Navigated Early Survivorship Transition in Patients With Newly Diagnosed Cancer and Their Caregivers

PRIMARY OBJECTIVES:

I. In a new model of survivorship care planning, planning started within the first two months of therapy, followed by additional survivorship care planning at the end of therapy or 6 months post diagnosis, evaluate the proportion of eligible survivors and participating caregivers who complete the survivorship care planning.

II. In a feasibility study of survivors and their identified support caregivers (70 survivors with or with a participating caregiver at VICC and 70 survivors with or without a participating caregiver at MMC), evaluate psychosocial well-being, engagement, resource utilization and adherence to recommended treatment and follow-up guidelines.

III. Assess the outcomes of survivors and participating caregivers treated at VICC and MMC to further individualize survivorship planning that will incorporate the optimal timing and content together with socioeconomic and cultural considerations. The pillars of this novel intervention (i.e., survivorship care planning, psychosocial assessment and patient engagement) are responsive to the recommendations of the IOM. The project proposed herein will build directly upon our work in the P20 grant and will set the stage for the planned R01 RCT, which would be directly responsive to NCI PAR 12-275. The ultimate aim is to inform best practices in survivorship planning in community and academic cancer centers, serving diverse, including underserved minority populations, with sufficient power to detect differences between treatment groups.

OUTLINE: Patients and their caregivers participate in an upfront survivorship care planning session.

Patients and their caregivers meet with the Survivorship Nurse Practitioner (NP) at the VICC or the Nurse Navigator (NN) at MMC during an initial survivorship care planning session (30 minutes total) to identify resources that may be needed during and following therapy. The patient and their caregiver then meet together with the NP or NN (60 minutes total) to discuss the planned therapy, the expected course of recovery and recommendations for follow-up, and are provided with a preliminary survivorship care plan (SCP). Caregivers also receive the National Cancer Institute publication, "When Someone You Love is Being Treated for Cancer". Patients and their caregivers proceed with therapy. At the end of therapy, patients and their caregivers schedule a one-hour visit with the NP or NN for a booster survivorship care planning session (SCPS). At this booster session, they will review the questionnaires and receive an individualized final SCPS and the "REACH for Survivorship" handbook.

After completion of treatment for cancer, patients and their caregivers complete follow up assessments at the end of treatment and again two months after the end of treatment.

• Educational Intervention (Other), also known as Education for Intervention, Intervention, Educational: Receive publication, "When Someone You Love is Being Treated for Cancer", a preliminary individualized Survivorship Care Plan (SCP), a final individualized SCP, and the "REACH for Survivorship" handbook.
• Follow-Up Care (Other): Complete Survivorship Care Planning session at end of treatment
• Psychosocial Assessment and Care (Procedure), also known as Psychosocial Assessment, Psychosocial Care, Psychosocial Care/Assessment, Psychosocial Studies, Psychosocial Support: Undergo the NEST intervention
• Questionnaire Administration (Other): Ancillary studies

Primary outcomes

• Patient and caregiver engagement, measured by the PHQ, IES-R, Distress Thermometer, & Effective Consumer Scale-17 & Psychosocial well-being, measured by the Patient Health Questionnaire (PHQ), Impact of Event Scale-Revised (IES-R), & Distress Thermometer [Up to 2 months following the end of therapy]: Will be compared between participants (patients and caregivers) and between those treated at VICC and MMC. Will use continuous scores on the depression, anxiety, and somatic symptom scales for the primary analyses; supplemental analyses will examine the percentage of patients above and below the recommended clinical cut-offs on these scales before and after the interventions. Will develop a regression model with the treatment group as the primary variable of interest.

Secondary outcomes

• Adherence to National Comprehensive Cancer Network (NCCN) guidelines, as measured by chart review (patients only) [Up to 2 months following the end of therapy]: Will develop a regression model with the treatment group as the primary variable of interest.
• Referral to subspecialists [Up to 2 months following the end of therapy]: Will develop a regression model with the treatment group as the primary variable of interest.
• Resource utilization, as measured by the Effectiveness in Obtaining Resources Scale and the Cancer Resource Survey [Up to 2 months following the end of therapy]: Will develop a regression model with the treatment group as the primary variable of interest.
• Usefulness of navigation, as measured by the Usefulness of Navigator instrument [Up to 2 months following the end of therapy]: Will develop a regression model with the treatment group as the primary variable of interest.

Other outcomes

• Completion rates [Up to 2 months following the end of therapy]: Will be descriptive. Will develop a regression model with the treatment group as the primary variable of interest. Will conduct univariable tests of significance using chi-squared tests.
• Participation rates [Up to 2 months following the end of therapy]: Will be descriptive. Will develop a regression model with the treatment group as the primary variable of interest. Will conduct univariable tests of significance using chi-squared tests.
• Process assessment, as measured by process evaluation questionnaire [Up to 2 months following the end of therapy]: Will be descriptive. Will develop a regression model with the treatment group as the primary variable of interest. Will conduct univariable tests of significance using chi-squared tests.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Newly diagnosed adult cancer patients from VICC and MMC
* Caregiver of enrolled newly diagnosed adult cancer patients from VICC and MMC
* No prior history of malignancy other than non-melanoma skin cancer
* Planned treatment for stages I - III cancer
* Treatment expected to be completed within 12 months
* English speaking

Exclusion Criteria:

* Prior history of malignancy other than non-melanoma skin cancer
* Patients treated with surgery alone will not be included
* Patients whose treatment is expected to last more than 12 months
* Non-English speaking

• Debra Friedman, Principal investigator, Vanderbilt University/Ingram Cancer Center

NIH grants: P30CA068485