Feasibility and Preliminary Efficacy of a Mindfulness-based Intervention for Children and Young Adults With High Grade or High-Risk Cancer and Their Caregivers
Condition: Glioblastomas; Sarcoma; Astrocytoma; Brain Cancer; Leukemia
MeSH terms: Sarcoma; Glioblastoma; Astrocytoma; Brain Neoplasms
Study type: Interventional

Summary: 
      Background:

      People cope with cancer in different ways. Mindfulness means focusing on the present moment
      with an open mind. Researchers want to see if this can help children and young adults with a
      high-grade high-risk cancer with poor prognosis.

      Objective:

      To learn if mindfulness is feasible and acceptable for children and young people with
      high-grade high-risk cancer with poor prognosis and their caregivers.

      Eligibility:

      Children ages 5-24 with a high-grade or high-risk cancer, with a caregiver who agrees to do
      the study

      Must have internet access (participants may borrow an iPod for the study)

      Must speak English

      Design:

      All participants will complete questionnaires. These will be about feelings, physical
      well-being, quality of life, and mindfulness.

      Researchers will review children's medical records.

      Participants will be randomly put in the mindfulness group or the standard care group.

      Participants in the standard care group will:

      Get general recommendations for coping with cancer

      Have check-in sessions 1 and 3 weeks after starting. These will last about 10 minutes each.

      After participants finish the standard care group, they may be able to enroll in the
      mindfulness group.

      Participants in the mindfulness group will:

      Attend an in-person mindfulness training session. The child participant will meet with one
      research team member for 90 minutes while the parent participant meets with another. Then
      they will come together for a half hour.

      Practice mindfulness exercises at least 4 days a week for 8 weeks.

      Be asked to respond to weekly emails or texts asking about their mindfulness practice

      Get a mindfulness kit with things to help them do their mindfulness activities at home.

      Have a 30-minute check-in with their coach 1 and 3 weeks after starting. This can be in
      person or by video chat.

      All participants (from both groups) will be asked to answer follow-up questions about 8 and
      16 weeks after starting the study. Participants will be paid $20 for each set of
      questionnaires they complete to thank them for their time.

      ...
    

Detailed description: 
      Background

        -  Children and young adults diagnosed with a high-grade or high-risk cancer (e.g., diffuse
           intrinsic pontine glioma, glioblastoma multiforme, relapsed-refractory leukemia,
           refractory metastatic sarcomas) face a poor prognosis given limited curative options.

        -  Recent research has indicated that this population of patients and their parents
           experience elevated stress and poorer health-related quality of life (HRQL) relative to
           normative samples.

        -  Recently published psychosocial standards of care in pediatric oncology strongly
           recommend that children diagnosed with cancer and their caregivers receive early and
           continued assessment of their wellbeing and have access to interventions to optimize
           functioning and HRQL. In addition, there is increasing recognition of the importance of
           palliative interventions early in the disease trajectory.

        -  Despite this recommendation, minimal research has examined supportive care interventions
           for this population early in the disease trajectory.

        -  Mindfulness-based interventions (MBIs) have empirical support for their feasibility and
           efficacy in alleviating emotional distress and physical symptoms in children and adults
           with chronic health conditions, including terminally-ill patients and their caregivers.

      Objectives

      -To assess the feasibility of an enhanced mindfulness intervention (EMI) in children and
      young adults (ages 5-24 years) with a high-grade or high-risk cancer with poor prognosis and
      one of their primary caregivers.

      Eligibility

        -  Children and young adults ages 5-24 years and a parent or adult primary caregiver

        -  Diagnosis of a high-grade or high-risk cancer with poor prognosis

        -  English speaking

        -  Must have access to a mobile device or computer with internet.

        -  Potential participants will be excluded if there is evidence of pre-morbid severe
           cognitive or psychiatric disability in parent or child that would impair their capacity
           for participation, or if there is evidence of clinical disease progression at the time
           of referral to this study, such that it would prevent the child from engaging in the
           intervention.

      Design

        -  This is a pilot randomized controlled trial that will compare feasibility and
           preliminary efficacy of an 8-week enhanced mindfulness intervention (EMI) group (n=10
           dyads) compared to a psychoeducation control group (n=10 dyads).

        -  All participants will complete measures of feasibility (primary outcome) and exploratory
           outcomes at baseline and following the 8-week intervention. Exploratory measures will
           include emotional (e.g., depression, anxiety) and physical (e.g., pain, fatigue)
           wellbeing, as well as baseline mindfulness/self-compassion.

        -  The 8-week EMI will consist of one initial in-person session with the child and parent,
           a series of at-home assignments, and two booster sessions. The psychoeducation group
           will be given educational material about coping with cancer.

        -  The psychoeducation group will be offered the opportunity to participate in the EMI 8
           weeks post-baseline
    

Intervention name(s): Enhanced Mindfulness Intervention; Psychoeducation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The 8-week EMI will consist of one initial in-person session with the participant and parent, a series of at home assignments, and two "booster" sessions. The psychoeducation group will be given educational material about coping with cancer.; The psychoeducation group will be offered the opportunity to participate in the EMI 8 weeks post-baseline.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Refractory Metastatic Sarcoma; Diffuse Intrinsic Pontine Glioma DIPG; Relapsed-Refractory Leukemia; Meditation; Quality of Life