MyHealth: Follow-up After Breast Cancer Treatment

Breast Cancer Clinical Trial

— MyHealth  

Official title:

MyHealth: Nurse-led Compared to Physician-led Breast Cancer Follow-up: A Randomized Controlled Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT02949167
• Other study ID #: Record.12714019
• Status: Active, not recruiting
• Phase: N/A
• Start date: November 2016
• Est. completion date: April 30, 2024

Study information

• Verified date: August 2021
• Source: Danish Cancer Society
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Approximately 24,000 women attend a follow-up care program after end of primary treatment for breast cancer (BC) in Denmark. There is no well-conducted, larger randomized controlled trials (RCT) outlining a gold standard for follow-up programs ensuring early detection of recurrence, good management of symptoms and cost-effectiveness. The primary aim of this randomised, controlled trial is to test whether a nurse-led individually tailored symptom management program (MyHealth) will significantly reduce reported symptoms among BC patients following primary treatment compared to physician-led scheduled follow-up. Secondary, the investigators will examine patient activation (self-management), anxiety, depression, fear of recurrence, work ability, time to recurrence, overall survival, health behavior changes, health care utilization and financial costs in the two arms.

The MyHealth program provides patients with a nurse-led education focusing on management of symptoms, an electronic platform to report symptoms to the nurses and support in symptom management and navigation of patients to appropriate health care services.

Description:

During an 18-month period, 494 primary BC patients will be recruited from the Departments of Oncology at Naestved and Roskilde Hospital. The women will be enrolled in the study following completion of primary treatment. Participants are randomized 1:1 to the intervention (Nurse-led follow up) or control group (physician-led follow-up) and followed for 5 years. No matter group assignment, all women will follow the national mammography screening programs.

Patients who accept to participate are asked to invite a close relative, preferably partners, to participate in the study. Patients, who do not want to participate in the randomization will be asked if they are willing to participate in the study by filling out two questionnaires. Patients who decline to participate in the MyHealth study will be enrolled in the standard follow-up.

The investigators will collect data using questionnaires, clinical databases, and national registers before intervention and for 5 years after inclusion both in the control and intervention arm. Questionnaires from validated scales are used to measure primary and secondary outcomes in both groups whereas Patient Reported Outcomes (PRO) are only collected in the intervention group. Patients who experiences relapse during the MyHealth intervention will not be asked to fill in the remaining outcome questionnaires or PROs since they quit the follow-up program in favor of treatment for recurrent disease.

During follow-up, the patient will consult the nurse or the project physician if PROs reveal a need, or if the patient require a consultation. In order to ensure that treatment of symptoms and referral to other health professionals will meet clinical guidelines the nurses are instructed to follow a detailed response algorithm, which is developed by the project physician in collaboration with experienced oncologists.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 503
• Est. completion date: April 30, 2024
• Est. primary completion date: April 30, 2024
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 40 Years and older

Eligibility

Inclusion Criteria:

• Complete remission following primary treatment for loco-regional BC (stage I-II) - No confirmed genetic predisposition to BC

• Female gender

• Performance status =3

• Read, understand and speak Danish

• No severe cognitive problems

• No severe psychiatric disease requiring treatment or any substance abuse.

Exclusion Criteria:

• Genetic predisposition for BC

• Patient younger than 40 years of age at diagnosis

• Control after recurrent breast cancer

• Other active cancer except non-melanoma skin cancer

• Severe cognitive problems or dementia

• Severe psychiatric disease requiring treatment, e.g. schizophrenia, alcohol or narcotic dependence

Related Conditions & MeSH terms

• Breast Cancer
• Breast Neoplasms

Intervention

Behavioral:
• MyHealth
The MyHealth intervention is a nurse-led individually tailored symptom management program, focused on patient education and regularly collection of Patient Reported Outcomes (PRO) subsequently evaluated by specialist nurses and navigation to health care service. The nurse will meet with the patient on three-five planned appointments focused on adjustment of life after breast cancer treatment including information on symptoms of relapse or late effects and how to react on these. Close relatives are invited if patients accept. Patients will report PRO´s on symptoms of recurrence and late effects every three months during the first year and thereafter every six months.The appointments with the nurse are finalized within 3-6 month and patients will be followed with PRO for three years.

Locations

Country	Name	City	State
Denmark	Department of Oncology and Palliative Care, Naestved Hospital	Naestved	Region Zealand

Sponsors (2)

Lead Sponsor	Collaborator
Danish Cancer Society	Region Sjælland

Country where clinical trial is conducted

Denmark, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Health Care Use	Study specific items on health care use single items	at 60 months
Primary	Changes in breast cancer specific symptom burden (TOI-PFB)	Trial Outcome Index-Physical/Functional/Breast (TOI-PFB) score of the Functional Assessment of Cancer Therapy -Breast (FACT-B) Domains: Physical well-being, Functional wellbeing,BC symptoms	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in breast cancer specific symptom burden	Functional Assessment of Cancer Therapy -Breast (FACT-B) Domains: Physical well-being, social/family well-being, Emotional well-being,Functional wellbeing, BC symptoms	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in knowledge, skill, and confidence for self-management	Patient Activation Measure (PAM)	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in anxiety	Generalized Anxiety Disorder (GAD-7)	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in self-management	The Health Education Impact Questionnaire (heiQ)	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in fear of recurrence	Concerns About Recurrence Questionnaire (CARQ-4)	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in Depression	The Patient Health Questionnaire (PHQ-9)	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in work ability	Work Ability Index (WAI)	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months
Secondary	Changes in quality-adjusted life year (QALY)	EuroQol 5 domains (5D), 5 levels (5L)	at inclusion, 6 months,12 months, 24 months, 36 months and 60 months