Neoplasms

Skin and Connective Tissue Diseases

All Conditions

Behaviors and Mental Disorders

Breast Neoplasms

Breast Diseases

Skin Diseases

Quality of Life

Control group - no additional coaching provided

Patients receive regular coaching to test if the coaching alters their perceived self-efficacy.

Patient coaching

Gerd Nagel, Professor MD

This is an open, prospective, multi-center, interventional study to evaluate the benefit and efficacy of individualized self-efficacy coaching for women with high-risk early breast cancer.

In total, 6 sites will be assigned 1:1 to either the experimental arm (Group A) or the control arm (Group B). The controlled site assignment will assure a balanced site-specific QoL between both groups at baseline. All patients will be medically treated according to guidelines. The experimental Group A will in addition receive regular self-efficacy coaching.

Breast cancer represents the leading cause of cancer in women in Switzerland with around 6,000 newly diagnosed cases per year. Beside the therapy- and cancer-associated somatic illness, about one third of patients develop anxiety disorders or depression and need psychotherapeutic or psychiatric care. Women with breast cancer display the highest psychic comorbidity compared to patients with other cancer entities (40% point prevalence) .

To assist with psychological coping with the disease several psycho-oncological interventions have been established in the past decades.

Self-efficacy describes the extent or strength of one's belief in one's own ability to complete tasks and reach goals. Nagel \& Schreiber have developed an individualized self-efficacy coaching for cancer patients to mobilize and strengthen the belief in one's own ability to deal with and fight the disease. The SECOM-PSWE study evaluates the impact of regular self-efficacy coaching on the perceived self-efficacy and the quality of life (QoL) in patients with early breast cancer.

Parallel Assignment of patients to two groups (group A: patients receive self-efficacy coaching, group B: patients do not receive additional coaching)

Self-efficacy Coaching for Women With Breast Cancer

Pilot Study: Individualized Self-efficacy Coaching, Quality of Life and Compliance for Women With High-risk Early Breast Cancer

Overall perceived self-efficacy is measured by a specifically developed questionnaire (questionnaire SWE). Analysis will be descriptive, separate for each group and performed according to the analysis manual. A difference between the groups is defined as 10% difference in median between the groups. The scale ranges from 10 to 40 points. The higher the score, the higher is perceived self-efficacy of the patient.

Overall quality of life is measured by the questionnaire FACT-G. Differences between the groups will be determined comparing total score. The scale ranges from 0 to 108 points. The higher the score, the better is quality of life.

Disease-related quality of life is measured by the questionnaire FACT-B. Differences between the groups will be determined comparing total score. The scale ranges from 0 to 148 points. The higher the score, the better is quality of life.

Active coping with the disease is measured by the questionnaire FKV-15. Differences between the groups will be determined comparing total score. The scale ranges from 15 to 75 points. The higher the score, the better the patient is coping.

Physical activity is measured by the questionnaire IPAQ. Differences between the groups will be determined comparing the level of physical activity. Analysis will be done according to the scoring manual. There is no minimum or maximum for the scale, the outcome is a continuous measure presented in Metabolic Equivalent of Task (MET)-minutes. The higher the outcome, the higher is the level of physical activity.

Duration of hormone therapy is determined by the questionnaire Compliance which consists of two items. Total duration of hormone therapy is measured in months and is compared between the groups. The questionnaire Compliance only applies to patients who receive hormone therapy.

Anxiety levels are measured by the questionnaire GAD-7. Analysis will be done according to the scoring manual. Differences between the groups will be determined comparing total score. The scale ranges from 0 to 21 points. The higher the score, the higher the level of anxiety.

Use of complementary medicine is measured by the questionnaire I-CAM-G. The number of complementary medical measures is determined descriptively and compared between the groups.

Occurrence of relapse is documented during the course of the study. The occurence of relapse is assessed by the investigator as per clinical routine and documented in the eCRF by three items.

Change of perceived self-efficacy is measured by a specifically developed questionnaire (questionnaire SWE) and compared between the groups. An increase in perceived self-efficacy is defined as the first increase in total score of five or more points. The scale ranges from 10 to 40 points. The higher the score, the higher is perceived self-efficacy of the patient.

