Impacts and Testing of the "Multi-domains Active-living Program" in Operable Non-Muscle Invasive Bladder Cancer Patients

NCT05739968 | Recruiting

• 1 other identifier: 201912156RIND
• Study Type: interventional
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

Among bladder cancer, the majority of them (70%) are non-muscle-invasive bladder cancer (NMIBC). The survival time is even longer in NMIBC. Patients with NMIBC receive surgery or transurethral resection of bladder tumor (TURBT). However, patients with NMIBC need to receive a three-month repeatedly intrusive cystoscope from diagnosis for the first year. Furthermore, following each cystoscope, patients will receive 3 to 6 times bladder BCG (Bacille Calmette Guérin) or chemotherapy. These repeatedly intrusive cystoscopes, TURBT, and intensive bladder treatments might cause impacts on patients' life. The investigator aims to (1) construct a Multi-domains Active-living Program (MAP) with e-health enhanced intervention; and (2) compare the effects of the MAP with oncology case manager (OCM) care (experimental group) and OCM care only (control group) on the indicators and quality of life. Intervention study is a 12-month two-group randomized trial, including OCM care only (control), Vs. MAP+OCM program (experimental group). MAP will be constructed based on literature review and preliminary results. Main contents of MAP are to (a) cope multi-domain of distress, and (b) develop an active life style to handle their life after cancer, including effective coping, relaxation, regular physical activities, and balance nutrition. Four face-to face interventions will be delivered, including: day before hospital discharge post-operation, before the last weekly instillations of induction therapy (around 6±2 weeks post operation), 2nd-time cystoscopy and before 1st maintenance therapy (around 3- month post operation) and 3rd-time cystoscopy which before the second cycle of maintenance therapy (around 6- month post operation) \[section 1-4\], respectively. A brief and automatic app reminder (before) and side-effect follow-up (after) from 2nd section of face-to face intervention will be sent. Boosting health education will also be provided by app/ phone calls or in person around 2 to 4 weeks after discharge. Patients in the MAP+OCM group also can raise their questions through APP to receive brief intervention. The outcomes will be assessed at 5 time points: time before first intervention, before 2nd to 4th interventions, and 12 months, T1-T5, respectively. We will use Generalized Estimated Equation (GEE) to analyze the data with total 120 subjects (60 Vs 60 estimated).

Conditions

Bladder Cancer; Quality of Life

Keywords

Bladder Cancer; Personalized Supportive Cancer Care Program; Physical symptom; Fear of cancer recurrence; Physical function; Sexual/intimacy; Physical activity

Outcome Measures

Primary Outcomes (11)

• Changes in Quality of Life (consisting of symptoms, function, and health status)

  Quality of life will be assessed by the EORTC-QLQ. This Instrument is consists of 30 items to measure three subscales, includes 2 items global health status/quality of life, 15 items functional domains and 13 items cancer common related symptoms or problems. Two items in global health status use a 7-point summated scale (1 = poor; 7 = excellent) and other items are rated on 4-point Likert's Scales (1=not at all; 4=very much). The scores will be transformed to a range from 0 to 100. In global health status and functional domains, the higher scores indicate better function. In the symptoms subscale, lower scores indicate less severe symptoms (Aaronson et al., 1993). The Taiwan Chinese version has been demonstrated to be both reliable and valid (Chie et al., 2004).

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Anxiety

  The severity of NMIBC patients' anxiety will be measured by the self-reporting Generalized Anxiety Disorder-7 (GAD-7). GAD is developed by Spitzer et al. (2006) and was used in a large primary care patient sample (Kroenke et al., 2007; Remes et al., 2016). The GAD-7 is a 7-item anxiety scale and is specifically linked to the DSM-IV (Text Revision) criteria (Spitzer et al., 2006). Response options were "not at all (score=0)," "several days (score=1)," "more than half the days (score=2)," and "nearly every day (score=3)," and the total GAD-7 score range is 0 to 21. The GAD-7 has good internal consistency (Cronbach α = 0.92) and test-retest reliability (intraclass correlation = 0.83) (Spitzer et al., 2006).

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Depression

  The severity of NMIBC patients' depression will be measured by the self-reporting Patient Health Questionnaire-9 (PHQ-9). PHQ-9 is form a three page the Patient Health Questionnaire (PHQ) and is the 9-item depression module from the full PHQ (Kroenke et al., 2001). This questionnaire is used to screen for depression in primary care and other medical settings and with good sensitivity and specificity (Levis et al., 2019). In each PHQ-9 component, the lowest score is 0 (not at all), the highest score is 3 (nearly every day) and the total PHQ score range is 0 to 27.

