Cancer Patients, Family Caregivers
Conditions
Keywords
Emotion Regulation Therapy, Addressing Caregiver Distress, Supportive Interventions, 20-407, Training participants
Brief summary
The purpose of this study is to compare two types of therapy for caregivers of cancer patients: Emotion Regulation Therapy for Cancer Caregivers (ERT-C) and Cognitive Behavioral Therapy (CBT-C). The researchers want to see if ERT-C is better than, the same as, or worse than traditional CBT-C at improving caregiver distress. The researchers will look at how the two types of therapy affect caregivers' anxiety, depression, and quality of life. The researchers will also see how ERT-C and CBT-C affect hormone and stress levels in caregivers' saliva samples. In addition, this trial will enroll cancer patients in this study to see how their caregivers' participation in ERT-C or CBT may affect the patients' quality of life, stress, and use of healthcare services. Participants who become bereaved while on study will be given the option to withdraw or remain on study. Assessments for bereaved caregivers will not include the Caregiver Quality of Life Index-Cancer (CQOLC) or the Caregiver Reaction Assessment (CRA).
Detailed description
CBT-C and ERT-C are each 8-session, individual, caregivers-directed interventions delivered by a trained study therapist listed on the face page and facilitated by a manualized workbook with between-session practice exercises. To accommodate caregivers and reduce compliance issues with attendance of sessions, the 8 sessions are to be completed within 8 to 16 weeks from initiation of the first session. Each session is 60 minutes in length and will be audio and video recorded for MSK participants; sessions will only be audio recorded for MGH participants. Specific modules and intervention components are described below. To accommodate as many caregivers as possible and in response to the restrictions placed on caregivers currently in the context of the COVID-19 pandemic, sessions will be offered via telepsychiatry (using WebEx , Zoom, Teams). Training case participants will be identified and consented onto the study for training purposes only. Participants who are consented as training cases will not be randomized and will not complete any assessments. Data collected on training cases will be used for training and supervision purposes on this study only. These records will not be shown outside of the study supervisors, therapist in training, and staff.
Interventions
OTHERCognitive Behavioral Therapy for Cancer Caregivers (CBT-C)
The sessions are outlined as follow: 1. psychoeducation, goal-setting, and describing the rationale for CBT (Session 1); 2. coping effectiveness training (Session 2); 3. identifying unhelpful cognitions and dysfunctional beliefs (Session 3); 4. challenging and restructuring unhelpful cognitions (Session 4); 5. behavioral activation within the limitations of the caregiving context (Session 5); 6. problem-solving (Session 6); 7. communication strategies and assertiveness training (Session 7); 8. consolidating gains, maintenance, and relapse prevention (Session 8).
The sessions are outlined as follow: 1. psychoeducation and motivation/dysregulation cue detection within caregiving contexts (Session 1); 2. attention regulation skills training (Sessions 1-2); 3. training in metacognitive skills (Sessions 3-4); 4. exposure to proactive living in the face of risk and loss while applying skills (Sessions 5-7); 5. consolidating gains, taking larger proactive steps, and relapse prevention (Session 8).
Sponsors
Memorial Sloan Kettering Cancer Center
University of Aarhus
Columbia University
University of California
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
This study will utilize a randomized, controlled, repeated measures design to investigate the efficacy of Emotion Regulation Therapy for Cancer Caregivers (ERT-C) vs. Cognitive Behavioral Therapy for Cancer Caregivers.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Caregivers: * As per self-report, age 18 years or older. * As per self-report, are a caregiver to an MSK or MGH patient with any site/stage of cancer who has received any type of treatment (e.g. curative, palliative) in the past 12 months. * Experience distress as evidenced by a score of 4 or greater on the Distress Thermometer (DT) and answer "Yes" to at least one of the follow-up questions (i.e. reporting that their distress is related to their caregiving experience, or their distress started or is related to caregiving or has gotten worse since the patient was diagnosed or began treatment. (N/A for training case participants) * English fluent: Self-report by subject identifying English as the preferred language for healthcare, and self-reported degree of fluency as speaking English "Very well." * As per self-report, residing in New York or New Jersey (for MSK participants), or Massachusetts (for MGH participants), or have the ability to complete sessions while complying with current telehealth regulations. Patients: * Age 18 years or older as per EMR. * Patient of an eligible caregiver per self-report or the EMR. * English speaking as per the EMR or self report by subject identifying English as the preferred language for healthcare, and self-reported degree of fluency as speaking English "Very well.".
Exclusion criteria
Caregivers: * As per self-report, presence of disorder that compromises comprehension of assessments or informed consent information (e.g., dementia). * As per the judgement of the consenting professional, clinical, PI, and/or as per the medical record, severe psychopathology or cognitive impairment which is likely to interfere with the participation or completion of the protocol or their ability to provide meaningful information * As per self-report, currently engaged in regular individual psychotherapeutic support (that the participant is unable or unwilling to put on hold for the course of treatment). * As per self-report, a lifetime history of bipolar disorder, schizophrenia, or schizoaffective disorder. * As per self-report, has medical condition or medication use known to confound measures of systemic inflammation (e.g., autoimmune disorder, inflammatory disease; uncontrolled thyroid disease; active infection; myocardial infarction or stroke in the last 6 months; Type I diabetes; acute hepatitis; recent vaccination for viral disease). (N/A for training case participants) * As per self-report, is a regular smoker, defined as having more than 2 cigarettes per day on most days. (N/A for training case participants) * As per self-report, providing care for a patient who has a caregiver is currently or formerly enrolled in this study ('formerly enrolled' is N/A for training case participants). * As per self-report, currently enrolled in another study focused on supportive care for caregivers (MGH participants only). Patients: * Presence of disorder that compromises comprehension of assessments or informed consent information (e.g., dementia) as per EMR or clinician judgment. * As per the judgement of the consenting professional, clinical, PI, and/or as per the medical record, severe psychopathology or cognitive impairment which is likely to interfere with the participation or completion of the protocol or their ability to provide meaningful information
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in Anxiety Symptoms | up to 6 months | as assessed via the HADS Developed by Zigmond and Snaith in 1983, the HADS produces two scales, one for anxiety (HADS-A) and one for depression (HADS-D), differentiating the two states. Items of the overall severity of anxiety and depression are rated on a five-point (0-4) severity scales (ranging from 0 = no not at all, to 4 = yes definitely), for a total score ranging from 0-21 for each subscale. A higher score indicates higher distress |
| Changes in Depressive Symptoms | up to 6 months | as assessed via the HADS Developed by Zigmond and Snaith in 1983, the HADS produces two scales, one for anxiety (HADS-A) and one for depression (HADS-D), differentiating the two states. Items of the overall severity of anxiety and depression are rated on a five-point (0-4) severity scales (ranging from 0 = no not at all, to 4 = yes definitely), for a total score ranging from 0-21 for each subscale. A higher score indicates higher distress |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORRebecca Saracino, PhD
Memorial Sloan Kettering Cancer Center
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 51.1 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 22 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 311 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 17 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants |
| Race (NIH/OMB) More than one race | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 3 Participants |
| Race (NIH/OMB) White | 287 Participants |
| Region of Enrollment United States | 95 Participants |
| Sex: Female, Male Female | 222 Participants |
| Sex: Female, Male Male | 32 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 124 | 0 / 120 | 0 / 0 | 13 / 95 |
| other Total, other adverse events | 0 / 124 | 0 / 120 | 0 / 0 | 0 / 95 |
| serious Total, serious adverse events | 0 / 124 | 0 / 120 | 0 / 0 | 0 / 95 |
Outcome results
None listed