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An online randomized controlled trial, with or without problem-solving treatment, for long-term cancer survivors after hematopoietic cell transplantation

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Abstract

Purpose

This randomized controlled trial examines the efficacy of INSPIRE, an INternet-based Survivorship Program with Information and REsources, with or without problem-solving treatment (PST) telehealth calls, for survivors after hematopoietic cell transplantation (HCT).

Methods

All adult survivors who met eligibility criteria were approached for consent. Participants completed patient-reported outcomes at baseline and 6 months. Those with baseline impaired scores on one or more of the outcomes were randomized to INSPIRE, INSPIRE + PST, or control with delayed INSPIRE access. Outcomes included Cancer and Treatment Distress, Symptom Checklist-90-R Depression, and Fatigue Symptom Inventory. Planned analyses compared arms for mean change in aggregated impaired outcomes and for proportion of participants improved on each outcome.

Results

Of 1306 eligible HCT recipients, 755 (58%) participated, and 344 (45%) had one or more impaired scores at baseline. We found no reduction in aggregated outcomes for either intervention (P > 0.3). In analyses of individual outcomes, participants randomized to INSPIRE + PST were more likely to improve in distress than controls (45 vs. 20%, RR 2.3, CI 1.0, 5.1); those randomized to INSPIRE alone were marginally more likely to improve in distress (40 vs. 20%, RR 2.0, CI 0.9, 4.5).

Conclusions

The INSPIRE online intervention demonstrated a marginal benefit for distress that improved with the addition of telehealth PST, particularly for those who viewed the website or were age 40 or older.

Implications for Cancer Survivors

Online and telehealth programs such as INSPIRE offer opportunities to enhance HCT survivorship outcomes, particularly for mood, though methods would benefit from strategies to improve efficacy.

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Funding

This research was supported by grants from the National Cancer Institute to K Syrjala, R01 CA112631 and R01 CA160684. W Leisenring was also supported in part by the NIH/NCI Cancer Center Support Grant P30 CA015704.

Author information

Authors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA

    Karen L. Syrjala, Jean C. Yi, Samantha B. Artherholt, Marie-Laure Crouch, Mary E. D. Flowers, Paul J. Martin & Wendy M. Leisenring

  2. University of Washington School of Medicine, Seattle, WA, USA

    Karen L. Syrjala, Joan M. Romano, Mary E. D. Flowers & Paul J. Martin

  3. University of California at San Francisco, San Francisco, CA, USA

    Allison S. Fiscalini

  4. Dartmouth Geisel School of Medicine, Hanover, NH, USA

    Mark T. Hegel

Authors
  1. Karen L. Syrjala
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  2. Jean C. Yi
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  3. Samantha B. Artherholt
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  4. Joan M. Romano
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  5. Marie-Laure Crouch
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  6. Allison S. Fiscalini
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  7. Mark T. Hegel
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  8. Mary E. D. Flowers
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  9. Paul J. Martin
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  10. Wendy M. Leisenring
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Corresponding author

Correspondence to Karen L. Syrjala.

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Syrjala, K.L., Yi, J.C., Artherholt, S.B. et al. An online randomized controlled trial, with or without problem-solving treatment, for long-term cancer survivors after hematopoietic cell transplantation. J Cancer Surviv 12, 560–570 (2018). https://doi.org/10.1007/s11764-018-0693-9

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  • DOI: https://doi.org/10.1007/s11764-018-0693-9

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