Cancer (Active Cancer, Meaning Not Being Cancer Free), of Any Stage and Involving Any Treatment/Care Regimen; i.e. Curative, Life-extending, or Palliative
Conditions
Keywords
palliative care, supportive care, cancer, family caregiver, older people, community, primary care
Brief summary
Most people with cancer are older, and this affects millions of Europeans yearly. Integrating high-quality, equitable, and cost-effective care across the continuum of supportive, palliative, and end-of-life care for both patients and family caregivers is highly relevant from a healthcare, prevention, and economic perspective. EU NAVIGATE is an interdisciplinary, cross-country, and intersectoral project funded by the European Union. The overall aim of the study is to evaluate the effectiveness and cost-effectiveness of a patient and family navigation intervention (NavCare-EU) for older people with cancer and declining health and their family caregivers in different healthcare systems in Europe. Nav-Care EU is a person- and family-centered non-pharmacological intervention in which navigators collaborate with patients and families to improve quality of life and improve levels of social support, foster empowerment, and facilitate timely and equitable access to health and social care services and resources as needed, throughout the supportive and palliative care continuum. NavCare-EU is based on the existing and successfully tested Nav-CARE(c) intervention from Canada. Effectiveness and cost-effectiveness will be evaluated through an international 6-country multisite pragmatic fast-track randomised controlled trial (RCT) with an embedded mixed methods process evaluation to compare the NavCare-EU intervention in addition to standard care with the provision of standard care alone. The RCT and process evaluation will be conducted in Belgium (Flanders), Ireland, Italy, the Netherlands, Poland, and Portugal. Participants are people with cancer and declining health, who are aged 70 years and older, as well as their close family caregivers. Specific objectives are: 1\. To compare the NavCare-EU intervention to care as usual, in terms of its: 1. Effectiveness on (1) global health status/quality of life, and the levels of social support (two co-primary outcomes); and on feelings of loneliness of older persons with cancer across the continuum of supportive, palliative, and end-of-life care; (2) family caregiver burden 2. cost-effectiveness 3. effects on different subgroups defined by characteristics known to affect health equity and equitable access, i.e., gender, age, socioeconomic status, extent of social support and living situation, and geographical location (rural vs. urban) 4. effectiveness and cost-effectiveness in different health care systems and care regimes in Europe 2\. To evaluate the implementation processes of the NavCare-EU intervention and the feasibility of its integration in different health care systems and care regimens in Europe, the contextual barriers and facilitators for effective and sustainable implementation, and the mechanisms involved in reaching the outcomes in each country, as perceived by patients, family caregivers, and other care providers
Interventions
BEHAVIORALNavCare-EU
NavCare-EU is a person- and family-centered intervention in which navigators collaborate with older persons and their close family caregivers across the continuum of supportive, palliative, and end-of-life care,. NavCare-EU is based on the existing and successfully tested Nav-CARE intervention from Canada. Navigators focus on connecting clients to social supports, both formal and informal, advocating for clients in meeting their quality-of-life goals, resourcing by identifying needs and negotiating access to meeting those needs, and engaging clients in what is most meaningful to them. Navigators are selected, trained, and mentored volunteers or professionals. NavCare-EU is based on the existing and successfully tested Nav-CARE(c) intervention from Canada.
Sponsors
University of Dublin, Trinity College
Uniwersytet Jagiellonski
Amsterdam UMC, location VUmc
University of Coimbra
University Ghent
University of British Columbia
Lega Italiana per la Lotta contro i Tumori
Vrije Universiteit Brussel
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
For older person with cancer Inclusion criteria * Have a cancer diagnosis (active cancer, meaning not being cancer free, of any stage and involving any treatment/care regimen; i.e. curative, life-extending, or palliative), AND * Aged 70 years or over, AND * Have declining or deteriorating health using the Clinical Frailty Scale, AND * Live at home (own home or home of the family caregiver) (or discharged home if recruited in hospital), AND * Live within the catchment area of the navigation programme/service
Exclusion criteria
* The close family caregiver living with the person with cancer or providing care at least on a weekly basis, and identified as the primary family caregiver by the person with cancer, if present, does not agree to participate in the study (unless participation is explicitly requested by the patient) , OR * Lives in a care or nursing home, or is incarcerated, OR * Currently receives care from a formally recognized community-based multidisciplinary or specialist palliative care team, OR * Is unable to provide informed consent or has difficulties understanding the information about the study , OR * Has a psychiatric condition (i.e. schizophrenia, bipolar disorder, or major depressive disorder) OR has an active substance abuse disorder OR * Is not able to participate in data collection in the country's language For close family caregiver (if present) Inclusion criteria * Aged 18 years or over , AND * Lives with the person with cancer OR provides care at least on a weekly basis, AND * Identified as primary family caregiver by the older person with cancer
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Global health status/quality of life of the older person with cancer | Change from baseline at 24 weeks. | Global health status/quality of life of the older person with cancer, measured with 2-item subscale from the EORTC-QLQ-C30 (revised) measuring health-related quality of life. |
| Levels of social support of the older person with cancer | Change from baseline at 24 weeks. | Levels of social support of the older person with cancer measured with the Medical Outcomes Study Social Support Survey (MOS) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Feelings of loneliness of the older person with cancer | Change from baseline at 24 weeks. | Feelings of loneliness (relational and social connectedness, and self-perceived isolation) of the older person with cancer, measured with the 3-item-UCLA Revised Loneliness Scale. |
| Caregiver burden of close family caregivers | Change from baseline at 24 weeks. | Caregiver burden of close family caregivers, measured with the Zarit Burden Interview Short Form |
Other
| Measure | Time frame | Description |
|---|---|---|
| Symptoms or problems experienced | Change from baseline at 24 weeks. | Symptoms or problems experienced (i.e. as measured by the EORTC-QLQ-C30 symptom subscales and the emotional functioning scale for cancer patients |
| well-being of older people | Change from baseline at 24 weeks. | well-being of older people (WOOP) (which captures a comprehensive set of well-being domains relevant to older people (broader than health) |
| Knowledge of resources and services and confidence in decision making and communicating those decisions | Change from baseline at 24 weeks. | Knowledge of resources and services and confidence in decision making and communicating those decisions (measured with the Nav-CARE engagement questionnaire). |
| Global health status/quality of life of the older person with cancer | Change from baseline at 48 weeks. | Global health status/quality of life of the older person with cancer, measured with 2-item subscale from the EORTC-QLQ-C30 (revised) measuring health-related quality of life. |
| Health and social care services and resource use | Change from baseline at 24 weeks. | Health and social care services and resource use (for economic evaluation) |
| positive aspects of caregiving of close family caregivers (measured with PAC scale) | Change from baseline at 24 weeks. | positive aspects of caregiving of close family caregivers (measured with PAC scale) |
| Health status | Change from baseline at 24 weeks. | Health status EQ-5D (has traditionally been used as outcome measure in economic evaluations) |
| Levels of social support of the older person with cancer | Change from baseline at 48 weeks. | Levels of social support of the older person with cancer measured with the Medical Outcomes Study Social Support Survey (MOS) |
| Feelings of loneliness of the older person with cancer | Change from baseline at 48 weeks. | Feelings of loneliness (relational and social connectedness, and self-perceived isolation) of the older person with cancer, measured with the 3-item-UCLA Revised Loneliness Scale. |
| Caregiver burden of close family caregivers | Change from baseline at 48 weeks. | Caregiver burden of close family caregivers, measured with the Zarit Burden Interview Short Form |
Contacts
Primary ContactLieve Van den Block, PhD
Backup ContactTinne Smets, PhD
Outcome results
None listed