Cancer Childhood
Conditions
Keywords
Childhood Cancer, Transition of care, Health-related social needs, Patient Navigation
Brief summary
The goal of this clinical trial is to improve the successful healthcare transition from pediatric to adult-focused care for childhood cancer survivors. The main questions it aims to answer are * Receipt of the intervention (vs. standard of care control) will increase the proportion of CCS achieving transition success to adult-focused survivorship care from 50% to 70%. * Receipt of the intervention (vs. standard of care control) will significantly reduce patients' unmet HRSN. * Intervention effectiveness will be moderated by sociodemographic factors (gender, race/ethnicity, insurance status), medical risk for late effects, HRSN burden, and patient-reported outcomes (quality of life, self-efficacy). Researchers will compare those that receive intervention versus standard of care. Patients are randomized to either an intervention group, receiving structured PN-led sessions and tailored support for care transitions, or a control group receiving standard follow-up by a nurse case manager. High-HRSN patients in the intervention arm get monthly check-ins and coordinated handoffs to adult care providers for continuity.
Interventions
BEHAVIORALNavigation
Follow Up
BEHAVIORALControl
Standard of Care
Sponsors
Children's Hospital Los Angeles
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 29 Years
Healthy volunteers
No
Inclusion criteria
* diagnosed between the ages of 0-19 years with cancer or with any condition treated with cancer-like therapy. * currently in follow up at survivorship clinic or had a survivorship launch visit during the 12 months prior to study activation. * current age 20-29 (\>95% of patients will be age 20-21) * meet LIFE Clinic transition readiness criteria, as clinically applied: * at least 5 years off treatment * medically stable * demonstrate a workable understanding of transition * have an identified primary care provider * able to speak and read English or Spanish * can provide informed consent.
Exclusion criteria
* do not meet transition criteria * speak a language other than English or Spanish * are significantly impaired and cannot provide informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of participants with Transition to Adult-Focused Survivorship Care | Within 18 months following transition "launch" (study enrollment/baseline) | The proportion of participants who complete a qualifying adult-focused survivorship care visit, defined as: For higher-risk survivors: a visit to the designated adult survivorship clinic For lower-risk survivors: a visit to a primary care provider that includes discussion of cancer history and/or late effects Transition success is: Self-reported by participants and Validated by study staff through contact with the receiving provider Participants without a cancer-focused component to the visit (e.g., urgent care, vaccination-only visits) will not be considered successful transitions. The outcome will be analyzed as a binary proportion (success vs. no success). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in HRSN score from baseline to each follow-up time point in each study arm. | Baseline to 18 months post-enrollment | Change in the number of unmet health-related social needs assessed using the CMS Accountable Health Communities (AHC) HRSN Screening Tool, including domains such as: Housing instability, Food insecurity, Transportation barriers, Utility assistance needs, and Employment, education, mental health, and disability (supplemental items) Count 6 (all social needs endorsed) to 0 (no social needs endorsed) |
| Change in Global Health-Related Quality of Life Score using Likert scale | Baseline to 18 months post-enrollment | Change in patient-reported quality of life measured using the PROMIS Global Health Scale (10-item instrument), generating: Physical health summary score Mental health summary score 0 (poor self reported health) -10 (best self reported health) |
| Change in General Self-Efficacy using Likert scale | Baseline to 18 months post-enrollment | Change in perceived self-efficacy measured using the PROMIS General Self-Efficacy 10-item scale. Scores reflect participants' confidence in managing health and behavior and are reported as standardized scores. 1 ( Lowest Confidence ) - 5 ( Highest Confidence ) |
| Change in mean scores for Patient-Reported Access to and Experience with Healthcare as measures by CAHPS (Consumer Assessment of Healthcare Providers and Systems) | Baseline to 18 months post-enrollment | Patient-reported measures derived from CAHPS (Consumer Assessment of Healthcare Providers and Systems) assessing: Global rating of healthcare Access barriers Insurance-related difficulties Outcomes reported as mean scores Count 0 (Worst Possible Assessment) to 10 (Best Possible Assessment) |
| Change in count for barriers to care as measured by Likert scale barriers to care questionnaire | Baseline to 18 months post-enrollment | 39-item questionnaire that includes subscales of pragmatics, health knowledge and beliefs, expectations about care, skills, and marginalization. Likert scale with 0-100 range, where 0 indicates the most barriers and 100 indicates no barriers. |
| Change in Informational Support score using a Likert scale. | Baseline to 18 months post-enrollment | Patient-reported social support measured using PROMIS short forms: Informational support (4 items each) Likert scale with 0-5 range, where 0 indicates the lowest social support and 5 indicates highest social support. |
| Change in Emotional Social Support score using a Likert scale. | Baseline to 18 months post-enrollment | Patient-reported social support measured using PROMIS short forms: Emotional support (4 items each) Likert scale with 0-5 range, where 0 indicates the lowest social support and 5 indicates highest social support. |
Countries
United States
Contacts
CONTACTDavid Freyer, DO, MS
PRINCIPAL_INVESTIGATORDavid Freyer, DO, MS
Children's Hospital Los Angeles
PRINCIPAL_INVESTIGATORKimberly Miller, PhD
Children's Hospital Los Angeles
Outcome results
None listed