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Fear of Cancer Recurrence

  The 7-item Fear of Cancer Recurrence (FCR7) is a unidimensional instrument to assess cancer patients' concern regarding the coming back or progression of cancer. The FCR7 comprises 4 items measuring the severity of worry about recurrence, 2 items measuring the interference caused by FCR, and 1 item assessing the patient's response to FCR. The first 6 items are scored from 1 (not at all) to 5 (all the time) with higher scores indicating higher levels of FCR. The last item assessing the interference of FCR is scored from 1 (not at all) to 10 (a great deal) with the higher the score, the more the interference. The Chinese version of FCR7 has been validated and proven reliable with overall Cronbach's alpha being 0.90 (Lee et al., 2019).

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Sleep Quality (consisting of sleep duration, sleep disturbances, sleep latency, daytime functioning, habitual sleep efficiency, subjective sleep quality, and sleep medication)

  The PSQI, which was developed by Buysee in 1989, is used to assess sleep quality on participants' sleep experiences during the past week (Buysse, Reynolds, Monk, Berman, \& Kupfer, 1989). The PSQI is included seven component scores which are sleep duration, sleep disturbances, sleep latency, daytime functioning, habitual sleep efficiency, subjective sleep quality, and sleep medication. In each PSQI component, the lowest score is 0 (better), and the highest score is 3 (worse). The total PSQI score range is from 0 to 21, and the higher the score the worse the sleep. If the total PSQI score is more than 5, the result means the person has sleep problems (Buysse et al.,1989; He et al., 2015;Van Onselen et al., 2010). Both the original as well as the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) have good reliability and validity. In CPSQI, Cronbach's a coefficient for the hospital sample and test-retest reliability were 0.83 and 0.85, respectively (Tsai et al., 2005).

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Physical Activity

  The Godin Leisure-Time Exercise Questionnaire (GLTEQ) is a simple tool to measure and classify cancer patients' levels of physical activity. The GLTEQ assesses types of leisure-time PA (LTPA) and their frequency and intensity over the previous 7 days. A total GLTEQ score is calculated as: (frequency of mild exercise×3) + (frequency of moderate exercise×5) + (frequency of strenuous exercise×9) (Godin, 2011; Godin \& Shephard, 1985). The GLTEQ score has been proven to have the optimum discriminant functions in classifying percentile of body fat and percentile of maximum oxygen intake (Godin \& Shephard, 1985).

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Nutrition Status

  Mini Nutritional Assessment (MNA) is a comprehensive nutritional assessment scale for the past three months, including anthropometry (body mass index, brachial circumference, calf circumference, skinfold width of the triceps and subscapular muscles), dietary intake, functional geriatric assessment (mini-mental state examination, activities of daily living). The questionnaire includes 18 items with a total score of 0-30 points. The sum of the MNA score distinguishes between elderly patients with: adequate nutritional status, MNA ≥ 24; at risk for malnutrition, MNA between 17 and 23.5. proteincalorie undernutrition, MNA\<17. This scale has been widely used, especially established as one of the most valid and most frequently used nutritional screening tools in older persons (Kaiser et al., 2010; Vellas et al., 1999).

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Balance

  The 14-item Berg Balance Scale (BBS) will be used to measure elderly people's balance (Berg, Wood-Dauphine, Williams, \& Gayton, 1989). It is an easily administrated tool and quick assessment in 10-15 minutes. Each item was scored from 0 (not at all) to 4 (all the time) with the sum score ranged from 0-56. The higher scores indicate better balance function and the score bellowing 45 points indicates the elderly is at fall risk. The BBS has been translated into Chinese and showed satisfying reliability and validity (Lima, Ricci, Nogueira, \& Perracini, 2018).

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Muscle strength and Endurance in Upper Limbs

  We will use Jamar grip strength meter to measure the strength of right and left upper limbs. Grip strength meter provided good reliability and validity for measuring muscle strength in the past studies (Cuesta-Vargas \& Hilgenkamp, 2015; Silva et al., 2019). Patients will be asked to stand up, put arms by sides, and hold the meter to make a fist with maximal force for two times to record upper limbs strength.

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Muscle strength and Endurance in Lower Limbs

  We will use microFET 2 to measure the strength of right and left hip flexor muscle. MicroFET 2 provided good reliability and validity for measuring muscle strength in the past studies (Cuesta-Vargas \& Hilgenkamp, 2015; Silva et al., 2019). Patients will be seated on the chair. The researcher will put the microFET 2 on the upper edge of knee, and then let patient maintain the thigh raise for four seconds to record the strength of right and left hip flexor muscle.

