Neoplasms

All Conditions

Skin and Connective Tissue Diseases

Symptoms and General Pathology

Nervous System Diseases

Carcinoma

Breast Neoplasms

Carcinoma in Situ

Pain, Postoperative

Pain

Carcinoma, Ductal

Carcinoma, Lobular

Carcinoma, Intraductal, Noninfiltrating

Postoperative Complications

Neurologic Manifestations

novel pain coping skills training intervention designed specifically for people with persistent pain (PP) following breast cancer surgery

skills training and experiential learning exercises

CST-PSP

general health education intervention that focuses on improving overall health

General health education

Rebecca Shelby, PhD

Dana Bovbjerg, PhD

The purpose of this study is to compare the benefits of skills training and health education interventions designed specifically to increase the well-being of people with persistent pain after breast surgery for lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), or invasive breast cancer, and to examine the roles of psychological and physiological variables as modifiable contributors to the continuing burden of persistent pain.

Persistent pain following breast surgery for lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), or invasive breast cancer is increasingly recognized as an important clinical and public health issue due to the large number of women affected, the powerful negative impact that persistent pain has on emotional and physical functioning and its financial costs. Most of the more than a quarter of a million women newly diagnosed with breast cancer in the U.S. this year will undergo surgery as a part of curative treatment. The prevalence of persistent pain following surgical removal of the affected breast (mastectomy) or more limited surgeries (lumpectomy) is high, ranging from 25-60% across studies. Unlike acute post-operative pain, which is a normal response to surgical trauma, persistent pain at or near the surgical site has an uncertain multifaceted etiology, and no satisfactory pharmacological treatment. A critical question is whether key pain-related psychosocial factors are drivers of the continuing burden of persistent pain, and whether they could be ameliorated by non-pharmacological intervention. The research planned under this award will provide a first critical test of the hypothesized driving role of pain catastrophizing in persistent pain after breast surgery. It also will explore the role of two other key psychosocial variables that may contribute to the burden associated with persistent pain after breast cancer surgery: self-efficacy for engaging in valued activities and psychological inflexibility. We have developed, manualized, and pilot tested a pain coping skills training intervention that specifically targets the needs of women with persistent pain following breast cancer surgery (CST-PSP) and aims to reduce pain catastrophizing, increase self-efficacy for engaging in valued activities, and increase psychological flexibility. We propose a multiple-site, randomized clinical trial to evaluate the efficacy of the CST-PSP intervention, as well as a health education intervention. The study will be conducted in diverse oncology clinics affiliated with Duke University/Duke Cancer Network and the University of Pittsburgh/UPMC Hillman Cancer Center. Participants (N=564) will be randomized to either receive: 1) CST-PSP, 2) health education with an interventionist, or 3) self-guided health education . Participants will complete assessments pre-intervention and at 3 months (post-intervention), 6 months follow-up, and 12 months follow-up. Study aims are: Aim 1: Examine the impact of intervention programs on persistent post-surgical pain severity and interference (i.e., PEG score), emotional distress (anxiety and depression), and cancer-specific distress. Aim 2: Investigate the impact of intervention programs on pain catastrophizing, pain self-efficacy, and psychological inflexibility, and evaluate these variables as possible mediators of the intervention benefits. Aim 3: Evaluate the impact of intervention programs on pain sensitivity and central sensitization, and explore whether changes in these variables mediate group differences in pain severity and interference.

Study staff conducting assessments will be blind to group assignment. To maintain blinding, we will use the following approaches: 1) all study staff will be trained on the importance of blinding and study procedures to maintain blinding; 2) participants will be provided with the rationale and instructions not to disclose their group assignment; 3) the study staff who conduct post-intervention assessments will not be given information about group assignment prior to the assessment; and 4) if a breach occurs, it will be documented and the participant will complete their assessment with a new assessor.

Well-Being After Breast Cancer Surgery

Improving Well-Being for Individuals With Persistent Pain After Surgery for Breast Cancer, Lobular Carcinoma in Situ, or Ductal Carcinoma in Situ: A Randomized Clinical Trial That Compares Three Behavioral Intervention Strategies and Examines Psychological Factors as Drivers of the Continuing Burden of Persistent Pain

6-item self-report of time spent utilizing healthcare in the past 4 weeks, as well as medication use and time spent on the intervention

5-item assessment of current health utility, plus 0 to 100 rating of overall health; QALYS will be derived from utility estimates

Persistent post-surgical pain burden 3-item measure: average pain intensity (P); interference with enjoyment in life (E); interference with general activity (G)

9-item assessment of depressive symptoms over the past two weeks

15-item measure of intrusive and avoidant cognition regarding breast cancer during the past week

13-item assessment of the degree to which participants experience catastrophic thinking during painful experiences

