Allogenic Bone Marrow Transplantation
Conditions
Keywords
allogenic bone marrow, rehabilitation, cancer
Brief summary
The goals of this phase III clinical trial is to determine effectiveness in the setting where it will be implemented as well as to gain an understanding of the context for implementation. Effectiveness of CaRE-4-alloBMT will be assessed using a parallel two-arm pragmatic randomized controlled trial (pRCT). Pragmatic trials are undertaken in "real world" settings and place a greater emphasis on external validity and generalizability to support the decision on whether to deliver an intervention. Participants will: * Complete a questionnaire package and an initial assessment with a registered Kinesilogist * Randomized into either the CaRE-4-alloBMT (Intervention group) or the Usual Care group. * Complete the patient reported outcome measures and physiological assessments at baseline (T0), hospital admission (T1), hospital discharge (T2), 3-months post-discharge (T3), and 6 months post-discharge (T4). Usual Care (UC). The UC group will receive standard cancer care provided to all patients undergoing alloBMT at Princeess Margaret, including the provision of self-directed online resources and a booklet-based physiotherapy program outlining the role of exercise and examples of exercises that can be done at the hospital and at home during recovery. At admission, patients undergo a nutrition assessment by the alloBMT dietician and are provided a caloric intake goal. They are asked to track their food intake through a food journal that is monitored by the alloBMT dietitian. When needed, as determined by the alloBMT team, patients are given access to supportive care services including psychosocial oncology and in-patient and outpatient rehabilitation. CaRE-4-alloBMT (Intervention, INT): Patients randomized to the intervention arm will receive usual care plus the CaRE-4-alloBMT intervention. The CaRE-4-alloBMT program is delivered from 4-8 weeks pre-transplant through to 6 months post-transplant (estimated at 8-9 months total). It uses a person-centered strategy and a multidimensional approach targeting physical activity and promoting self-management skills to enhance nutrition, psychosocial functioning and to help manage common side effects.
Interventions
BEHAVIORALCaRE-4-alloBMT
The program is informed by established behaviour change theory, including motivational interviewing (MI), theory of planned behaviour, self-efficacy, and the model of supportive accountability, and has a number of embedded behaviour change techniques, which are known to increase effectiveness. The program also harnesses current and emerging eHealth technologies to overcome barriers to accessing and providing cancer rehabilitation. Key components of the intervention are: 1) Individualized progressive exercise prescriptions; 2) Remote monitoring of heart rate, sleep and weight with Fitbit devices; 3) Self-management skills teaching (online modules on topics such as exercise, eat and cook for wellness, mindfulness, fatigue, brain health, etc); 4) Person-to-person clinical support (remote check-in calls with a kinesiologist)
Sponsors
Jennifer Jones
Canadian Institutes of Health Research (CIHR)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• scheduled to undergo alloBMT and are: * \> 18 years of age; * receiving treatment for a hematologic cancer; * completing pre- and post-transplant care at PM; * able to access on-line study material; and * able to understand (spoken and written) English. Participants receiving a second transplant at the time of screening will be included if they meet the above criteria.
Exclusion criteria
* scheduled to be admitted to the hospital for their alloBMT \< 2 weeks from the initial assessment booking, as this will not allow enough time for the prehabilitation phase of the study; * are participating in any other clinical trials or supportive care intervention studies; or * have comorbidities or musculoskeletal complications that preclude participation in the exercise programs.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 36-Item Short Form Health Survey questionnaire (SF-36) | 3 months post-discharge | The SF-36 is a measure of health status and consists of 36 questions that cover eight health domains and two summary scales: the physical component summary (PSC) and the mental component (MSC). For this project the PCS was chosen as the primary outcome. The minimum score value is a zero and represents the lowest level of health, maximum disability or severe pain. The maximum score is 100 and represents the highest value of health, no disability or no pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Initial hospital stay Transplant outcomes | Year 4 | Initial length of stay will be measured in days and will extracted from patient charts at the end of the study. |
| Number of readmission Transplant outcomes | Year 4 | The number of readmissions per patient who underwent alloBMT and participating in the study will extracted from patient charts at the end of the study. |
| Number of days in hospital Transplant outcomes | Year 4 | The total number of days spent in the hospital by patients who underwent alloBMT and participating in the study will extracted from patient charts at the end of the study. |
| Overall survival Transplant outcomes | At year 4 | Overall survival (transplant-related mortality vs survival rates) patients who underwent alloBMT and participating in the study will extracted from patient charts at the end of the study. |
| EQ 5D 5L | 9 months | The instrument is a standardized descriptive system comprising five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each evaluated through a single item and measures quality of life. The maximum score of 1 represents having no problems in any of the 5 dimensions and best health while a minimum score of a negative value indicates worse health. |
| Modified Patient-Generated Subjective Global Assessment | 9 months | The instrument is a one-page tool that classifies patients into four nutritional levels, which are predictive of overall survival in cancer patients and measures nutritional status. |
| Hospital Anxiety and Depression Scale (HADS) | 9 months | This instrument includes 2 subscales designed to identify and quantify depression and anxiety in physically ill patients. The minimum score of zero and a maximum score of 21 where a higher score indicates higher distress. |
| 12-item World Health Organization's Disability Assessment Schedule 2.0 (WHODAS 2.0) | 9 months | The instrument measures disability in accordance with the International Classification of Functioning, Disability, and Health. Participants rate their ability to perform 12 activities across six domains of functioning. A minimum score of zero indicates no disability and a maximum score of 48 indicates full disability. |
| Demographic and clinical information | A one-time questionnaire to be completed at baseline/prior to initial assessment. | Demographic and clinical details will be collected from participants at the time of initial assessment via an intake questionnaire, including age, sex, gender, ethnicity, education level, socioeconomic status, and comorbidities. |
Countries
Canada
Contacts
CONTACTJennifer M Jones, PhD
CONTACTCharmaine A Silva, MSc
PRINCIPAL_INVESTIGATORJennifer M Jones, PhD
UHN Princess Margaret Cancer Centre
Outcome results
None listed