ECHO Model for Advanced Cancer Care Quality

Overseen By Sriram Yennu

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: M.D. Anderson Cancer Center

Disqualifiers: Unable to understand consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 27

312 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial investigates the experience and satisfaction of care in patients with cancer that has spread to other places in the body (advanced) and their caregivers living in underserved areas of Kenya, Nigeria, Ghana, South Africa, India and Ethiopia as part of Project Extension for Community Healthcare Outcomes (ECHO). Project ECHO is a model of medical education and care management that empowers clinicians to provide better care to more people where they live. Understanding the experiences and satisfaction of patients and caregivers may help improve healthcare workforce capacity and increase access to specialty care for the world's rural and underserved populations.

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 is best to discuss this with the research team or your doctor.

What data supports the effectiveness of the treatment Project ECHO for advanced cancer care?

The ECHO model has shown promise in building cancer control capacity among healthcare professionals, suggesting it could improve care quality for advanced cancer patients by enhancing knowledge and skills in underserved areas. ^{1 2 3 4 5}

How does the ECHO Model for Advanced Cancer Care Quality differ from other treatments for advanced cancer?

The ECHO Model is unique because it uses a telementoring approach to improve cancer care by connecting local healthcare providers with specialists, allowing for shared knowledge and best practices without the need for patients to travel. This model helps reduce disparities in cancer care, especially in underserved areas, by providing high-quality education and support to healthcare professionals. ^{4 6 7 8 9}

Research Team

Sriram Yennu

Principal Investigator

M.D. Anderson Cancer Center

Eligibility Criteria

This trial is for adult patients with advanced cancer and their caregivers in Kenya, Nigeria, Ghana, South Africa, India, and Ethiopia. Participants must be able to read English and have a life expectancy of at least one year. Caregivers need to be the primary support person. Healthcare providers interested in Project ECHO can also join if they commit for two years.

Inclusion Criteria

I am willing to stay in touch with the research team by phone or in person.

I am 18 years old or older.

Caregiver willing to be accessible to the research team for follow-up by telephone or in person

Exclusion Criteria

I am able to understand and sign the consent form.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

ECHO Clinics and Workshops

Participants participate in online ECHO clinics over 1 hour twice monthly for 12 months and in-country workshops twice per year.

12 months

24 online sessions, 2 in-country workshops

Patient and Caregiver Assessment

Patients and caregivers complete questionnaires and interviews about their experience and satisfaction with care.

24 months

3 in-person or phone questionnaires every 3 months for patients; up to 8 questionnaires for caregivers

Follow-up

Participants are monitored for changes in quality of life and symptom distress.

12 months

Treatment Details

Interventions

• Project ECHO

Trial Overview The trial evaluates Project ECHO's impact on palliative care quality through telementoring clinics, workshops, education programs for oncologists, medical chart reviews, and questionnaires assessing patient/caregiver satisfaction in underserved areas.

Participant Groups

Group I: Arm III: Caregivers (questionnaire) Experimental Treatment 1 Intervention

Caregivers complete an in-person or phone questionnaire over 5 minutes up to 8 times about their experience and satisfaction with the cancer care their family member has received. Caregivers complete a 15-minute interview in person or by phone their family member received by their physician.

Group II: Arm II: Patients (questionnaire, medical chart review) Experimental Treatment 2 Interventions

Patients complete 3 in-person or phone questionnaires over a total of 20 minutes every 3 months for 2 years about their symptoms, emotional and physical well-being, and their experience and satisfaction with outpatient oncology care. Patients' medical charts are reviewed for data collection. Patients complete a 15 minute interview in person or phone about the care they received by their physician at baseline, end of month 4 and month 12.

Group III: Arm I: ECHO Participants (ECHO clinics, workshop, education) Experimental Treatment 3 Interventions

Participants participate in online ECHO clinics over 1 hour twice monthly for 12 months and in-country workshops twice per year. Participants also receive 5 core lectures through an internet-based professional education curriculum.

Who Is Running the Clinical Trial?

M.D. Anderson Cancer Center

Lead Sponsor

Trials

3,107

Recruited

1,813,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

There is a significant lack of research on the unique needs of cancer survivors with advanced or metastatic cancer, highlighting the necessity for better understanding their physical and psychosocial symptoms.

The National Cancer Institute has identified key research areas to address these gaps, including improving symptom management, enhancing communication between healthcare providers and patients, and developing tailored survivorship care models.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Survivorship for Individuals Living With Advanced and Metastatic Cancers: National Cancer Institute Meeting Report. Mollica, MA., Smith, AW., Tonorezos, E., et al.[2022]

A new conceptual framework has been developed to create quality indicators for end-of-life care in advanced cancer patients, focusing on improving pain management, symptom relief, and coordination of care.

