Culturally adapted mobile treatment of chronic pain in adolescent survivors of pediatric bone sarcoma

适应文化的移动治疗小儿骨肉瘤青少年幸存者的慢性疼痛

基本信息

批准号：
10595896
负责人：
Nicholas S Phillips
金额：
$ 129.38万
依托单位：
ST. JUDE CHILDREN'S RESEARCH HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-20 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10595896
关键词：
Address Adolescence Adolescent Adult Affective Analgesics Anxiety Area Behavior Black Populations Black race Bone neoplasms Brain region Cancer Survivor Child Childhood Cognitive Cognitive Therapy Development Diagnosis Discrimination Disease Effectiveness Emotional Ethnic group Ewings sarcoma Face Fatigue Feedback Future General Population Geography Health Services Accessibility High Prevalence Hispanic Hispanic Populations Impairment Incidence Intervention Long-Term Survivors Mental Depression Mental Health Neurocognition Not Hispanic or Latino Operative Surgical Procedures Outcome Pain Pain intensity Pain management Parents Patients Pediatric Oncology Group Phase Physical Function Placebos Population Population Heterogeneity Prefrontal Cortex Prevalence Procedures Quality of life Race Randomized Randomized Clinical Trials Reporting Research Risk Sampling Sensory Site Sleep Social Functioning Structural Racism Supportive care Survivors Therapeutic Intervention Thinking Time Toxic effect Treatment Efficacy Underserved Population Youth associated symptom base cancer care childhood cancer survivor childhood sarcoma chronic pain chronic pain management comorbidity curative treatments daily functioning depressive symptoms deprivation ethnic difference ethnic diversity evidence base experience follow-up functional disability high risk implementation strategy implementation trial improved indexing member mortality opioid use osteosarcoma pain processing patient population physical conditioning post intervention programs racial and ethnic racial and ethnic disparities racial disparity remote delivery remote intervention sarcoma sleep quality social health determinants standard of care survivorship uptake

项目摘要

ABSTRACT More than 70% of children and adolescents diagnosed with a bone sarcoma now survive at least five years post- diagnosis. Unfortunately, curative treatments result in toxicities that leave many survivors with a substantial burden of adverse physical and mental health outcomes, including chronic pain. Up to 59% of long-term survivors report pain, and bone sarcoma survivors are 4 times as likely to report pain with daily interference compared to other survivors and have increased opioid use and markers for misuse. Relevant to this application, Black and Hispanic survivors disproportionately experience pain during survivorship. We suspect this disparity may be explained, in part, by social determinants of health (SDOH), which also contribute to disparities in the general population. Despite the high prevalence and burden of pain among Black and Hispanic childhood cancer survivors, non-pharmacologic interventions tailored for this population are lacking. Cognitive behavioral therapy (CBT) is an established non-pharmacologic treatment for chronic pain that focuses on addressing maladaptive thoughts and behaviors related to pain, and when combined with transcranial direct current stimulation (tDCS) of brain regions responsible for cognitive and affective processing of pain may enhance chronic pain control in cancer survivors. The recent development of mobile CBT programs and remote delivery of tDCS has reduced barriers to access care. However, these programs have not been adapted to be culturally responsive to underserved populations thus limiting their reach, utility, and uptake. We propose to culturally tailor an established, evidence-based mobile CBT program for chronic pain to Black and Hispanic adolescent survivors. Once the program is fully adapted, we propose to pair the culturally adapted mobile CBT with remotely delivered tDCS in a racially/ethnically diverse sample of non-Hispanic White, non-Hispanic Black, and Hispanic adolescent survivors of pediatric bone sarcoma. Further, we propose to examine the impact of patient-reported comorbidities (e.g., depression, anxiety, sleep) and SDOHs (e.g., area deprivation index, parent SES) on intervention outcomes. Importantly, non-pharmacological interventions delivered during adolescence and early survivorship are critical to modify a trajectory of chronic pain and negative outcomes into adulthood. Positive results from this study will be used for a future Phase 3 implementation trial to demonstrate generalizability and scalability to the large and geographically diverse population of all childhood cancer survivors with chronic pain.

抽象的超过 70% 被诊断患有骨肉瘤的儿童和青少年现在至少能存活五年诊断。不幸的是，治疗方法会产生毒性，使许多幸存者遭受严重的伤害。不良身心健康结果的负担，包括慢性疼痛。高达 59% 的长期幸存者报告疼痛，与日常干扰相比，骨肉瘤幸存者报告疼痛的可能性是其他人的 4 倍其他幸存者，阿片类药物的使用和滥用标记有所增加。与此应用程序相关，黑色和西班牙裔幸存者在生存过程中经历痛苦的比例不成比例。我们怀疑这种差异可能是部分原因是健康的社会决定因素（SDOH），这也导致了总体差异人口。尽管黑人和西班牙裔儿童癌症的患病率和疼痛负担很高对于幸存者来说，缺乏针对这一人群的非药物干预措施。认知行为疗法（CBT）是一种针对慢性疼痛的既定非药物治疗方法，重点解决适应不良问题与疼痛相关的想法和行为，以及与经颅直流电刺激 (tDCS) 相结合的情况负责疼痛认知和情感处理的大脑区域可能会增强慢性疼痛控制癌症幸存者。最近移动 CBT 程序和 tDCS 远程交付的发展减少了获得护理的障碍。然而，这些计划尚未适应文化需求服务不足的人群，从而限制了其覆盖范围、效用和吸收。我们建议在文化上定制为黑人和西班牙裔青少年幸存者的慢性疼痛建立了基于证据的移动 CBT 计划。一旦该计划完全适应，我们建议将适应文化的移动 CBT 与远程交付配对在非西班牙裔白人、非西班牙裔黑人和西班牙裔青少年的种族/民族多样化样本中进行 tDCS 小儿骨肉瘤的幸存者。此外，我们建议检查患者报告的合并症的影响干预（例如抑郁、焦虑、睡眠）和 SDOH（例如面积剥夺指数、家长 SES）结果。重要的是，在青春期和早期生存期间提供非药物干预对于改变成年后慢性疼痛和负面结果的轨迹至关重要。由此取得积极成果研究将用于未来的第 3 阶段实施试验，以证明其普遍性和可扩展性患有慢性疼痛的儿童癌症幸存者人数众多且分布广泛。