Change of quality of life is measured by the questionnaire FACT-G and compared between the groups. An increase in quality of life is defined as the first increase in total score of five or more points. The scale ranges from 0 to 108 points. The higher the score, the better is quality of life.

Change of disease-related quality of life is measured by the questionnaire FACT-B and compared between the groups. An increase in disease related quality of life is defined as the first increase in total score of five or more points. The scale ranges from 0 to 148 points. The higher the score, the better is quality of life.

Depression is measured by the questionnaire PHQ-9. Differences between the groups will be determined comparing total score. Analysis will be done according to the scoring manual. The scale ranges from 0 to 27 points. The higher the score, the higher the level of depression.

Use of micronutrients is measured by the questionnaire I-CAM-G. The number of different types of micronutrients is determined descriptively and compared between the groups.

iOMEDICO AG

Stiftung Patientenkompetenz

All Drugs and Chemicals

Hormones

Mitogens

Patients in this group receive a continuous standardized MOATT based patient education and coaching and optional eMBSR (electronic Mindfulness-Based Stress Reduction) within the first 24 weeks of Abemaciclib treatment.

Patients in this group receive a patient management according local routine.

Jenny Palmrich

Oliver Knapp, PhD

Hans Tesch, Prof. Dr. med.

Manfred Welslau, Dr. med.

The aim of the IMPACT - Implementing Patients' competence in oral breast cancer therapy - study is to evaluate the effectiveness of a standardized patient education and coaching and optional eMBSR for therapy management provided by specially trained oncology nurses regarding persistence rate, side effects management and unplanned therapy interruptions in outpatient oncology care for patients under Abemaciclib treatment.

Breast cancer therapy has advanced by far over the last decade. Introduction of novel therapies as well as the introduction of mammography screening are thought to have reduced mortality over the last decade. More women are treated on an individual basis, trying to avoid toxic and non-effective therapies.

However, every year about 18.000 women are diagnosed with metastastic breast cancer in Germany. Breast cancer remains one of the main reasons for deaths among women and is the main reason for death due to cancer in younger women.

Once a tumor is metastasized, well balanced treatment decisions have to be made to take both into consideration, a high chance of tumor control and a low risk for side effects. Especially in the metastatic setting symptom control and quality of life need to be in the focus of the therapy and patient care.

Modern anticancer strategies are designed against specific molecular targets with the goal of sparing normal, non-neoplastic tissues. Choosing specific molecular targets, however, is problematic. CDK4/6 (Cyclin dependent kinase 4 and 6) are important candidate targets for therapeutic intervention.

Traditionally, anticancer therapy has been dominated by intravenous drug therapy. However, oral agents, like CDK4/6 inhibitors, provide an attractive approach to this kind of treatment and use of oral treatments is increasing. Currently, there are three CDK4/6 inhibitors that have reached clinical practice in the management of ER+ HER2- advanced disease. One of them is Ademaciclib which is approved in the US since September 2017 for "adult patients who have hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer that has progressed after taking therapy that alters a patient's hormones".

Oral agents for cancer treatment are increasingly prescribed due to their benefits. However, this type of therapy requires a high level of self-management competence by the patient. A standardized patient education provided by physicians and oncology nurses may influence the handling of the oral agents in a positive way regarding side effects and unplanned therapy interruptions.

When it comes to oral agents, the place of treatment is the patients' home. In this treatment setting, correct treatment management cannot be utilized without identifying a patient's needs to be empowered to become an expert of his/her treatment because cancer therapies are commonly difficult to handle and the medication often shows a high risk of side effects and interactions with other drugs. Care providers are challenged by the question of how mostly elderly and multimorbid patients and their supporting relatives can be enabled with essential competencies to manage their treatment by themselves. Before patients start their cancer therapy, they are usually provided with information about the treatment by their physician. However, patients often feel overwhelmed by all the details in this stressful situation and tend to have a reduced capacity to assimilate complex information. Education and additional support at the beginning and in the course of the treatment can be a useful approach for patients to better handle this situation.

