Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study

Rahul Banerjee, Chiung-Yu Huang, Lisa Dunn, Jennifer Knoche, Chloe Ryan, Kelly Brassil, Lindsey Jackson, Dhiren Patel, Mimi Lo, Shagun Arora, Sandy W Wong, Jeffrey Wolf, Thomas Martin Iii, Anand Dhruva, Nina Shah, Rahul Banerjee, Chiung-Yu Huang, Lisa Dunn, Jennifer Knoche, Chloe Ryan, Kelly Brassil, Lindsey Jackson, Dhiren Patel, Mimi Lo, Shagun Arora, Sandy W Wong, Jeffrey Wolf, Thomas Martin Iii, Anand Dhruva, Nina Shah

Abstract

Background: For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized well-being-related support via phone calls and SMS text messaging, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period, which is generally characterized by symptomatic exacerbations and 2-week hospitalizations.

Objective: We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period.

Methods: We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning on day -5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to well-being. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations occurring at least once every 4 weeks during the study period. Secondary endpoints were electronic patient-reported outcome assessments of QOL, distress, and sleep disturbances.

Results: Of the 20 patients who were screened, 17 (85%) chose to enroll and 15 (75%) underwent SCT as planned. Of these 15 patients (median age 65 years, range 50-81 years), 11 (73%) demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during the 3-month study period was once every 6.2 days (range 3.9-28 days). During index hospitalizations with median lengths of stay of 16 days (range 14-31 days), the median frequency of conversations was once every 5.3 days (range 2.7-15 days). Electronic patient-reported outcome assessments (94% adherence) demonstrated an expected QOL nadir during the second week after SCT. The prevalence of elevated distress was highest immediately before and after SCT, with 69% of patients exhibiting elevated distress on day -5 and on day +2.

Conclusions: DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous SCT for multiple myeloma. The limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC use. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is underway to investigate the efficacy of DLC with regard to patient well-being.

Trial registration: ClinicalTrials.gov NCT04432818; https://ichgcp.net/clinical-trials-registry/NCT04432818.

Keywords: cancer; digital health; digital life coaching; feasibility; high-dose chemotherapy; life coaching; mobile phone; multiple myeloma; patient engagement; stem cell therapy; stem cell transplantation.

Conflict of interest statement

Conflicts of Interest: RB reports the following disclosures: Curio Science (honoraria), Guidepoint Global (consulting), Sanofi (consulting), SparkCures (consulting), and Pack Health (institutional research funding, not for this study). KB reports the following disclosures: Pack Health (employment), AbbVie (research), Astellas (research), BMS (research), Daiichi Sankyo (research), Genentech (research), GSK (research), and Sanofi (research). LJ reports the following disclosures: Pack Health (employment). DP reports the following disclosures: Pack Health (employment). ML reports the following disclosures: EUSA Pharma (consulting) and Oncopeptides (consulting). SWW reports the following disclosures: Amgen (consulting), BMS (research), Caelum (research), Genentech (research), Fortis (research), GSK (research), Janssen (research), and Sanofi (consulting). JW reports the following disclosures: Amgen (consulting), Celgene (consulting), Janssen (consulting), Novartis (consulting), and Takeda (consulting). TGM reports the following disclosures: Amgen (research), GSK (consulting), Janssen (research), Juno (consulting), Roche (consulting), Sanofi (research), and Seattle Genetics (research). NS reports the following disclosures: Amgen (consulting), Bluebird Bio (research), BMS/Celgene (consulting/research), CareDx (consulting), GSK (consulting), Indapta Therapeutics (consulting), Janssen (research), Karyopharm (consulting), Kite (consulting), Nektar (research), Poseida (research), Sanofi (consulting), Sutro Biopharma (research), and Teneobio (research). The remaining authors report no relevant disclosures.

©Rahul Banerjee, Chiung-Yu Huang, Lisa Dunn, Jennifer Knoche, Chloe Ryan, Kelly Brassil, Lindsey Jackson, Dhiren Patel, Mimi Lo, Shagun Arora, Sandy W Wong, Jeffrey Wolf, Thomas Martin III, Anand Dhruva, Nina Shah. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.03.2022.

Figures

Figure 1
Figure 1
Flow diagram of enrolled patients. Abbreviations: DLC, digital life coaching; MM, multiple myeloma; SCT, stem cell transplantation.
Figure 2
Figure 2
Timeplot of bidirectional conversations. Days relative to SCT during which at least one bidirectional conversation took place are marked either by unboxed X icons (for outpatient) or boxed X icons (for inpatient). The 16-week study subperiod is divided into four 28-day subperiods as shown. *These patients underwent SCT but dropped out of the study prior to digital life coaching initiation. SCT: stem cell transplantation.
Figure 3
Figure 3
Repeated ePRO assessments over time. For QOL (physical), QOL (mental), and sleep disturbances, values represent population-adjusted T-scores with a mean of 50 and SD of 10. Higher values represent better physical/mental QOL and worsened sleep, respectively. For % elevated distress, values represent the percentage of patients at each timepoint who reported elevated distress (defined as a Distress Thermometer score of 4 or higher) [58]. ePRO: electronic patient-reported outcome; PROMIS: Patient-Reported Outcome Measurement Information System; QOL: quality of life; SCT: stem cell transplantation.

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Source: PubMed

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