing, referrals, prescriptions, self-management). HN-STAR produces a survivorship care plan that includes all reported concerns and the actions selected in clinic. The survivorship care plan is given to the survivor and the primary care provider. Three months, six months, and nine months later, the survivor uses HN-STAR from home (or clinic) to report their concerns again, and a new survivorship care plan is created each time.
Our trial randomizes 20-36 oncology practices from the National Community Oncology Research Program to use HN-STAR or provide usual care to 298-400 recent survivors of head and neck cancer. We hypothesize that survivors in the HN-STAR arm will have greater improvement in patient-centered outcomes (including cancer-related well-being, symptoms, and patient activation) over one year compared to survivors in the usual care arm, measured by surveys at baseline and one year later. We also hypothesize that survivors in the HN-STAR arm will be more likely to receive care that is aligned with evidence-based recommendations during the year of the study than survivors in the usual care arm. Our final aim investigates the implementation of HN-STAR in clinical practice, using interviews and surveys of survivors, providers, and other clinic staff to understand the feasibility, acceptability, appropriateness, and other aspects of providing survivorship care to head and neck cancer survivors.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 470
- Age ≥18 years.
- Diagnosis of primary or locoregionally recurrent head and neck squamous cell carcinoma, specifically oral cavity, larynx, oropharynx, hypopharynx, and unknown squamous cell carcinoma primary.
- Completed chemotherapy and/or radiation therapy with curative intent for head and neck squamous cell carcinoma ≤ 24 months prior to designated clinician visit.
- Deemed free of disease at last assessment.
- Cognitively and physically able to complete study survey per local NCORP site staff discretion.
- Scheduled for a clinic visit with a provider who has agreed to participate in this study and meets requirements for the arm to which their practice has been assigned (the practice designated clinician) for routine follow-up.
- Willing to complete study assessments 3, 6, and 9 months after the designated clinic visit either 1) remotely (via telephone or videoconference using smartphone, tablet, or computer) or 2) at the clinic to complete study assessments on a clinic tablet or computer.
Survivor
- In active cancer treatment (including hormone therapy) for any other cancer, excluding local therapy for non-melanoma skin cancer.
- Evidence of prior cancer (excluding non-melanoma skin cancer) within 3 years of the designated clinician visit.
- Head and neck tumor histology of lymphoma, adenocarcinoma or melanoma.
- Recurrent, persistent, or progressive disease at last assessment (per scan or clinical assessment).
- Does not speak or read English, because the HN-STAR tool is only available in English at this time.
- Received only surgery as treatment for head and neck cancer.
- Current, planned enrollment, or in follow-up on another interventional symptom management study protocol, as per patient self-report or research staff members' knowledge at the time of consent. Concurrent participation in treatment or imaging studies is allowed.
Designated Clinician Inclusion Criteria:
- Age > = 18 years
- MD, DO, NP, or PA
- Able to speak and read English, because the HN-STAR tool is only available in English at this time.
- Routinely provides care for cancer patients or survivors.
- Willing to complete study-specific trainings and incorporate HN-STAR or provide usual care in a routine follow-up care visit
Stakeholders Inclusion Criteria:
- Age > = 18
- Member of the practice clinical or administrative team who is involved in the oversight of the delivery of head and neck cancer survivorship care or who would make decisions about implementing head and neck survivorship tools such as HN-STAR. This could include clinic administrators, nurse navigators, key clinical team members, program directors, and other staff (e.g., service line or nursing leaders).
- Employed for at least one month at the practice.
- Able to speak and reads English, because the HN-STAR tool is only available in English at this time.
Stakeholder Exclusion Criteria:
- Is the designated clinician at the practice.
Primary Care Provider Inclusion Criteria:
- Provides primary care (general preventative care) to a survivor enrolled in the HN-STAR study.
- Age >= 18
- MD, DO, NP, or PA
Primary Care Provider Exclusion Criteria:
- Provides Oncology Care
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description HN-STAR HN-STAR Intervention -
- Primary Outcome Measures
Name Time Method Change in HNC-Specific QOL Baseline & 1 year Measured using Trial Outcome Index from the Functional Assessment of Cancer Therapy Head and Neck. It is a 23-item summary measure that ranges from 0 to a maximum of 96 where higher scores indicate better overall physical and functional outcomes.
