Scalable TELeheaLth Cancer CARe: The STELLAR Program to Treat Cancer Risk Behaviors

Study Overview
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Brief Summary
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The goal of this clinical trial is to improve cancer patient's health, survival, and quality of life by dispelling risk behaviors for Northwestern Memorial Health Care (NMHC) patients who are cancer survivors. The main question[s] STELLAR aims to answer are: How best to combine three behavior interventions (physical activity promotion, smoking cessation, obesity treatment) into one treatment. Evaluate the reach of the program. We will look at the number, proportion, and representativeness of participants in terms of disease characteristics, socioeconomic status, telehealth readiness, and race/ethnicity. Evaluate the effects of the STELLAR program relative to enhanced usual care (information provision) on cancer risk behaviors, patient care access, care quality, and communication. Participants will be provided goals related to their physical activity, smoking, and/or weight loss and asked to track their health behaviors via an app, excel file, or on paper. At baseline, 3 months, 6 months and 12 months into the study, participants will provide survey responses and physical measurements like height and weight. Additionally, those in the STELLAR group will complete 16 telehealth sessions with study staff to discuss progress towards their study goals. Researchers will compare the STELLAR intervention group to the Enhanced Usual Care group to see if the STELLAR intervention group is able to reach more participants that Enhances Care only.

Detailed Description
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The goal of this clinical trial is to decrease adverse outcomes and improve cancer patient's health, survival, and quality of life by dispelling risk behaviors for Northwestern Memorial Health Care (NMHC) patients. The main question[s] STELLAR aims to answer are: How best to combine three existing effective cancer risk behavior interventions (physical activity promotion, smoking cessation, obesity treatment) into one treatment program within the existing NMHC environment. Evaluate the reach of the STELLAR program. We will look at the number, proportion, and representativeness of individuals who are willing to participate in terms of disease characteristics, socioeconomic status, telehealth readiness, and race/ethnicity. Evaluate the effects of the STELLAR program relative to enhanced usual care (information provision) on cancer risk behaviors, patient care access, care quality, healthcare utilization, patient-provider communication, cost and health outcomes (symptoms and quality of life). Participants will be recruited through several channels (MyNM, direct outreach from research staff, EDW). Interested patients will then be randomly assigned to the STELLAR program arm, or Enhanced Usual Care. Participants in the STELLAR program will be enrolled for a year into the program. Participants will be provided goals related to their physical activity, smoking, and/or weight loss and asked to track their health behaviors via an app, excel file, or on paper. At baseline, 3 months, 6 months and 12 months into the study, participants will provide survey responses and physical measurements like height and weight. Additionally, those in the STELLAR group will complete 16 telehealth sessions with study staff to discuss progress towards their study goals. Researchers will compare the STELLAR intervention group to the Enhanced Usual Care group to see if the STELLAR intervention group is able to reach more participants that Enhances Care only.

Official Title
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Scalable TELeheaLth Cancer CARe: The STELLAR Program to Treat Cancer Risk Behaviors

Conditions
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Obesity, Smoking Cessation, Physical Inactivity

Intervention / Treatment
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* Behavioral: multiple behavior change therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Northwestern Medicine patient Over 18 years old Meet at least 2 of the following 3 criteria: Engage in <150 min/week of physical activity BMI of ≥25 Report daily smoking. History of cancer (all tumor types) Ability to attend telehealth visits either via landline, cell phone, smartphone, tablet, laptop, or desktop computer Exclusion Criteria: Currently in another dietary, weight loss, smoking cessation (including cessation pharmacotherapy), or physical activity treatment/intervention. Limited level of oral and written English or Spanish Cognitively impaired adults Prisoners. Participants will be excluded from the physical activity and weight loss interventions (but not the smoking cessation component) for: Absolute contraindications to exercise (i.e., acute myocardial infarction, complete heart block, acute congestive heart failure, unstable angina, uncontrolled hypertension), metastatic disease or planned elective surgery Pregnant or plans to become pregnant. Individuals engaging in the physical activity or weight loss interventions must pass pre- physical activity participation screening or obtain medical clearance

