340 Participants Needed

Comprehensive Care Model for Cancer Survivors

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Overseen ByAylin Diaz-Valladares, MA
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: Baylor College of Medicine
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Approved in 2 JurisdictionsThis treatment is already approved in other countries

Trial Summary

What is the purpose of this trial?

Cancer survivors have unique healthcare needs, including managing serious late effects, ongoing surveillance, lifestyle modifications to reduce second cancer risk, and psychosocial support. Nearly 70% of survivors have at least one comorbid chronic condition in addition to cancer, which complicates the delivery of quality cancer care. Medically underserved patients, who bear the highest burden of multiple chronic conditions, are at increased risk for poor outcomes during and after cancer treatment. Enhancing communication and collaboration between oncologists and primary care providers (PCPs) could improve health outcomes and care transitions for these patients, who often lack healthcare knowledge and access to supportive care. This study evaluates a novel shared care model for cancer survivors with chronic comorbidities, called OPTIMISE (Oncology-Primary Care Partnership to Improve Comprehensive Survivorship Care), in the largest safety-net healthcare system in Houston, Texas. Three hundred newly diagnosed breast, gastrointestinal, and hematological cancer patients being treated with curative intent and having comorbidities requiring ongoing management will be randomized to either OPTIMISE or Usual Medical Care (UMC). UMC patients will receive cancer treatment directed by their oncologist, a survivorship care plan (SCP) at the end of active treatment, and surveillance visits based on national guidelines. OPTIMISE patients will: 1) have an oncology nurse navigator assigned to their care team at diagnosis to facilitate oncologist-PCP communication; 2) receive coordinated care between their oncologist and PCP throughout cancer treatment and surveillance, facilitated by structured communication and referral processes; 3) receive an SCP that incorporates comorbidity management; and 4) follow a risk-stratified shared care model where some routine oncologist follow-up visits are replaced by PCP visits. Aim 1a evaluates OPTIMISE's impact on patient chronic disease self-management (primary outcome) and quality of life (secondary outcome). Aim 1b explores OPTIMISE's effects on healthcare use and patient unmet needs during and after treatment. Aim 2 examines OPTIMISE's impact on oncologist and PCP attitudes and care coordination. Aim 3 elucidates patient- and system-level factors influencing implementation outcomes. If effective, OPTIMISE could expand to other cancers and enhance care transitions in various medical settings.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on managing chronic conditions alongside cancer treatment, so it's likely you can continue your medications, but you should confirm with the trial coordinators.

What data supports the effectiveness of the treatment OPTIMISE, Lynparza for cancer survivors?

The research highlights the importance of comprehensive care models for cancer survivors, which can address physical and psychological needs. While specific data on OPTIMISE, Lynparza is not provided, integrated care models have shown improvements in areas like pain and depression, suggesting potential benefits for similar treatments.12345

How is the Comprehensive Care Model for Cancer Survivors different from other treatments?

The Comprehensive Care Model for Cancer Survivors is unique because it integrates palliative care (supportive care for serious illness) into survivorship care, addressing not just physical health but also psychological and social needs. This model shifts from a traditional medical approach to a wellness-focused approach, aiming to improve coordination of care and address long-term health needs after cancer treatment.13567

Research Team

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Hoda Badr, PhD

Principal Investigator

Baylor College of Medicine

Eligibility Criteria

This trial is for adults over 18 with a new or recent diagnosis of early-stage breast, GI, or blood cancer who are undergoing standard treatments. They must also have chronic conditions like diabetes or hypertension, engage in unhealthy lifestyle behaviors, and be fluent in English or Spanish. Both their oncologist and primary care provider must agree to participate.

Inclusion Criteria

For healthcare providers: 1) Person is an oncologist or PCP who treats patients with breast, GI, or hematologic malignancies at Harris Health BT/Smith Clinic

Exclusion Criteria

I am unable to understand or make decisions due to cognitive issues.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive cancer treatment with either OPTIMISE or Usual Medical Care (UMC) models, including coordination between oncologists and PCPs for comorbidity management.

4 months
Routine clinic visits at 2 and 4 months after treatment initiation

Survivorship Care Planning

Participants receive a survivorship care plan (SCP) at the end of active treatment, which includes reviews of therapies received, recommended surveillance, and lifestyle modifications.

