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

February 13, 2023 updated by: National Taiwan University Hospital

Impacts and Testing of the "Multi-domains Active-living Program (MAP)" in Newly Diagnosed Operable Non-Muscle Invasive Bladder Cancer Patients - Current Status and the Effects of Combining With eHealth-Enhanced Randomized Controlled Trial

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).

Study Overview

Detailed Description

Background: Non-muscle invasive bladder cancer (NMIBC) covers the majority of bladder cancer incidence. Operable NMIBC patients have to receive Transurethral Resection of Bladder Tumor (TURBT), every-three-month repeated cystoscopes and bladder-irrigated chemotherapy in the first year. The intrusion, repeated cystoscope/treatments and recurrence concern may influence NMIBC patients' quality of life.

Purposes: This is a 2-phase study. The aim of Phase I (first year) is to (1) test the psychometrics of NMIBC-specific Quality of Life (QOL) questionnaire "EORTC QLQ NMIBC 24-Chinese"; (2) examine patients' distress across multi-domains, including impacts on QOL, symptoms, physical function (upper/lower leg muscle power, balance), sexual/intimacy, fear of recurrence, and physical activity. Phase II (2nd&3rd year) is a two-group randomized trial for newly diagnosed NMIBC patients. It 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) of the effects on the above indicators (phase I) and the number of unexpected hospital visits.

Methods: Phase I is an instrument validation study. The "EORTC QLQ-NMIBC24-Chinese" will be to develop and examine of its psychometrics. We will also explore the above mentioned domains of QOL, distress, care needs, frequency of taking physical activities, etc. by questionnaire interview/assessment; and objective physical function measures (low leg muscle strengths and balance ability). An estimated sample size is 240 subjects. Phase II 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).

Expected Outcome: This is the first study to test EORTC QLQ-NMIBC24 Chinese version, patients' distress and physical function as well as construct and test of a multi-domain MAP program. It would help us further build up evidence-based care and generalize to bladder cancer patients.

Study Type

Interventional

Enrollment (Anticipated)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Yeur-Hur Lai, Professor
  • Phone Number: 288429 886-2-23123456
  • Email: laiyhwk@ntu.edu.tw

Study Locations

      • Taipei, Taiwan
        • Recruiting
        • National Taiwan University Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • 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

Exclusion Criteria:

  • 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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: control group
Control Group: Usual care + oncology case manager (OCM) care, UC group or Control group
Usual care + oncology case manager (OCM) care
Experimental: experimental group
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.
Multi-domains Active-living Program (MAP) with e-health enhanced intervention + usual care + oncology case manager (OCM) care

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes in Quality of Life (consisting of symptoms, function, and health status)
Time Frame: 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.
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
Time Frame: 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.

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
Time Frame: 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.

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
Time Frame: 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.
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)
Time Frame: 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.
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
Time Frame: 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.
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
Time Frame: 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.
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
Time Frame: 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.
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
Time Frame: 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.
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
Time Frame: 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.
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
Time Frame: 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.
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.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 1, 2021

Primary Completion (Anticipated)

December 31, 2025

Study Completion (Anticipated)

December 31, 2026

Study Registration Dates

First Submitted

January 26, 2023

First Submitted That Met QC Criteria

February 13, 2023

First Posted (Estimate)

February 22, 2023

Study Record Updates

Last Update Posted (Estimate)

February 22, 2023

Last Update Submitted That Met QC Criteria

February 13, 2023

Last Verified

January 1, 2023

More Information

Terms related to this study

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

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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