Home Chemotherapy Intervention for Children With Cancer - a Feasibility Study (INTACTatHome)

Parent-Administered Low-Dose Cytarabine to Children and Adolescents With Cancer at Home - a Feasibility Study

Children with cancer undergo intensive treatment with many serious side effects and frequent in- and outpatient visits. Studies show that the frequent hospitalizations are very disruptive to children and their families, who strive to maintain a normal everyday life. The aim of the study is to test a parent-led home-administered low-dose cytarabine intervention that will not compromise the quality of treatment and care, increase the caregiver burden or the experienced symptoms of the children. The methodical approach is based on The Medical Research Council's framework to develop and evaluate complex interventions in health care using both clinical observational methods, participatory methods, surveys and qualitative ethnographic methods. The overall goal of the project is to support and ease the everyday lives of children with cancer and their families during the intensive treatment periods.

Study Overview

• Status: Recruiting
• Conditions: Childhood Cancer; Supportive Care
• Intervention / Treatment: Other: parent-led home-administered low-dose Cytarabine

Detailed Description

This single-arm feasibility study is conducted at Copenhagen University Hospital, Rigshospitalet, in Denmark at the Department of Pediatric Oncology and Hematology.The PI started to recruit participants March 2022. Patients with Acute Lymphoblastic Leukemia (ALL), Philadelphia positive Acute Lymphoblastic Leukemia (PH+ALL) and Lymphoblastic Lymphoma (LBL) are eligible for inclusion if their parents speak and understand Danish or English, able to manage basic treatment and care such as oral medication, mobilization, nutrition, central venous catheter care and practice good personal hygiene. The parents' competences are assessed by the PI in collaboration with a team of project- and ward nurses who know them. Participants are recruited between day 15 and 29 from diagnosis. Parents to eligible participants and adolescents aged 15+ receive oral and written information and provide written informed consent before inclusion. Children and adolescents less than 15 years of age receive oral information and provide oral consent if possible according to their age. Parents to the included participants are offered to administer the protocolized low-dose bolus (injection) Cytarabine in their children's CVCs at home. The administration procedure is developed as a simple and safe non-touch technique. The parents receive a video and paper-based guideline and information material followed by a 3-step nurse-led education program. The parents can administer the Cytarabine at home when they (and the child/adolescent) feel safe and comfortable managing the procedure and when the nurses are sure that the parents can manage the procedure at home. The first dose of Cytarabine is always administered at the hospital.

• Study Type: Interventional
• Enrollment (Anticipated): 15
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Louise I Roug, RN, MA; Phone Number: +45 20625228; Email: louise.ingerslev.roug@regionh.dk
• Study Contact Backup: Name: Helena Hansson, RN, PHD; Phone Number: +45 35459400; Email: helena.hansson@regionh.dk

Study Locations

• Denmark
  • Danmark
    • Copenhagen, Danmark, Denmark, 2100
      • Recruiting
      • Louise Ingerslev Roug
      • Contact: Louise I Roug, Nurse, MA; Phone Number: +45 20625228; Email: louise.ingerslev.roug@regionh.dk
      • Contact: Helena Hansson, Nurse, Ph.D; Phone Number: 35459400; Email: helena.hansson@regionh.dk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 year to 17 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

- Children/adolescents diagnosed with ALL, LBL or PH+ ALL

Exclusion Criteria:

• If their parents did not understand, read and speak Danish
• If the parents did not manage the children/adolescents' basic care and treatment needs (CVC care, oral medication, hygiene, nutrition, mobilization, ect.)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: parent-led home-administered low-dose Cytarabine; Parents to the included participants are offered to administer the protocolized low-dose bolus (injection) Cytarabine in their children's CVCs at home. The administration procedure is developed as a simple and safe non-touch technique. The parents receive a video and paper-based guideline and information material followed by a 3-step nurse-led education program. The parents can administer the Cytarabine at home when they (and the child/adolescent) feel safe and comfortable managing the procedure and when the nurses are sure that the parents can manage the procedure at home. The first dose of Cytarabine is always administered at the hospital.

Other: parent-led home-administered low-dose Cytarabine; Parents to the included participants are offered to administer the protocolized low-dose bolus (injection) Cytarabine in their children's CVCs at home. The administration procedure is developed as a simple and safe non-touch technique. The parents receive a video and paper-based guideline and information material followed by a 3-step nurse-led education program. The parents can administer the Cytarabine at home when they (and the child/adolescent) feel safe and comfortable managing the procedure and when the nurses are sure that the parents can manage the procedure at home. The first dose of Cytarabine is always administered at the hospital.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment rate	Number of families who consent to participate in the study	From day 15 (from protocol start) until the last day with low dose cytarabine treatment which depends on protocol stratification and randomization (mean intervention period = 22 weeks)
Attrition rate	Number of drop-outs during the intervention	From time of obtained consent until end of intervention period (mean intervention period = 22 weeks)
Demand (dose)	Number of parent-led home-administered low-dose Cytarabine (total and average)	From day 38 up to day 167 from protocol start. Four to eight timepoints depending on number of protocolized cytarabine doses (mean intervention period = 22 weeks)
Education time	Time (minutes) nurses spent on education for parents before the intervention	From time of obtained consent until start of intervention (2-4 weeks)
Adverse events	Severe and non-severe events	From recruitment start to end of intervention (mean intervention period = 22 weeks)
Respons rate	Number of responses on PENAT questionnaire	Everyday during each four-day-long chemo-cycle to five days after (one to eight cycles are given depending on the specific protocol).The typical intervention period is 22 weeks
Respons rate	Number of responses on CMCC and SS questionnaires	At the end of each chemo-cycle (day 4, each chemo-cycle is four days). The typical intervention period is 22 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nausea and Vomiting during low-dose Cytarabine treatment (tentative)	Questionnaire (PENAT - measuring chemotherapy induced nausea and vomiting))	Starting day one of the Cytarabine cycle and stops five days after (9 days). Each Cytarabine cycle is four days. There can be from four to eight cycles of Cytarabine in the Protocol.
Caregiver Demands (tentative)	Questionnaire (CMCC: Care of My Child with Cancer)	Day four (and the last day) of each cycle of Cytarabine (each cycle is four days)
Satisfaction and safety (tentative)	Questionnaire measuring parents and children/adolescents' experience of satisfaction and safety managing the home-administration of Cytarabine)	Day four (and the last day) of each cycle of Cytarabine (each cycle is four days)
The family's experience of the intervention of home-administered Cytarabine	qualitative interviews with parents and children/adolescents	Interviews are conducted after end intervention (approximately day 167 since protocol start)
Adaption, Integration, implementation	Qualitative process evaluation of the feasibility areas: Adaption, integration and implementation	Fieldnotes are collected at various timepoints during the in total study/intervention period = 43 weeks

Collaborators and Investigators

• Sponsor: Rigshospitalet, Denmark

Study record dates

Study Major Dates

• Study Start (Actual): March 11, 2022
• Primary Completion (Anticipated): December 31, 2022
• Study Completion (Anticipated): February 28, 2023

Study Registration Dates

• First Submitted: April 25, 2022
• First Submitted That Met QC Criteria: May 10, 2022
• First Posted (Actual): May 12, 2022

Study Record Updates

• Last Update Posted (Actual): May 12, 2022
• Last Update Submitted That Met QC Criteria: May 10, 2022
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Keywords: Home chemotherapy
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Cytarabine
• Other Study ID Numbers: LROU0001-1

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No