7-item questionnaire designed to measure psychological inflexibility

25-item questionnaire designed to measure hypersensitivity to senses and signs of central sensitization

Designed to measure central hyperexcitability using a digital pressure algometer measured pressure that is first perceived as painful and recorded in kg

Designed to measure central pain mediation using weighted pinprick probes

7-item assessment of symptoms of anxiety over the past two weeks

9-item questionnaire designed to measure chronic pain patients' perceived self-efficacy for engaging in activities

University of Pittsburgh Medical Center

Duke University

a self-management intervention for enhancing skills to improve adherence and reduce symptom interference (SM-AET) (active intervention group)

general health education Intervention (control group)

self-management for improving adherence and reducing symptom interference (SM-AET)

SM-AET

general health education intervention that focuses on improving overall health.

general health education

Adjuvant endocrine therapy (AET) is a crucial component of treatment used to prevent recurrence and reduce breast cancer-related mortality for breast cancer patients with hormone receptor positive disease. Studies report low rates of adherence to AET (38% to 86%) and in our preliminary work, 65% of breast cancer patients taking AET reported one or more non-adherent medication taking behaviors (e.g., skipped dose, forgot, adjusted dose) in the past month. Symptoms (e.g., arthralgia, vasomotor symptoms) associated with AET are strongly related to non-adherence and early discontinuation of treatment. Poor adherence to AET due to symptoms may compromise the effectiveness of AET. Prior to conducting a clinical trial, we will conduct user testing of the self-management intervention protocol with 20 women. In the proposed randomized clinical trial, 400 women who are taking AET for breast cancer will be randomly assigned to one of two conditions: 1) a self-management intervention for improving adherence and symptom management, or 2) a general health education control condition. The self-management intervention integrates three key theory-based strategies for improving adherence to AET: coping skills training for managing symptoms (e.g., arthralgia, vasomotor symptoms), behavioral strategies for improving medication adherence, and symptom and medication education. The intervention addresses the specific symptoms a woman is experiencing and is designed to meet the needs of women who are at high risk for non-adherence to AET (e.g., low socioeconomic status, low literacy). The self-management intervention is administered by a nurse via the telephone, and combines the use of phone calls and tailored interactive voice messaging based on information exchanged during phone sessions and real-time adherence data obtained from smart medication bottles. Women randomly assigned to the control condition will receive a general health education intervention that is delivered by a nurse via the telephone. This study will take place in the Duke Cancer Institute breast clinic and in community hospitals that are members of the Duke Cancer Network, which will allow access to women receiving care outside the medical center setting and increase generalizability of findings to a variety of settings. Adherence to AET will be assessed over the 18 month period following study enrollment using wireless smart medication bottles that provide real-time adherence data and pill counts completed by study staff during in-person study assessments. Patient-reported outcome measures assessing symptoms, perceived necessity of AET, concerns about AET, and self-efficacy will be obtained at baseline and 3, 6, 12, and 18 months. To increase the likelihood of later implementation of the self-management intervention, the cost effectiveness of the intervention will be evaluated.

Improving Well-Being for Breast Cancer Patients

Improving Well-Being for Breast Cancer Patients Taking Adjuvant Endocrine Therapy

The Treatment Crediblity Questionnaire is a 5-item measure of the degree to which participants perceive a treatment as credible and expect positive outcomes (e.g., how helpful does the therapist seem to you?; how confident are you that this treatment will help you manage your symptoms and health concerns?). The Satisfaction with Therapy and Therapist Scale is a 13-item measure that has been modified to obtain participants' satisfaction with the intervention and the nurse delivering the intervention sessions. Items assess satisfaction with and global improvement (i.e., how much did the intervention help with your symptoms and health concerns) after intervention.

The SM-AET protocol includes eight sessions and two maintenance calls administered by a nurse via the phone. The intervention also includes interactive voice messaging that is tailored based on participants' medication taking behavior. Adherence to AET will be assessed using smart pill bottles (i.e., bottle opening and percent of pills remaining).

A revised 16-item measure based on the Medication Adherence Rating Scale and our prior studies is used to assess self-reported adherence. Items were revised to refer specifically to participants' AET medication, assess medication-taking behaviors related to adherence (e.g., forgetting), and capture intentional and unintentional nonadherence over the past month.

The 32-item Menopause Specific Quality of Life Questionnaire (MENQOL) assesses the degree of symptom interference in the past week related to four domains: physical symptoms, vasomotor symptoms, psychosocial symptoms, and sexual symptoms.

The Brief Pain Inventory - Short form (BPI-SF) is used to assess pain interference in the past week across 9 areas (e.g., general activity, mood, sleep, enjoyment of life). Five items adapted from the Arthritis Impact Measurement Scale-II (AIMS-II; e.g., How would you describe the joint aching that you usually had?; How often did joint aching make it difficult to sleep?) and four items modified from the BPI-SF pain severity scale (e.g., Please rate stiffness in your joints by selecting the one number that best describes your stiffness at its worst in the past week) are used to measure aching and joint stiffness.

