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Completed

NCT Number: NCT04372459

Online Psychosocial Cancer Screening, Monitoring and Stepped Treatment in Cancer Survivors

This multicenter randomized controlled study will appraise the effectiveness and cost-utility of an e-health ecosystem with integrated and stepped psychosocial services that will be compared with the usual psychosocial care. The study is developed in the acute survival phase among breast cancer survivors. The outcomes of both interventions will be compared in terms of the amount of waiting time to receive psychosocial care and changes in several psychosocial variables. Finally, a comparative economic analysis will be conducted in other relevant psychosocial and health parameters. The e-health platform is expected to outperform usual care in the aforementioned indicators, while reaching high acceptability and usability by survivors, and additionally reducing costs for health providers.

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Key information

Conditions

Breast Cancer Breast Diseases Breast Neoplasms Emotional Disorder Neoplasms Neoplasms by Site Psychological Distress Skin Diseases Skin and Connective Tissue Diseases

Age range

18 year–85 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Institut Català d'Oncologia L'Hospitalet

L'Hospitalet de Llobregat, Barcelona, 08908, Spain

About this study

Cancer diagnosis and treatment causes a huge psychosocial impact on breast cancer survivors. Psychosocial treatments in cancer survivors have already demonstrated their effectiveness in reducing emotional distress and improving quality of life although the access to them still presents important barriers, such as poor early detection, long waiting times for diagnosis or treatment, as well as other restrictions related to work, mobility or economic situation. In addition, the current digitization of screening, monitoring and psychosocial treatment poses a revolution in the improvement of the quality of care and the reduction of its economic burden. The objectives of this study are, first, to assess the clinical efficacy of an e-health platform that includes integrated and stepped psychosocial services, in comparison to usual psychosocial care, and second, to examine its cost-utility.

The study methodology is that of a multicentre randomised controlled trial with 2 parallel groups (experimental versus control group). Approximately 193 patients diagnosed with breast cancer in the acute survival phase will be recruited from 3 University hospitals in Catalonia (Spain) and will be randomised to one of two treatment conditions. All participants will be evaluated at the beginning of the study (T1: recruitment), 3 months from T1 (T2), 6 months from T1 (T3) and 12 months from T1 (T4). Primary outcome measures will include detection of clinical cases, amount of waiting time from detection to psychosocial intervention, and proportion of cases solved in the different steps of the intervention, as well as outcomes related to emotional distress, quality of life, post-traumatic stress and growth and therapeutic alliance. Secondary outcomes will include the acceptability of the platform by patients through satisfaction questionnaires and the usability of the platform. For the cost-utility analysis, the investigators will assess quality-adjusted life years (QALYs) and costs related to the number of days of sick leaves, healthcare utilization, adherence to pharmacological treatment, health professionals' costs, infrastructure and transport costs.

The study will provide an important advance in the treatment of breast cancer; in the long term, it is expected to improve the quality of patient care and the treatment efficacy and to reduce waiting lists as well as direct and indirect costs associated with the treatment of the disease in Spain.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients aged between 18 and 70 years with BC, within 6 weeks after diagnosis.
  • Having online access and a user-level knowledge of Internet.
  • Understanding of Spanish language.

Exclusion criteria

  • Major depressive episode.
  • Significant autolytic ideation.
  • Showing symptoms of psychosis or substance abuse.
  • Intellectual disability.
  • Having a mobile phone with an old release of Android operating system, which is not compatible with the platform.

Treatment and study plan

Online integrated and stepped psychosocial care

Behavioral

This program features four levels of care, increasing in intensity of psychosocial care as patients move from one level to the next one.

Step 1: Screening and monitoring of several psychosocial variables through the central mobile application of the program (App ICOnnecta't).

Step 2: Online guided and self-help psychoeducation Campus in which patients can consult videos and online resources, co-constructed between health professionals and patients, containing reliable and rigorous information related to the oncological process.

Step 3: Online community of psychosocial support. Participants can choose from 12 cancer-related discussion forums and share with the community any health-related question that worries them fostering, thus, debate and stimulating peer-support.

Step 4: Intensive online group psychotherapy (App ICOnnecta't Videoconsultation), based on the Group Positive Psychotherapy program for cancer survivors (Ochoa, Sumalla, Maté, Castejón, Rodríguez et al., 2010).

Usual psychosocial care

Behavioral

This active control group will receive the standard psychosocial treatment for cancer survivors in the participating centers, led by a clinical psychologist and consisting of 8 individual, 45/60-minute sessions, each of which every 1-2 months, focused on providing emotional support and psychoeducation during the first year of primary cancer treatment.

Primary outcomes

  1. Change in Emotional Distress (HADS)

    Time frame: Time 1: Baseline; Time 2: Change between Time 1 and 3 months post-intervention; Time 3: Change between Time 1 and 6 months post-intervention; Time 4: Change between Time 1 and 12 months post-intervention

    Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983; Spanish validation by Costa-Requena, Pérez Martín, Salamero Baró, & Gil Moncayo, 2009). It consists of 14 items, 7 for anxiety and 7 for depression, on a four-point Likert scale (range 0-3), with the total score ranging from 0 to 42. Higher scores indicate a greater level of distress.