1 month

Follow-up

Participants are monitored for safety and effectiveness after treatment, with follow-up surveys at 3, 6, and 12 months post SCP delivery.

12 months
Surveys at 3, 6, and 12 months post SCP delivery

Treatment Details

Interventions

  • OPTIMISE
Trial Overview The OPTIMISE program is being tested against usual medical care. It includes an oncology nurse navigator to help coordinate between the patient's cancer doctor and primary care provider during treatment and survivorship planning that incorporates managing other health conditions.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: OPTIMISEExperimental Treatment1 Intervention
OPTIMISE components to facilitate Patient self-management support are: 1) a bilingual oncology nurse navigator (ONN) and care coordination; 2) distress screening; 3) tailored comorbidity self-management action planning, 4) tailored survivorship action planning, and 5) surveillance reminders and follow-up. OPTIMISE components to facilitate provider decision support are: 1) when the initial referral is made, the ONN will send the PCP treatment plan summary (based on the ASCO treatment plan template) and standardized fact sheets on treatment toxicities; 2) throughout treatment, there will be bi-directional and structured communication between oncologist and PCP facilitated by the ONN; 3) The ONN will send the SCP to the PCP describing surveillance guidelines and summary of late effects. Finally, OPTIMISE will adopt a risk-stratified shared care model of post-treatment survivorship care.
Group II: Usual Medical Care (UMC)Active Control1 Intervention
UMC consists of standard oncologic care from point of diagnosis. Cancer patients with comorbidities are encouraged by their oncologist to follow up with their PCP regarding comorbidity management but no formal referral process is in place. At the end of cancer treatment (with standard, definitive therapies), patients meet with a nurse (Survivorship Nurse Practitioner, NP) to review the SCP, which is based on ASCO templates and populated from the EHR. The Survivorship NP also reviews therapies received, recommended surveillance, common late effects, and recommended lifestyle behaviors. Patients are given a printed copy of the SCP and are encouraged to share this information with their PCP. Cancer surveillance follows the traditional oncologist led model regardless of patient risk for recurrence.

Find a Clinic Near You

Who Is Running the Clinical Trial?

Baylor College of Medicine

Lead Sponsor

Trials
1,044
Recruited
6,031,000+

Findings from Research

A systematic review of 11 studies, including 8 randomized controlled trials, found that the shared care model for cancer survivors is as effective as usual care in terms of quality of life and clinical outcomes, while also being highly acceptable to patients and practitioners.
Patient satisfaction with shared care was reported to be higher than with usual care, suggesting that improved communication between primary and hospital care can enhance follow-up for cancer survivors.
The Effectiveness of Shared Care in Cancer Survivors-A Systematic Review.Zhao, Y., Brettle, A., Qiu, L.[2022]
Cancer survivors face lifelong risks of late effects from their treatment, which can lead to serious health issues, highlighting the importance of regular long-term follow-up care.
The 'Personalized Cancer Survivorship Care Model' developed in this study emphasizes personalized, multidisciplinary care that empowers survivors and supports self-management, aiming to improve health outcomes and cost-effectiveness across various healthcare systems.
Cancer Survivorship Care: Person Centered Care in a Multidisciplinary Shared Care Model.Loonen, JJ., Blijlevens, NM., Prins, J., et al.[2020]
The Ned algorithm is a nurse-led survivorship care model designed for men with prostate cancer, developed through collaboration with 20 clinical experts and 3 patient partners, aiming to improve decision-making and continuity of care.
This algorithm includes a structured alert system based on patient responses, allowing for timely interventions and empowering patients to manage their symptoms, although further validation through trials is needed.
An Actionable Expert-System Algorithm to Support Nurse-Led Cancer Survivorship Care: Algorithm Development Study.Pfisterer, KJ., Lohani, R., Janes, E., et al.[2023]

References

The Effectiveness of Shared Care in Cancer Survivors-A Systematic Review. [2022]
Cancer Survivorship Care: Person Centered Care in a Multidisciplinary Shared Care Model. [2020]
An Actionable Expert-System Algorithm to Support Nurse-Led Cancer Survivorship Care: Algorithm Development Study. [2023]
Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews. [2023]
Bridging the gap: Palliative care integration into survivorship care. [2023]
Survivorship care models for breast cancer, colorectal cancer, and adolescent and young adult (AYA) cancer survivors: a systematic review. [2019]
Implementing a survivorship care plan for patients with breast cancer. [2022]