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is a randomized control trial with 2 parallel intervention arms. One arm will be the active treatment group, and the other an enhanced usual-care control group. Assessors will be blinded to study condition, and intervention will be behavioral.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: STELLAR Program<br>STELLAR arm participants will receive goals related to their physical activity, smoking, and/or obesity, and will be asked to meet those goals weekly/daily. Participants will also be asked to record their weight, activity, and/or cigarette smoking daily, and will complete 16 telehealth sessions with study staff across the 12 months of the study. Will have physical measures taken or extracted from the medical record at baseline, 3 months, 6 months, and 12 months. | Behavioral: multiple behavior change therapy<br>* goals related to their physical activity, smoking, and/or obesity, and will be asked to meet those goals weekly/daily. Participants will also be asked to record their weight, activity, and/or cigarette smoking daily, and will complete 16 telehealth sessions with study staff across the 12 months of the study. Will have physical measures taken or extracted from the medical record at baseline, 3 months, 6 months, and 12 months.<br>|
| No Intervention: Enhanced Usual Care<br>Patients in the EUC group will receive informational packets about their risk behaviors - obesity, physical inactivity, and/or smoking. Will have physical measures taken or extracted from the medical record at baseline, 3 months, 6 months, and 12 months | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reach/Access | A) We will evaluate the Reach of the risk behavior screening system by assessing the number of cancer survivors exposed to EHR screening and the proportion and representativeness of those who enroll in the study and are randomized. B) We will also evaluate the Reach of the STELLAR intervention by assessing the proportion and representativeness (in terms of disease characteristics, socioeconomic status, telehealth access, technology literacy, race/ethnicity, and insurance status) of those randomized to active intervention who attend at least one treatment session. | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Smoking | Assessed using Timeline Followback interview, participants who report any smoking, even a puff, in the 7 days prior to the visit will be classified as a current smoker | baseline, 3, 6, 9, and 12 months | 
| Body Weight | patient reported body weight in lbs. | baseline, 3, 6, 9, and 12 months | 
| Self-Reported Weekly Amount (in days and minutes) of Moderate Intensity Physical Activity | Patient-reported weekly amount of moderate intensity physical activity in days and minutes will be assessed at each time point. Participants will be asked in the last 7 days, how many days they engaged in moderate intensity activity. Then on the days they were active, about how many minutes they were active (Less than 30 Minutes; 30 minutes to less than 1 hour; 1 hour to less than 1.5 hours; 1.5 hours to less than 2 hours; 2 hours to less than 2.5 hours; Over 2.5 hours) | baseline, 3, 6, 9 and 12 months | 
| Godin Leisure Time Exercise Questionnaire | It is a valid and reliable measure of PA participation. Participants will indicate frequency of participation in strenuous, moderate, and mild exercise over the past 7 days and average time spent in each activity | baseline, 3, 6, 9 and 12 months | 
| Total Healthcare Cost and Amount of Patient Care Utilization | The following data will be extracted from the medical record: unplanned, all-cause hospital admissions; potentially avoidable, all-cause emergency department use; 7-day hospital readmissions; and use of triage clinic. Since not all patients receive all their care within the NMHC system, they will also be asked to self-report these data. | baseline, 3, 6, 9, and 12 months | 
| Rating of Care Quality as Measured by the Consumer Assessment of Healthcare Providers & Systems Cancer Care Survey) | Relevant subscales from AHRQ's Consumer Assessment of Healthcare Providers & Systems (CAHPS) Cancer Care Survey will be used: The specific subscales include: How Well the Cancer Care Team Communicates with Patients. This subscale asks the participant about provider communication on a 4-point scale from never to always in terms of how well the provider explained things in an easy-to-understand way, listened carefully to patient, showed respect to patient, and spent enough time with patient. Availability of Interpreters. This subscale asks yes/no if the patient ever needed an interpreter for visits, and if yes, how often they received one on a 4-point scale from never to always Overall Rating of Cancer Team and Cancer Care. This is a single question asking patients to rate their provider on a 1-10 scale with 1 being the worst provider possible and 10 being the best provider possible | baseline, 3, 6, 9, and 12 months | 
| Rating of Patient-Provider Communication and Shared Decision-Making as Measured by The Interpersonal Process of Care (IPC32) | The Interpersonal Process of Care (IPC32), will assess the patient's thoughts on physician-patient interpersonal interactions. The IPC evaluates: The patients' assessment of their physician's communication quality by asking how often physicians perform certain activities (e.g. eliciting concerns, explanations) on a scale from 1 = never to 5 = always. The patient's assessment of how often their provider includes them in decisions about their own health (shared-decision making) on a scale from 1 = never to 5 = always. The patient's assessment of their provider's interpersonal style based on how often the provider displayed certain behaviors (e.g. compassion, respect) on a scale from 1 = never to 5 = always. | baseline, 3, 6, 9, and 12 months | 
| Rating of Symptoms and Functioning as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS-29) Profile | The Patient-Reported Outcomes Measurement Information System (PROMIS-29) Profile assesses fatigue, depression, anxiety, ability to participate in social roles and activities, sleep disturbance, physical function, and pain interference/intensity on a 1-5 rating scale with 1 being the worst rating and 5 being the best. | baseline, 3, 6, 9, and 12 months | 
| Rating of Quality of Life Using the Health Related Quality of Life Short Form (HRQOL SF-12) | Quality of Life will be assessed using the Health Related Quality of Life Short Form (HRQOL SF-12). The tool measures two independent dimensions of HRQOL: physical (physical functioning, role functioning, bodily pain, and general health) and emotional (vitality, social functioning, role functioning and mental health) as well as an aggregate score. Scores range from 0 to 100, with higher scores indicating better physical and mental health functioning. | baseline, 3, 6, 9, and 12 months |