eHealth Intervention for Late Effects of Childhood Cancer

针对儿童癌症晚期影响的电子健康干预

• 批准号: 10360427
• 负责人: Tara M Brinkman
• 金额: $ 66.44万
• 依托单位: ST. JUDE CHILDREN'S RESEARCH HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10360427
• 关键词: Address; Adolescent; Adult; Anxiety; Behavior; Biological Markers; Cardiac health; Cardiovascular Diseases; Cardiovascular system; Child; Childhood Cancer Survivor Study; Childhood Cancer Treatment; Chronic; Clinical; Cognitive Therapy; Cohort Studies; Comorbid Insomnia; Development; Diagnosis; Fatigue; Female; General Population; Geography; Health; Health Professional; Inflammation; Internet; Intervention; Late Effects; Long-Term Survivors; Malignant Childhood Neoplasm; Malignant Neoplasms; Mediating; Mental Depression; Mental Health; Morbidity - disease rate; Neurocognitive; Neurocognitive Deficit; Online Systems; Outcome; Patient Education; Population; Population Heterogeneity; Quality of life; Randomized; Randomized Clinical Trials; Reporting; Risk; Sampling; Sleep; Sleep disturbances; Sleeplessness; Survivors; Symptoms; Thinking; Toxic effect; Training; United States; base; cancer therapy; cardiovascular health; cardiovascular risk factor; childhood cancer survivor; cognitive performance; comorbidity; comparison intervention; curative treatments; eHealth; efficacious intervention; efficacy evaluation; emotional distress; emotional symptom; future implementation; health care availability; health related quality of life; improved; intervention effect; male; malignant breast neoplasm; neurotoxic; physical conditioning; post intervention; programs; psychologic; recruit; reduce symptoms; remediation; standard of care; survivorship; symptomatic improvement; web-based intervention

ABSTRACT More than 80% of children diagnosed with a malignancy now survive five years, with most living well into adulthood. This has resulted in a growing population of childhood cancer survivors, estimated to approach half a million by 2020. Unfortunately, curative treatments result in toxicities that leave many survivors with a substantial burden of adverse physical and mental health outcomes. Morbidities commonly observed after childhood cancer treatment include neurocognitive impairment in 40-50% of survivors, emotional distress, and cardiovascular disease. These late effects are often comorbid and may interact to synergistically contribute to adverse health outcomes. Symptoms of insomnia, reported by approximately 30-45% of adult survivors of childhood cancer, are believed to be a key player in this dynamic. We have demonstrated that insomnia is associated with neurocognitive impairment in adult survivors of childhood cancer and that reduction in insomnia is associated with improved cognitive performance. In the general population, insomnia is also associated with increased cardiovascular symptoms, including a 45% increased risk of developing or dying from cardiovascular disease. We hypothesize that by treating insomnia, improvements will be observed in neurocognitive function, emotional distress, and biomarkers of cardiovascular risk. Cognitive Behavioral Therapy for Insomnia (CBTi) is an established non-pharmacologic treatment that focuses on addressing problematic thoughts and behaviors related to insomnia. However, limited access to and availability of health care professionals trained to deliver CBTi has led to development of internet-based CBTi, which has been found effective in treating insomnia and comorbid psychological and fatigue symptoms in the general population and in survivors of adult onset cancers. We are proposing to conduct a randomized clinical trial to evaluate the efficacy of an internet-based CBTi intervention (SHUTi) on insomnia in adult survivors of childhood cancer. Importantly, while SHUTi has been shown to be efficacious in other populations, symptoms of insomnia in adult survivors of childhood cancer may have persisted for several decades and often co-occur with other treatment-related late effects. Therefore, we propose to examine the direct impact of SHUTi on improving insomnia, and the mediating effect of improved insomnia on neurocognitive functioning. We also will examine the contribution of changes in emotional distress and biomarkers of cardiovascular health following treatment for insomnia to survivor quality of life. We will recruit 352 survivors with comorbid insomnia and neurocognitive problems from the Childhood Cancer Survivor Study (CCSS). Positive results from this study cohort and our use of an internet-based intervention are likely to generalize and be scalable to the large and geographically diverse population of childhood cancer survivors with chronic health conditions.

抽象的 现在有80％以上被诊断出患有恶性肿瘤的儿童现在生存了五年，大多数人生活得很好 成年。这导致了越来越多的儿童癌症幸存者，估计接近一半 到2020年，一百万美元。不幸的是，治愈性治疗导致毒性，使许多幸存者拥有 不利的身体和心理健康成果负担很大。通常在 儿童癌症治疗包括40-50％幸存者的神经认知障碍，情绪困扰和 心血管疾病。这些后期效果通常是合并的，可能会与协同互动有助于 不利的健康结果。失眠的症状，大约30-45％的成人幸存者报告 儿童癌症被认为是这种动态的关键人物。我们已经证明失眠是 与儿童癌症成人幸存者的神经认知障碍相关，失眠症的减少 与改善的认知表现有关。在一般人群中，失眠也与 心血管症状增加，包括增加或死于心血管的风险增加45％ 疾病。我们假设通过治疗失眠，将在神经认知功能中观察到改善， 情绪困扰和心血管风险的生物标志物。失眠（CBTI）的认知行为疗法为 既定的非药物治疗 与失眠有关。但是，受过培训的医疗保健专业人员的访问和可用性有限 CBTI导致了基于Internet的CBTI的发展，该CBTI被发现有效治疗失眠和 普通人群和成人发作癌症幸存者的合并心理和疲劳症状。 我们建议进行一项随机临床试验，以评估基于Internet的CBTI的功效 对儿童癌症成年幸存者失眠的干预（闭塞）。重要的是，虽然Shuti一直 证明在其他人群中有效，成年童年幸存者失眠的症状 癌症可能已经持续了几十年，并且经常与其他与治疗有关的晚期同时发生 效果。因此，我们建议检查闭嘴对改善失眠和中介的直接影响 改善失眠对神经认知功能的影响。我们还将研究变化的贡献 治疗失眠后，情绪困扰和心血管健康的生物标志物生存质量 生活。我们将招募352个幸存者，患有童年的连续症失眠和神经认知问题 癌症幸存者研究（CCSS）。这项研究队列的积极结果以及我们对基于互联网的使用 干预措施可能会概括并扩展到大量和地理不同的人群 儿童癌症幸存者患有慢性健康状况。