Prostate Cancer Clinical Trial
Official title:
Effectiveness of Community-based Football Compared With Usual Care on Quality of Life in Men With Prostate Cancer: the FC Prostate Community Randomized Controlled Trial
Prostate cancer is the most common malignancy in men. Three million are currently living in
the United States with the disease and this number is expected to rise to four million in
2024. Most live many years with the disease and experience significant morbidity both due to
disease progression and treatment toxicity. Exercise has shown to improve QoL and reduce
treatment toxicity. Moreover epidemiological evidence has suggested that physical activity
improves survival.
Football has been shown to induce positive effects on body composition and bone markers in a
subgroup of prostate cancer patients, those receiving androgen deprivation therapy.
The objective is to examine the effectiveness of football in prostate cancer survivors.
PLAN FOR THE STATISTICAL ANALYSES
This plan has been prepared and is laid forward before any follow-ups are conducted. The plan
delineates the analyses of the FC PC trial; any deviations will be laid forward and discussed
in the final publication.
The primary statistical analysis targets the effect on prostate cancer (PCa) specific Quality
of Life (QoL) of a treatment policy offering community based football to men with prostate
cancer. In particular, patients will be analysed in the treatment group to which they were
randomly allocated respecting the intention-to-treat principle (ITT). The appropriate method
for addressing this effect depends on the assumptions made about missing data (drop-outs).
Our main analysis is valid under the missing at random assumption but we will also present
sensitivity analyses robust to non-ignorable patterns among patients with incomplete data.
Per protocol analyses will be performed to estimate the de jure effect of the treatment for
compliant patients. The "per protocol" population will be defined as those trial participants
from the intervention group that have attended the football intervention at least 12 times in
the first 12 weeks and 24 times in 6 months intervention period.
Significance tests will be two-sided with a maximal type I error risk of 5 %. To address the
problem of multiple comparisons for secondary analyses when several outcomes are tested or
multiple constracts are extracted from the same statistical model p-values will be adjusted
using the step-down Bonferrroni method of Holm (Holm 1979) or appropriate modern
alternatives.
Trial profile A CONSORT diagram will show trial participant flow. Number of screened patients
fulfilling inclusion criteria and trial subjects included in analyses together with reasons
for exclusion of trial subjects will be reported.
Primary outcome The continuous outcome score of FACT-P will be calculated using the official
scoring guideline. As described in the scoring guideline missing items will be prorated by
multiplying the sum of the subscale with the number of the items in the subscale, then
divided by the number of items answered. This will only be done if more than 50% of the items
are answered in the subscales and 80% are answered in the total questionnaire. The change
score of the total FACT-P at 12 weeks will be calculated by subtracting the total 12 week
score from the respective trial participant's baseline score. Analysis of covariance will be
used (Vickers and Altman 2001), group and ADT-status will be set as factors, the response
will be change in FACT-P and covariates are age and baseline score. The results will be
presented as least squares means (LSMEANS) differences between the two groups with 95 %
confidence intervals and p-values.
Secondary outcomes including safety outcomes Changes from baseline to 6 month for LBM, BMC,
BMD, and total body fat mass will be analysed in the same manner as the primary outcome.
QoL, Functional Well-Being and Physical Activity (based on MET values derived from the IPAQ
questionnaire) measured at baseline, 12 weeks and 6 months will be analysed using a mixed
model for repeated measurements. Changes from baseline to 12 weeks or 6 months will be
treated as the response, the model will include fixed effects of factors: group, ADT,
sampling time and their interactions, and the analysis will be adjusted for age and baseline
value. The correlation between measurements on the same patient will be modeled using a
random effect of patient.
Safety outcomes will be listed for each group and the number of fractures and falls that
resulted in seeking medical assessment will be compared across groups using Fisher's exact
test.
Subgroup analyses are planned to be reported for the patients treated with androgen
deprivation therapy therefore results will be given both for the overall treatment effect and
for subgroup obtained by stratifying level of according to androgen deprivation therapy. To
verify the credibility of our subgroup analyses, we apply the criteria proposed by Sun and
colleagues (Sun et al. 2012), i.e. the subgroup variable is a baseline characteristic, is a
stratification factor, is specified a priori and includes only a small number of analyses.
Outline of figures and tables The first figure in the main publication will be a CONSORT flow
diagram. The second figure will illustrate changes in the primary and secondary outcomes,
except safety outcomes, at 12 weeks and 6 months, according to treatment group.
A third figure will display mean curves for the primary outcome for patients in different
groups according to pattern of missing data. In particular, mean curves will be shown
separately for completers and patients with missing data at one or more assessment times. The
figure will be used to guide the type of sensitivity analyses performed to adjust results for
a potentially deviating pattern for patients with incomplete observations.
Tables will be in following order; first a table delineating trial subjects characteristics,
secondly a table showing changes in primary and secondary outcomes both at 12 weeks and 6
months. Thirdly safety outcomes will presented according to group and type.
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