  2. Change in Post-traumatic Stress (PCL-5)

    Time frame: Time 1: Baseline; Time 2: Change between Time 1 and 3 months post-intervention; Time 3: Change between Time 1 and 6 months post-intervention; Time 4: Change between Time 1 and 12 months post-intervention

    Post-traumatic Stress Disorder Checklist-Civilian version (PCL-5) (Blevins, Weathers, Davis, Witte, & Domino, 2015). The official Spanish translation of the instrument was provided by the National Center for Post-Traumatic Stress Disorder (www.ptsd.va.gov/). The PCL-5 is a 20-item questionnaire, corresponding to the "Diagnostic and Statistical Manual for Mental Disorders Version 5" symptom criteria for PTSD. The self-report rating scale is 0-4 for each symptom, reflecting a change from 1-5 in the DSM-IV version. Rating scale descriptors are the same: "Not at all," "A little bit," Moderately," "Quite a bit," and "Extremely." A total symptom severity score (range - 0-80) can be obtained by summing the scores for each of the 20 items, with higher scores indicating worse outcomes.

  3. Change in Post-traumatic Growth (PTGI)

    Time frame: Time 1: Baseline; Time 2: Change between Time 1 and 3 months post-intervention; Time 3: Change between Time 1 and 6 months post-intervention; Time 4: Change between Time 1 and 12 months post-intervention

    Post-traumatic Growth Inventory (PTGI) (Tedeschi & Calhoun, 1996; Spanish validation by Costa-Requena and Gil, 2007). It is a 21-item instrument based on a 6-point Likert scale (0=no change - 5=very high degree of change), which assesses positive changes experienced after a trauma. Total scores range from 0 to 105 with higher scores indicating better outcomes.

  4. Change in Therapeutic alliance (WAI-P)

    Time frame: Time 2: Change between Time 1 and 3 months post-intervention; Time 3: Change between Time 1 and 6 months post-intervention; Time 4: Change between Time 1 and 12 months post-intervention

    Working Alliance Inventory-Patient Version (WAI-P; Horvath, 1981; Horvath & Greenberg, 1986, 1989; Spanish validation by Andrade-González & Fernández-Liria, 2015). It consists of 36 items with seven possible response options (1 = never, 2 = rarely, 3 = occasionally, 4 = sometimes, 5 = often, 6 = very often, 7 = always). The scoring range of the overall WAI-P is 36-252 points with higher scores indicating better outcomes.

  5. Change in Quality of Life (EQ-5D-3L)

    Time frame: Time 1: Baseline; Time 2: Change between Time 1 and 3 months post-intervention; Time 3: Change between Time 1 and 6 months post-intervention; Time 4: Change between Time 1 and 12 months post-intervention

    EuroQoL-EQ-5D-3L (EuroQol Group, 1990; Spanish validation by Abadia et al., 1999). It consists of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. Total scores range from 0-100 with higher scores indicating better outcomes.

Secondary outcomes

  1. Healthcare utilization

    Time frame: Time 4: 12 months post-intervention

    Total number of visits to each healthcare professional (oncologist, nursing staff, psychologist, psychiatrist, social worker, emergency department) (Electronic Health Record).

  2. Change in Medication use and adherence (ARMS)

    Time frame: Time 1: Baseline; Time 2: Change between Time 1 and 3 months post-intervention; Time 3: Change between Time 1 and 6 months post-intervention; Time 4: Change between Time 1 and 12 months post-intervention

    Adherence to Refills and Medications Scale (ARMS; Kripalani, Risser, Gatti, & Jacobson, 2009; Spanish validation by Gonzalez-Bueno et al., 2017). It consists of 12 questions: 8 aimed at assessing the patient's ability to properly administer the medication and 4 regarding its correct intake based on a four-point Likert scale (range from 1=never to 4=always; total score range 12-48), with lower scores indicating better adherence.

  3. Work absenteeism

    Time frame: Time 4: 12 months post-intervention

    Number of days of patients' sick leaves (Electronic Health Record).

  4. Professionals' salaries

    Time frame: Time 4: 12 months post-intervention

    Number of professionals involved in the online treatment or usual care as well as the number of professionals' working hours per week and costs (Electronic Health Record).

  5. Infrastructure costs

    Time frame: Time 4: 12 months post-intervention

    Costs per user and per month for the development and maintenance of the online platform (experimental group) and costs of hospital's infrastructure per face-to-face visits per user and month.

  6. Transport costs

    Time frame: Time 4: 12 months post-intervention

    Cost estimate per patient using a specific transport according to mobility data in Catalonia area.

Other outcomes

  1. Emotional wellbeing (experimental group only)

    Time frame: Administration every 7 days until the end of treatment (or study completion), an average of 1 year

    Emotional thermometer (ET) - Visual Analogue Scale (VAS) (0-10) of the ICOnnecta't application.

  2. Health education

    Time frame: Single administration per educational topic (7 thematic blocks, 16 topics, 40 questionnaires) until the end of treatment (or study completion), an average of 1 year

    Scores on health education questionnaires from Campus of ICOnnecta't. Higher scores indicate better health education acquisition.

  3. Usability (experimental group only) (SUS)

    Time frame: 21 days after registration

    System Usability Scale (SUS) (Brooke, 1996). The SUS is a 10-item questionnaire with five response options that range from 4 = "Strongly agree" to 0 = "Strongly disagree". The SUS provides a "quick and dirty" reliable tool for measuring the usability of a range of systems.The participant's scores for each question are converted to a new number, added together and then multiplied by 2.5 to convert the original scores of 0-40 to 0-100. Higher scores indicate better outcomes.

  4. Satisfaction (experimental group only)

    Time frame: 21 days after registration

    Visual Analogue Scale (VAS) (0-10).

Sponsors and collaborators

Lead sponsor

Institut Català d'Oncologia

Other

Registry information

Official study title

Online Psychosocial Cancer Screening, Monitoring and Stepped Treatment in Cancer Survivors: A Randomized Controlled Trial

Acronym: ICOnnectat-B

Important dates

Study start
2021
Primary completion
2023
Study completion
2023
First posted
May 4, 2020
Registry last updated
Mar 6, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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