Head and Neck Cancer
Conditions
Brief summary
Informed by a previous trial in general cancer patients, the investigators aim to conduct a multi-centre Phase III explanatory RCT to demonstrate a significant impact of PTSD Coach on levels of anxiety in head and neck cancer (HNC) patients, including saliva and hair cortisol as bio-immunological indicators for stress. However, prior to proposing a larger trial requiring 267 patients, the investigators aim to demonstrate feasibility of recruitment and compliance with protocol procedures in a Phase II Pilot of 60 newly diagnosed HNC patients. The EG will receive PTSD Coach + usual care, compared to two control groups (UC and AC). AC will be comprised of a game app (e.g., Tetris, Candy Crush, or Solitaire) and will be structurally equivalent to the EG to control for distraction (attention on something pleasant or a task) and the human factor involved in usage prompting (i.e., same exposure time + contacts with personnel), since either distraction or the human contact with staff may, alone, lower anxiety. From a resource allocation perspective, it is important to know if the positive effects of PTSD Coach are due to the intervention itself or to the use of an app and its usage prompting. The investigators believe that PTSD Coach will be even more effective at reducing anxiety in HNC patients, as it teaches specific CBT techniques and uses psychoeducation already found to be more effective than distraction alone.
Detailed description
See above
Interventions
DEVICEPTSD Coach
PTSD Coach is a mobile mental health app that addresses the issue of mental health and stigma which can be used as a stand-alone education and symptom management and contains 4 modules: 1) Learn- Module, 2) Self- Assessment-Module, 3) Manage Symptoms-Module and 4) Find Support-Module.
BEHAVIORALGame application
This control condition is important to control for distraction (attention on something pleasant or a task) and the human factor involved in usage prompting (i.e., same exposure time + contacts with personnel), since either distraction or the human contact with staff may, alone, lower anxiety
Sponsors
Canadian Institutes of Health Research (CIHR)
Jewish General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Newly diagnosed with HNC (all HNC sites; TNM classification system); first occurrence, progression or recurrence \<4 weeks at referral. 2. Willing to complete PTSD Coach or game app within 3 weeks as they await treatment onset. 3. \>18 years old 4. Alert and capable of giving free and informed consent according to referring clinician.
Exclusion criteria
1. Karnofsky Performance Status (KPS) score \< 60 (rated by referring oncologists/nurses or Research Coordinator) or expected survival \<6 months according to clinical judgment of physicians and/or nurses. 2. Suicidal. Present a score of ≥2 on the Beck Depression Inventory (BDI) suicide item. 3. Known diagnosis of schizophrenia or schizoaffective disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PTSD Coach app Acceptability | 2 months post-randomization | Is the PTSD Coach app acceptable to at least 80% of newly diagnosed head and neck cancer patients, as indicated by 80% positive responses on the Pilot-Study Questionnaire (PSQ; adapted from the CSQ-8; Attkisson & Zwick, 1982) |
| Feasibility of recruitment for a full trial study | 2 months post-randomization | 1. Can we recruit a sufficient number (i.e., n=60 over 8 months or 8/month) of newly diagnosed head and neck cancer patients? AND 2. Can we retain a sufficient proportion (i.e., ≥85% at three months post-randomization, having completed the primary outcome) of head and neck patients in all trial arms to allow completion of a full study (n=267) in a timely fashion? |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Completion of intervention in a timely manner | 2 months post-randomization | At least 90% of experimental group complete PTSD Coach within 3 weeks from randomization. At least 85% of the content for each module of PTSD Coach be completed. At least 90% of the attention control complete their assigned condition as planned (i.e., 45 min/week over 3 weeks). |
| Sample size calculation for full trial study | 2 months post-randomization | Identify the 80% upper confidence interval for pooled standard deviation at baseline for use of full trial sample calculation. |
Countries
Canada
Outcome results
None listed