The 7-item Insomnia Severity Index (ISI) is a measure of participants' perceived severity of sleep difficulties and the interference of these difficulties with emotional distress, daily functioning, and quality of life in the last two weeks.

The 8-item Patient Reported Outcomes Information System Fatigue Scale (PROMIS Fatigue) assesses fatigue over the past seven days.

The eight-item Patient Reported Outcomes Information System Depression Scale (PROMIS Depression) assesses depressive symptoms. The eight-item Patient Reported Outcomes Information System Anxiety Scale (PROMIS Anxiety) is used to assess symptoms of anxiety.

The 6-minute walk test assesses women's abilities to exert effort in activity and the degree of pain experienced during activity. Women are asked to walk along an indoor hallway for 6-minutes with the goal being to walk as far as possible within the allotted time. Total distance in feet walked during the allotted time is recorded.

In the timed get up and go test participants are asked to stand up from a chair, walk 10 feet, turn, walk back to the chair, and sit down. Total time to complete the task is recorded in seconds.

Grip strength is assessed using a latex free JAMAR hydraulic hand dynamometer. The participant sits with her forearm in a neutral position, and wrist between 0° and 30° dorsiflexion and between 0° and 15° ulnar deviation. She then squeezes the handle of the dynamometer as hard as she can. Data is recorded in pounds. Three trials are conducted with each hand.

Eleven items assess barriers to taking medication over the past month. Specifically, women rate how often certain situations (e.g., forgetfulness, problematic side effects, being out of routine) make it difficult for them to take their medications every day.

Five items from the Treatment Burden Questionnaire assess how often, time spent, frequency, or inconveniences associated with recommended health care present a problem for the participant.

The 10-item Beliefs about Medicines Questionnaire (BMQ) assesses perceived necessity and concerns about AET (e.g., my health depends on my medicine, my medicine protects me from becoming ill).

An 8-item scale will measure self-efficacy for managing symptoms. Participants are asked to rate how confident they are that they can manage common symptoms (e.g., aches and plain, sexual side effects and hot flashes/sweating) related to AET. The 13-item Self-Efficacy for Appropriate Medication Use Scale assesses self-efficacy for taking medications across various situations (e.g., when no one reminds you to take the medicine, when you have a busy day planned, when you are away from home).

The 5-level EuroQol-5 Dimensions (EQ-5D-5L) health questionnaire assesses current health status across five domains that map to a 0 (dead) to 1 (perfect health) scale representing the relative utility (or desirability) of health-related quality of life. These utility weights are used to derive quality-adjusted life years (QALYs).

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Uterine Cervical Neoplasms

Uterine Neoplasms

Genital Neoplasms, Female

Urogenital Neoplasms

Uterine Cervical Diseases

Uterine Diseases

Genital Diseases, Female

Genital Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

1. Motivational group education specifically focused on cervical cancer prevention;
2. Dynamic group interaction and role play discussion sessions on the benefits of Self-Sample collection HPV testing and procedures;
3. Engaging community bilingual physicians in cervical cancer screening and referral;
4. Patient navigation assistance.

Comparison group participants received general health education focusing on healthy lifestyle, and prevention of disease through routine health examinations.

Motivational group education by trained bilingual community health educators (CHEs) on cervical cancer prevention

Education on cervical cancer prevetnion

Dynamic group interaction and role play discussion sessions on the benefits of Self-Sample collection HPV testing and procedures;

Dynamic group interaction

Engaging community bilingual physicians in cervical cancer screening and referral;

Physician engagement

Patient navigation assistance will be provided to participants who tested HPV positive for further diagnostic testing and treatment.

Patient Navigation

general health education focusing on healthy lifestyle, and prevention of disease through routine health examinations.

General Health Education

Grace Ma, PhD

The study was to pilot test the feability of using HPV self-sampling testing to increase cervical cancer screening among under-served Asian women through engaging community-based organizations in the greater Philadelphia and New York City area, addressing a significant global cancer burden, the preventable infection-related cervical cancer.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Well-Being After Breast Cancer Surgery	NCT04225585	Coping Skills T... General Health ...	CST-PSP General health ...	18 Years -	Duke University
Improving Well-Being for Breast Cancer Patients	NCT02707471	Self-management... General Health ...	SM-AET general health ...	21 Years -	Duke University
HPV Self-test to Increase Cervical Cancer Screening in Asian Women	NCT04612660	Cervical Cancer	Education on ce... Dynamic group i... Physician engag... Patient Navigat... General Health ...	30 Years - 55 Years	Temple University

Spots Global Cancer Trial Database for general health education