Effects of an e-Home Based Symptom Management and Mindfulness Training Programme on QoL in Breast Cancer Survivors

Effects of an e-Home Based Symptom Management and Mindfulness Training Programme on Quality of Life in Breast Cancer Survivors

Breast cancer is the most common cancer in women in Singapore. Breast cancer survivors usually experience side effects/symptoms after surgery and/or adjuvant chemotherapy and/or radiotherapy such as fatigue, lymphedema, problems with sleeping, peripheral neuropathy, and anxiety/depression. Currently, there is no study to include both symptom management and mindfulness training components for breast cancer survivors. And given breast cancer survivors have infrequent clinical follow-up, we aim to develop an e-Home based symptom management and mindfulness training programme for breast cancer survivors and to determine its effects on quality of life, symptom distress, psychosocial adjustment, psychological morbidity, and unplanned outpatient attendance or hospitalisation in breast cancer survivors. We employ a randomised clinical trial with four study arms (with 47 subjects in each arm) together with a process evaluation; group 1 (usual care), group 2 (experimental group: five weekly sessions of online symptom management + mindfulness training programme and usual care), group 3 (comparison group 1: five weekly sessions of online symptom management programme and usual care), and group 4 (comparison group 2: five weekly sessions of online mindfulness training programme and usual care). Subjects will complete questionnaires measures of 6-item Social Support Questionnaire, Breast Cancer Survivor Self-Efficacy Scale, the Quality of Life-Cancer Survivor Scale, Memorial Symptom Assessment Scale, Psychosocial Adjustment to Illness Scale, short version of the Fear of Recurrence Scale, Hospital and anxiety Depression Scale and Five Facet Mindfulness Questionnaire at baseline (printed questionnaires), at 8 weeks from baseline, at 12 weeks from baseline and at 24 weeks from baseline by an online system or printed questionnaires. Individualised semi-structured interview (15-25 mins) for experimental and comparison groups will be conducted at 24 weeks from baseline to understand the subjects' experiences of the study programme. Data will be analysed using SPSS version 24. Baseline demographic and clinical information of subjects in the experimental, comparison and control groups will be summarised using descriptive statistics, and will be compared using chi square tests and ANOVA/ANCOVA tests. Intention-to-treat approach will be used. Repeated measures analysis of variance will be used to examine the differences on outcome measures among the experimental, comparison and control groups across study time points. In addition, differences in changes in outcome measures among experimental, comparison groups and usual care groups will be tested using multilevel modelling techniques. A p-value smaller than 5% will be considered as statistically significant. Content analysis will be conducted to analyse the interviews data.

Study Overview

• Status: Completed
• Conditions: Quality of Life; Oncology; Breast Cancer Survivors; Symptom Management; Mindfulness Based Cognitive Therapy
• Intervention / Treatment: Other: Online mindfulness training; Other: Online symptom management

• Study Type: Interventional
• Enrollment (Actual): 172
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Singapore
  • Singapore, Singapore
    • National University Hospital
  • Singapore, Singapore
    • National Cancer Centre Singapore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• women aged 21 or above
• able to speak and read English
• diagnosed with breast cancer stage 0 to 3 for the first time
• have completed cancer treatment including breast surgery and/or adjuvant chemotherapy and/or radiotherapy between 6 months to 5 years previously
• with and without ongoing HER2 target therapy (e.g.: Herceptin) and/or hormonal therapy
• with ECOG Performance Status score of 0 to 1
• able to understand the study and give informed consent
• have access to the internet through a handheld device

Exclusion Criteria:

• they are illiterate
• have serious psychiatric disorders (e.g. schizophrenia, dementia, and intellectual disabilities)
• with ECOG Performance Status score of 2 or above