- Secondary Outcome Measures
Name Time Method Change in symptom burden Baseline & 1 year Measured using PRO-CTCAE items for relevant symptoms.
Change in patient activation Baseline & 1 year Measured using Patient Activation Measure Short Form. PAM score ranges from 0 to 100, with higher score meaning higher level of activation.
Change in QoL Baseline & 1 year Measured using scales from the EORTC QLQ-C30. Scales from the EORTC QLQ-C30 evaluate functional status, global health status and symptoms. All scales range from 0 to 100, with higher scores representing higher functioning, QoL or symptoms.
Change symptom burden Baseline & 1 year Measured using scales from the EORTC QLQ-HN43. Symptom subscales from the EORTC QLQ- HN43 range from 0 to 100, with higher scores representing higher symptom burden.
Change in pain Baseline & 1 year Measured using Brief Pain Inventory Short Form. Pain severity and interference items are measured using a scale from 0 to 10, with higher scores indicating worse pain or interference. The average is used as a summary measure of pain severity and pain interference.
Change in perceived quality of cancer care Baseline & 1 year Measured using the CAHPS® Cancer Care Survey.
Adherence and surveillance of guideline concordant care These variables will be derived from the medical record during the year following the initial visit. Rate at which survivors had ≥1 visit to a primary care provider in the year following the initial visit will be compared by arm. Receipt or non-receipt of guideline-concordant cancer surveillance will be derived from the oncology medical records and compared by arm.
Trial Locations
- Locations (49)
ThedaCare Regional Cancer Center
🇺🇸Appleton, Wisconsin, United States
John H Stroger Jr Hospital Cook County
🇺🇸Chicago, Illinois, United States
Kingman Regional Medical Center
🇺🇸Kingman, Arizona, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Beebe South Coastal Health Campus
🇺🇸Frankford, Delaware, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
MedStar Georgetown University Hospital
🇺🇸Washington, District of Columbia, United States
MedStar Washington Hospital Center
🇺🇸Washington, District of Columbia, United States
Phoebe Putney Memorial Hospital
🇺🇸Albany, Georgia, United States
Augusta University Medical Center
🇺🇸Augusta, Georgia, United States
Carle at The Riverfront
🇺🇸Danville, Illinois, United States
Carle on Vermilion
🇺🇸Danville, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸Mattoon, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Maine Medical Partners Otolaryngology
🇺🇸Portland, Maine, United States
Reid Health
🇺🇸Richmond, Indiana, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Harold Alfond Center for Cancer Care
🇺🇸Augusta, Maine, United States
OptumCare Cancer Care at Fort Apache
🇺🇸Las Vegas, Nevada, United States
OptumCare Cancer Care at Seven Hills
🇺🇸Henderson, Nevada, United States
Maine Medical Partners - South Portland
🇺🇸South Portland, Maine, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
OptumCare Cancer Care at Charleston
🇺🇸Las Vegas, Nevada, United States
Sanford Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
AnMed Health Cancer Center
🇺🇸Anderson, South Carolina, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Saint Francis Hospital
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Butternut
🇺🇸Greenville, South Carolina, United States
Bon Secours Saint Francis Medical Center
🇺🇸Midlothian, Virginia, United States
Prisma Health Cancer Institute - Faris
🇺🇸Greenville, South Carolina, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Aspirus Langlade Hospital
🇺🇸Antigo, Wisconsin, United States
Ascension Saint Francis - Reiman Cancer Center
🇺🇸Franklin, Wisconsin, United States
Ascension Saint Elizabeth Hospital
🇺🇸Appleton, Wisconsin, United States
Aspirus Cancer Care - James Beck Cancer Center
🇺🇸Rhinelander, Wisconsin, United States
Aspirus Regional Cancer Center
🇺🇸Wausau, Wisconsin, United States
Aspirus Cancer Care - Stevens Point
🇺🇸Stevens Point, Wisconsin, United States
Ascension Columbia Saint Mary's Hospital - Milwaukee
🇺🇸Milwaukee, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Saint Francis Cancer Center
🇺🇸Greenville, South Carolina, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Montefiore Medical Center-Einstein Campus
🇺🇸Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸Bronx, New York, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States