Breast Neoplasms Clinical Trial
Official title:
A Randomized Controlled Trial of Smart Management Strategy for Health (SMASH) Program for Overcoming Cancer Crisis and Growing Positively in Cancer Survivors
The purpose of this study is to evaluate the efficacy of the "Smart Management Strategy for Health (SMASH)" program, which is designed to help cancer patients overcome their cancer crisis proactively and grow positively.
<Hypothesis> This study hypothesizes that the intervention being provided (SMASH program)
will demonstrate improvements in cancer survivors' health management in the fields of (i)
physical activity, body mass index, and positive growth, (ii) self-management strategies of
health (SMASH Assessment Tool; SAT), (iii) overall physical, mental, social, spiritual health
conditions and Quality of Life (QoL), and (iv) the execution and maintenance of health habits
("10 Rules for Highly Effective Health Behavior").
<Patient registry> Cancer survivors, who have just completed their cancer treatments
(surgery, radiation, chemotherapy), will be recruited from five medical centers in Korea and
randomly allocated to one of following three groups: 2 experiment groups and 1 attention
control group. This recruitment process would start after the approval of protocol by the
Institutional Review Board (IRB), and proceed through following steps: (i) the physician in
charge confirms that the patient has finished his or her treatment and determines whether the
patient is eligible to participate in the study by checking the recent (less than one year)
results of the patient's basic medical exams (blood pressure, body temperature, heart rate,
respiratory rate, weight, and height) and basic lab tests (blood chemistry,
electrocardiogram, chest PA, complete blood count, liver function test, BUN/Cr), (ii) A nurse
explains the purpose and method of the study to the patient, and asks to complete informed
consent form, (iii) the patient who agrees for participation will complete a brief screening
questionnaire (Godin's Leisure Time Exercise, weight/height, and PostTraumatic Growth
Inventory(PTGI)), (iv) the patient meeting the criteria as determined by the screening
questionnaire is asked to complete the baseline assessment questionnaire at home, (v) cases
who finish the baseline assessment questionnaire and meet all criteria are considered study
participants and are randomly assigned to one of the three study arms.
<Quality control (patient data)> This study assumes that patients who are directly referred
to the study by collaborating physicians are valid cancer cases. Data collected from study
participants on screening forms will be reviewed by researchers at the central institution
for missing responses and inconsistencies.
<Sample size>
The sample size of 477 participants was based upon the following assumptions:
- a two-sided Type I error of 0.05
- drop-out rate of 10%
- an attainment of goal behavior of 5% in the active comparator arm and 20% in the
experiment arm, and a power of 90% to detect a between-arm difference
<Statistical analysis plan > The primary endpoint was based on three-outcome composite
achievement of PA, weight and PTGI score at 12 months. All analyses will be conducted on the
basis of intention-to-treat. Arm differences at 3, 6, and 12 months in behavior change
(physical activity, body mass index, posttraumatic growth) will be tested with logistic
regression, controlling for the respective baseline values. Arm differences in levels of Mini
Dietary Assessment Index (MDI), execution of health habits, SMASH Assessment Tool (SAT),
Quality of Life (QoL), health condition, incurred medical expenses, incurred Complementary
and Alternative Medicine (CAM) expenses will be explored using a mixed model that estimates
the effect of SMASH program over time, which will correlate repeated observations on
particular participants after adjustment for baseline scores.
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