The framework outlines five essential steps for developing these indicators, ensuring they are evidence-based, feasible, and relevant to the needs of seriously ill patients and their families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A framework for assessing quality indicators for cancer care at the end of life. Seow, H., Snyder, CF., Mularski, RA., et al.[2009]

Only 5.0% of patients with advanced solid tumors received outpatient specialty palliative care (OSPC) in 2016, highlighting a significant gap in access to these services.

Patients were 19 times more likely to use OSPC if their oncologist's practice was located in the same facility as the OSPC clinic, and those living closer (under 30 minutes) were also significantly more likely to access these services, indicating that clinic location and travel time are critical factors in OSPC utilization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

System-Level Factors Associated With Use of Outpatient Specialty Palliative Care Among Patients With Advanced Cancer. Yu, JA., Ray, KN., Park, SY., et al.[2023]

The Project ECHO model has been evaluated for its effectiveness in training healthcare professionals in underserved communities about cancer prevention and survivorship care, showing it is a feasible approach to enhance cancer control capacity.

Preliminary evidence suggests that this model can successfully democratize knowledge among health professionals, potentially improving cancer care in areas with limited resources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Building Cancer Control Capacity in Health Professionals Through Telementoring: A Survey Study of a Cancer Prevention and Survivorship Care ECHO Program. Milgrom, ZZ., Severance, TS., Scanlon, CM., et al.[2023]

Patient-reported outcome measures (PROMs) can significantly enhance the care of metastatic breast cancer (MBC) patients by improving health-related quality of life (HRQoL) and balancing survival with quality of life, as identified by the Advanced Breast Cancer Global Alliance's goals for 2015-2025.

Nurses and nurse practitioners play a vital role in implementing PROMs in routine care, which can lead to better patient outcomes, including improved communication, access to support services, and meeting patients' informational needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient-Reported Outcome Measures to Improve the Care Continuum for Patients With Metastatic Breast Cancer: Opportunities and Implications for Nursing Practice. de Ligt, KM., de Rooij, BH., Koppert, LB., et al.[2023]

Project ECHO is a knowledge dissemination platform designed to improve cancer care by increasing workforce capacity and sharing best practices, particularly in underserved communities.

The platform has been successfully implemented in various programs worldwide, demonstrating its potential to address disparities in cancer care, especially in low and middle-income countries facing a growing cancer burden.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. Varon, ML., Baker, E., Byers, E., et al.[2021]

The Project ECHO initiative successfully implemented a telementoring model for cancer care in Buenos Aires, evaluating 80 patients from 37 centers over 3 years, which helped improve access to expert medical knowledge for gastrointestinal tumors.

This approach not only reduced disparities in cancer care by facilitating multidisciplinary discussions but also proved to be cost-effective by minimizing unnecessary treatments and travel expenses for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of a virtual multicenter gastrointestinal tumor board to reduce cancer disparities in Argentina. Esteso, F., Tissera, NS., O'Connor, JM., et al.[2022]

Project ADAPT aims to improve care coordination for patients with metastatic breast cancer (MBC) by implementing a collaborative care model across multiple community hospitals, ensuring that patients receive optimal care regardless of their location.

The study is currently in the exploration phase, having recruited 21 participants to refine the collaborative care process, with plans to enroll more patients and oncologists to evaluate the model's impact on referral satisfaction and overall care experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapting and Developing an Academic and Community Practice Collaborative Care Model for Metastatic Breast Cancer Care (Project ADAPT): Protocol for an Implementation Science-Based Study. Housten, AJ., Okere, UC., Colditz, GA., et al.[2023]

Project ECHO is an effective model that enhances the skills and confidence of primary care clinicians through telementoring, allowing patients in underserved areas to receive high-quality care without long travel times.

A new replication tool developed for the ECHO model has successfully improved its implementation in the Army Pain initiative, suggesting it could enhance the fidelity of ECHO replications globally.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expanding Health Care Access Through Education: Dissemination and Implementation of the ECHO Model. Katzman, JG., Galloway, K., Olivas, C., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Survivorship for Individuals Living With Advanced and Metastatic Cancers: National Cancer Institute Meeting Report. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

A framework for assessing quality indicators for cancer care at the end of life. [2009]

3. United States pubmed.ncbi.nlm.nih.gov

System-Level Factors Associated With Use of Outpatient Specialty Palliative Care Among Patients With Advanced Cancer. [2023]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Building Cancer Control Capacity in Health Professionals Through Telementoring: A Survey Study of a Cancer Prevention and Survivorship Care ECHO Program. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Patient-Reported Outcome Measures to Improve the Care Continuum for Patients With Metastatic Breast Cancer: Opportunities and Implications for Nursing Practice. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Implementation of a virtual multicenter gastrointestinal tumor board to reduce cancer disparities in Argentina. [2022]

8. Canada pubmed.ncbi.nlm.nih.gov

Adapting and Developing an Academic and Community Practice Collaborative Care Model for Metastatic Breast Cancer Care (Project ADAPT): Protocol for an Implementation Science-Based Study. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Expanding Health Care Access Through Education: Dissemination and Implementation of the ECHO Model. [2022]