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

• Changes in Functional Mobility

  The Timed Up and Go test (TUG) is a frequently used clinical performance-based evaluation of a person's mobility, balance, walking ability, and fall risk (Herman et al., 2011). The patient gets up from an armchair, goes three meters, turns around, walks back, and then sits down again while being watched and timed (Podsiadlo \& Richardson, 1991). A person who needs more than 12 seconds to finish the TUG runs the danger of falling. (Lusardi et al., 2017). The test is a reliable and valid test for quantifying functional mobility and is easily included as part of the medical examination.

  The outcomes will be assessed at 5 time points: day before hospital discharge post-operation(Day 0), around 6±2 weeks post operation, around 3-month, 6-month and 12-month post operation.

Study Arms (2)

control group

ACTIVE COMPARATOR

Control Group: Usual care + oncology case manager (OCM) care, UC group or Control group

Other: Usual care + oncology case manager (OCM) care

experimental group

EXPERIMENTAL

The experimental group is Multi-domains Active-living Program (MAP) with e-health enhanced intervention + usual care + oncology case manager (OCM) care. Main contents of MAP are to (a) cope multi-domain of distress, and (b) develop an active life style to handle their life after cancer, including effective coping, relaxation, regular physical activities, and balance nutrition. Four face-to face interventions will be delivered, including: day before hospital discharge post-operation, before the last weekly instillations of induction therapy (around 6±2 weeks post operation), 2nd-time cystoscopy and before 1st maintenance therapy (around 3- month post operation) and 3rd-time cystoscopy which before the second cycle of maintenance therapy (around 6- month post operation) \[section 1-4\], respectively.

Other: Multi-domains Active-living Program (MAP) with e-health enhanced intervention + usual care + oncology case manager (OCM) care

Interventions

Usual care + oncology case manager (OCM) care OTHER

Usual care + oncology case manager (OCM) care

control group

Multi-domains Active-living Program (MAP) with e-health enhanced intervention + usual care + oncology case manager (OCM) care OTHER

Multi-domains Active-living Program (MAP) with e-health enhanced intervention + usual care + oncology case manager (OCM) care

experimental group

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• age ≥20 years
• operable newly diagnosed NMIBC patients who know their diagnosis and do not receive cystectomy (still keep their own bladder)
• patients can verbally communicate with others
• Mandarin / Chinese-reading and speaking

You may not qualify if:

• patients who has inoperable bladder cancer
• patient who has muscle invasive bladder cancer (MIBC) with expected cystectomy surgery in the time of diagnosed
• primary cancer unknown
• conscious unclear

Sponsors & Collaborators

• National Taiwan University Hospital: lead
• National Taiwan University: collaborator

Study Sites (1)

National Taiwan University Hospital

Taipei, Taiwan

RECRUITING

Related Publications (24)

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MeSH Terms

Conditions

Urinary Bladder Neoplasms; Coitus; Motor Activity

Interventions

oncomodulin

Condition Hierarchy (Ancestors)

Urologic Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Urinary Bladder Diseases; Urologic Diseases; Male Urogenital Diseases; Sexual Behavior; Behavior

Study Officials

• Yeur-Hur Lai, Professor

  School of Nursing, College of Medicine, National Taiwan University

  STUDY CHAIR

Central Study Contacts

Yeur-Hur Lai, Professor

CONTACT

886-2-23123456; laiyhwk@ntu.edu.tw

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR
• Masking Details: This study was not fully blinded; however, the group allocation was concealed from the patient and primary researcher until after baseline assessments were completed. A primary researcher obtained patient consent, collected self-reported assessments, and if the patients were randomized to intervention group, the intervention trainer explained the MAP program to participants. The study statistician and data managers remained blinded at all times.
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This is a randomized controlled clinical trial which to compare the effects of the OCM care only (control) vs. MAP+OCM program (experimental group) on non-muscle invasive bladder cancer (NMIBC) patients. For both groups, we assessed patients' outcomes (including baseline data) for 5 times (T1=baseline/during hospitalization of receiving surgery \& before their hospital; T2 to T5 = 6±2 weeks, 3, 6, 12 months after operation).

Study Record Dates

• First Submitted: January 26, 2023
• First Posted: February 22, 2023
• Study Start: April 1, 2021
• Primary Completion: December 31, 2025
• Study Completion (Estimated): December 31, 2026
• Last Updated: June 5, 2024

Record last verified: 2024-06

Data Sharing

• IPD Sharing: Will not share

Locations

TW (1)