Recent studies showed the positive impact of supportive care programs on patients provided by nurses. Patient-focused motivation techniques and education performed by nurses are suitable to strengthen the patients' understanding of risks and benefits from the anti-cancer treatment and oral agents. These care programs can prevent an incorrect medication intake due to misunderstandings, lead to a decrease of treatment-related symptoms like pain and fatigue and reduce critical events. In addition, patient education can facilitate supportive care through a better communication between patient and health care provider and may advance the early detection of adverse toxicity events and foster rapid symptom management.

Mindfulness based stress reduction (MBSR) shows a positive effect on mental health in breast cancer patients. The evidence confirms that MBSR reduces anxiety, depressiveness and stress of breast cancer patients and increases the health-related quality of life. A key ingredient to reduce the damaging effects of chronic stress, reducing distress, and improving quality of life is to have patients engage in behaviors that decrease sympathetic and increase parasympathetic arousal. Studies show that MBSR have a positive effect on many systems in our body and create fundamental changes in the way the brain functions. MBSR can affect neurotransmitters (i.e. glutamate, GABA) and neuromodulators (i.e. dopamine, serotonin, epinephrine), which are essential in maintaining a healthy balance between sympathetic and parasympathetic arousal, therefore, helping to manage the stress response.

The aim of the IMPACT - Implementing Patients' competence in oral breast cancer therapy - study is to evaluate the effectiveness of a standardized patient education and coaching and optional eMBSR for therapy management provided by specially trained oncology nurses regarding persistence rate, side effects management and unplanned therapy interruptions in outpatient oncology care for patients under Abemaciclib treatment.

Implementing Patients´ Competence in Oral Breast Cancer Therapy

A Randomized, Controlled Study of Standardized Patient Coaching Versus Patient Management According to Local Practice for Patients With Hormone Receptor Positive HER2 Negative Metastatic Breast Cancer Treated With Abemaciclib

The primary objective of this study is to evaluate both study arms regarding the (potential) effect of patient management according to local routine versus continuous standardized patient education and coaching using the MOATT on persistence rate within the first 24 weeks of Abemaciclib treatment.

Total time of patient decided interruptions in days during 24 weeks of Abemaciclib therapy in both study arms.

The effect of eMSBR after 24 weeks of Abemaciclib therapy.

After weeks 2, 6, 12, 18 and 24, quality of Life (QoL) will be assessed by the FACT-B (Version 4.0) questionnaires.

After weeks 2, 6, 12, 18 and 24, patient distress will be assessed via distress thermometer.

Self-efficacy will be patient reported and surveyed through a patient dairy.

Type and duration of side-effects will be patient reported and surveyed through a patient dairy.

Health related stress will be patient reported and surveyed via distress thermometer questionnaire.

Therapy related knowledge will be surveyed via MOATT (MASCC Oral Agent Teaching Tool).

Amount of relevant events will be surveyed through patient self-reporting via patient diary.

Relevant events (in days) will be surveyed through patient self-reporting via patient diary.

Incidence of adverse events and serious adverse events will be reported according to NCI Common Toxicity Criteria Version 5.0.

Progression free survival (PFS) rate at 24 weeks of therapy. PFS is defined as time interval from start of therapy until progressive proven with clinical measures according to expertise and daily clinical routine or death from any cause, whichever comes first.

Overall survival (OS) rate at 24 months is defined as the time to death from therapy start of Abemaciclib.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Self-efficacy Coaching for Women With Breast Cancer	NCT03478384	Breast Cancer	Patient coachin...	18 Years -	Stiftung Patientenkompetenz
Self-efficacy Coaching for Women With Breast Cancer	NCT03478384	Breast Cancer	Patient coachin...	18 Years -	Stiftung Patientenkompetenz
Implementing Patients´ Competence in Oral Breast Cancer Therapy	NCT04030728	Metastatic Brea... Advanced Breast...		18 Years -	Onco Medical Consult GmbH

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