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Usual care group; Usual care is meant the routine medical and health care services at the hospital.
Experimental: Experimental group; Five weekly sessions of online symptom management + mindfulness training programme + usual care	Other: Online mindfulness training; 5 weekly sessions of online self-administered mindfulness training programme in which they will receive audio-recorded and video-recorded instructions, pictorial or text-based instructions for various mindfulness exercises such as body scan meditation, mindful breathing and walking meditation.; Other: Online symptom management; 5 weekly online education module in which they will receive video-recorded, audio-recorded, pictorial or text-based instructions for various self-management strategies. Topics include fatigue, pain, numbness/tingling, lymphedema, anxiety/depression, and problems with sleeping.
Active Comparator: Comparison group 1; Five weekly sessions of online symptom management programme + usual care	Other: Online symptom management; 5 weekly online education module in which they will receive video-recorded, audio-recorded, pictorial or text-based instructions for various self-management strategies. Topics include fatigue, pain, numbness/tingling, lymphedema, anxiety/depression, and problems with sleeping.
Active Comparator: Comparison group 2; Five weekly sessions of online mindfulness training programme and usual care	Other: Online mindfulness training; 5 weekly sessions of online self-administered mindfulness training programme in which they will receive audio-recorded and video-recorded instructions, pictorial or text-based instructions for various mindfulness exercises such as body scan meditation, mindful breathing and walking meditation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change from baseline quality of life score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline quality of life score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline quality of life score at 24 weeks	Change between baseline and at 24 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Change from baseline social support score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline social support score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline social support score at 24 weeks	Change between baseline and at 24 weeks
Change from baseline self-efficacy score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline self-efficacy score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline self-efficacy score at 24 weeks	Change between baseline and at 24 weeks
Change from baseline symptom score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline symptom score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline symptom score at 24 weeks	Change between baseline and at 24 weeks
Change from baseline psychosocial adjustment to illness score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline psychosocial adjustment to illness score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline psychosocial adjustment to illness score at 24 weeks	Change between baseline and at 24 weeks
Change from baseline fear of recurrence score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline fear of recurrence score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline fear of recurrence score at 24 weeks	Change between baseline and at 24 weeks
Change from baseline anxiety and depression score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline anxiety and depression score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline anxiety and depression score at 24 weeks	Change between baseline and at 24 weeks
Change from baseline mindfulness score at 8 weeks	Change between baseline and at 8 weeks
Change from baseline mindfulness score at 12 weeks	Change between baseline and at 12 weeks
Change from baseline mindfulness score at 24 weeks	Change between baseline and at 24 weeks

Collaborators and Investigators

• Sponsor: National University of Singapore
• Collaborators: National University Hospital, Singapore; National Cancer Centre, Singapore
• Investigators: Principal Investigator: Karis Cheng, National University of Singapore

Publications and helpful links

General Publications

• Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x.
• Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, Sobel K, Coyle N, Kemeny N, Norton L, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30A(9):1326-36. doi: 10.1016/0959-8049(94)90182-1.
• Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006 Mar;13(1):27-45. doi: 10.1177/1073191105283504.
• Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006 Feb 15;106(4):751-8. doi: 10.1002/cncr.21671.
• Champion VL, Ziner KW, Monahan PO, Stump TE, Cella D, Smith LG, Bell CJ, Von Ah D, Sledge GW. Development and psychometric testing of a breast cancer survivor self-efficacy scale. Oncol Nurs Forum. 2013 Nov;40(6):E403-10. doi: 10.1188/13.ONF.E403-E410.
• Ferrell BR, Dow KH, Grant M. Measurement of the quality of life in cancer survivors. Qual Life Res. 1995 Dec;4(6):523-31. doi: 10.1007/BF00634747.
• Cheng KK, Darshini Devi R, Wong WH, Koh C. Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period. Eur J Oncol Nurs. 2014 Feb;18(1):3-9. doi: 10.1016/j.ejon.2013.10.005. Epub 2013 Dec 5.

Study record dates

Study Major Dates

• Study Start (Actual): December 6, 2016
• Primary Completion (Actual): March 14, 2020
• Study Completion (Actual): March 14, 2020

Study Registration Dates

• First Submitted: October 10, 2016
• First Submitted That Met QC Criteria: October 11, 2016
• First Posted (Estimate): October 13, 2016

Study Record Updates

• Last Update Posted (Actual): September 23, 2020
• Last Update Submitted That Met QC Criteria: September 22, 2020
• Last Verified: September 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms
• Other Study ID Numbers: R-545-000-073-592

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO