Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
COMPLETED
Clinical Phase
NA
Total Enrollment
23 participants
Study Classification
INTERVENTIONAL
Study Start Date
2024-01-03
Study Completion Date
2025-05-30
Brief Summary
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The goal of this research study is to evaluate an online inter-professional pain management program for survivors of breast cancer.
The main questions it aims to answer:
1. whether this treatment will help address the pain management concerns of patients,
2. whether it is feasible to offer this treatment in the future as multi-centre randomized controlled trial (RCT).
Participants will be asked to attend a 6-week online pain management group sessions (1h/week). Participants will also be asked to fill out questionnaires before and after the program completion.
The main questions it aims to answer:
1. whether this treatment will help address the pain management concerns of patients,
2. whether it is feasible to offer this treatment in the future as multi-centre randomized controlled trial (RCT).
Participants will be asked to attend a 6-week online pain management group sessions (1h/week). Participants will also be asked to fill out questionnaires before and after the program completion.
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Detailed Description
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Survivors of breast cancer often experience chronic pain that is undertreated and gets in the way of their functioning, relationships, mental health, and quality of life. There is little research on the best ways of treating chronic pain in cancer that make good use of all the expertise offered by different health care providers such as nurses, psychologists, and physiotherapists. In addition, little is known about how to offer such a service in an online format.
This study aims to pilot an online interprofessional pain management program for survivors of breast cancer. The investigators would like to know whether this treatment will help address the pain management concerns of patients, and whether it is feasible to offer this treatment in the future as multi-centre randomized controlled trial (RCT).
Participants in the study will attend a 6-week online pain management program (I-Can-Manage-Pain after cancer) that will cover the topics of understanding cancer pain, exercises to manage pain and psychological strategies to cope with pain. Questionnaires will be administered before and after the program to assess their satisfaction and changes in outcomes related to pain, quality of life, confidence to manage their pain, and use of health care services. The feasibility of implementing the study and the program will be pre-determined by an acceptability criteria for patient recruitment, completion of questionnaires, participation in the online sessions, and satisfaction with the pain management program.
It is hoped that study findings will help inform the development of treatment programs to improve post-treatment pain management and the quality of life of survivors of breast cancer patients.
This study aims to pilot an online interprofessional pain management program for survivors of breast cancer. The investigators would like to know whether this treatment will help address the pain management concerns of patients, and whether it is feasible to offer this treatment in the future as multi-centre randomized controlled trial (RCT).
Participants in the study will attend a 6-week online pain management program (I-Can-Manage-Pain after cancer) that will cover the topics of understanding cancer pain, exercises to manage pain and psychological strategies to cope with pain. Questionnaires will be administered before and after the program to assess their satisfaction and changes in outcomes related to pain, quality of life, confidence to manage their pain, and use of health care services. The feasibility of implementing the study and the program will be pre-determined by an acceptability criteria for patient recruitment, completion of questionnaires, participation in the online sessions, and satisfaction with the pain management program.
It is hoped that study findings will help inform the development of treatment programs to improve post-treatment pain management and the quality of life of survivors of breast cancer patients.
Conditions
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Breast Cancer
Cancer, Treatment-Related
Pain Cancer
Study Design
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Allocation Method
NA
Intervention Model
SINGLE_GROUP
A pre-post study design.
Primary Study Purpose
TREATMENT
Blinding Strategy
NONE
Study Groups
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Cancer Pain Management Group
Participants in the study will attend a 6-week online pain management program (I-Can-Manage-Pain after cancer) that will cover the topics of understanding cancer pain, exercises to manage pain and psychological strategies to cope with pain. Questionnaires will be administered before and after the program
Group Type
EXPERIMENTAL
I-Can-Manage-Pain after cancer (Pain Management Program)
Intervention Type
BEHAVIORAL
6-week online interprofessional cancer pain management program (I-Can-Manage-Pain after cancer) for survivors of breast cancer. The program will cover the topics of understanding cancer pain, exercises to manage pain and psychological strategies to cope with pain
Interventions
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I-Can-Manage-Pain after cancer (Pain Management Program)
6-week online interprofessional cancer pain management program (I-Can-Manage-Pain after cancer) for survivors of breast cancer. The program will cover the topics of understanding cancer pain, exercises to manage pain and psychological strategies to cope with pain
Intervention Type
BEHAVIORAL
Eligibility Criteria
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Inclusion Criteria
1. diagnosis of Stage 1-3 breast cancer;
2. had surgical excision at least 3 months ago;
3. completed neoadjuvant/adjuvant chemotherapy and/or radiation treatment at least 4 months ago;
4. within 5 years post active cancer treatment;
5. persistent pain within the last 3 months that is bothersome;
6. medical clearance to participate in the intervention
7. over 18 years of age;
8. verbal fluency in English;
9. have access to internet and technology to participate in the online program. Patients currently receiving adjuvant endocrine therapy or molecularly targeted therapies or who have completed these therapies within the last 5 years are eligible to participate.
2. had surgical excision at least 3 months ago;
3. completed neoadjuvant/adjuvant chemotherapy and/or radiation treatment at least 4 months ago;
4. within 5 years post active cancer treatment;
5. persistent pain within the last 3 months that is bothersome;
6. medical clearance to participate in the intervention
7. over 18 years of age;
8. verbal fluency in English;
9. have access to internet and technology to participate in the online program. Patients currently receiving adjuvant endocrine therapy or molecularly targeted therapies or who have completed these therapies within the last 5 years are eligible to participate.
Exclusion Criteria
* Participants will be excluded from the study if they:
1. demonstrate significant cognitive impairment as determined by the clinical judgment of the provider;
2. have a pre-existing non-cancer pain condition,
3. have severe emotional distress that interferes with group participation as determined by scores above 15 on the Patient Health Questionnaire-9.
1. demonstrate significant cognitive impairment as determined by the clinical judgment of the provider;
2. have a pre-existing non-cancer pain condition,
3. have severe emotional distress that interferes with group participation as determined by scores above 15 on the Patient Health Questionnaire-9.
Minimum Eligible Age
18 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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McMaster University
OTHER
Sponsor Role
collaborator
Hamilton Health Sciences Corporation
OTHER
Sponsor Role
lead
Responsible Party
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Karen Zhang
Clinical, Health and Rehabilitation Psychologist
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Karen Zhang, PHD
Role: PRINCIPAL_INVESTIGATOR
Hamilton Health Sciences Corporation
Locations
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Juravinski Cancer Centre
Hamilton, Ontario, Canada
Site Status
Countries
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Canada
References
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Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013 May;50(5):587-92. doi: 10.1016/j.ijnurstu.2012.09.010. Epub 2012 Nov 15. No abstract available.
Reference Type
BACKGROUND
Orsmond GI, Cohn ES. The Distinctive Features of a Feasibility Study: Objectives and Guiding Questions. OTJR (Thorofare N J). 2015 Jul;35(3):169-77. doi: 10.1177/1539449215578649.
Reference Type
BACKGROUND
Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010 Jan 6;10:1. doi: 10.1186/1471-2288-10-1.
Reference Type
BACKGROUND
Burckhardt CS, Jones KD. Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery. Health Qual Life Outcomes. 2005 Apr 28;3:30. doi: 10.1186/1477-7525-3-30.
Reference Type
BACKGROUND
Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2018 Jan;167(1):157-169. doi: 10.1007/s10549-017-4485-0. Epub 2017 Aug 31.
Reference Type
BACKGROUND
Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1-226. No abstract available.
Reference Type
BACKGROUND
Feeney LR, Tormey SM, Harmon DC. Breast cancer and chronic pain: a mixed methods review. Ir J Med Sci. 2018 Nov;187(4):877-885. doi: 10.1007/s11845-018-1760-y. Epub 2018 Feb 5.
Reference Type
BACKGROUND
Wang K, Yee C, Tam S, Drost L, Chan S, Zaki P, Rico V, Ariello K, Dasios M, Lam H, DeAngelis C, Chow E. Prevalence of pain in patients with breast cancer post-treatment: A systematic review. Breast. 2018 Dec;42:113-127. doi: 10.1016/j.breast.2018.08.105. Epub 2018 Sep 4.
Reference Type
BACKGROUND
Forsythe LP, Alfano CM, George SM, McTiernan A, Baumgartner KB, Bernstein L, Ballard-Barbash R. Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior. Breast Cancer Res Treat. 2013 Jan;137(2):617-30. doi: 10.1007/s10549-012-2335-7. Epub 2012 Dec 15.
Reference Type
BACKGROUND
Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008 Aug 19;99(4):604-10. doi: 10.1038/sj.bjc.6604534.
Reference Type
BACKGROUND
Levy MH, Chwistek M, Mehta RS. Management of chronic pain in cancer survivors. Cancer J. 2008 Nov-Dec;14(6):401-9. doi: 10.1097/PPO.0b013e31818f5aa7.
Reference Type
BACKGROUND
Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 2011 Jul;12(7):725-46. doi: 10.1016/j.jpain.2010.12.005. Epub 2011 Mar 24.
Reference Type
BACKGROUND
Novy DM, Aigner CJ. The biopsychosocial model in cancer pain. Curr Opin Support Palliat Care. 2014 Jun;8(2):117-23. doi: 10.1097/SPC.0000000000000046.
Reference Type
BACKGROUND
The British Pain Society. (November 2013). Guidelines for pain management programmes for adults: An evidence-based review prepared on behalf of the British Pain Society. https://www.britishpainsociety.org/static/uploads/resources/files/pmp2013_main_FINAL_v6.pdf
Reference Type
BACKGROUND
Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, Constine LS, Cooper A, Glare P, Keefe F, Koyyalagunta L, Levy M, Miaskowski C, Otis-Green S, Sloan P, Bruera E. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016 Sep 20;34(27):3325-45. doi: 10.1200/JCO.2016.68.5206. Epub 2016 Jul 25.
Reference Type
BACKGROUND
McCowat M, Fleming L, Vibholm J, Dixon D. The Psychological Predictors of Acute and Chronic Pain in Women Following Breast Cancer Surgery: A Systematic Review. Clin J Pain. 2019 Mar;35(3):261-271. doi: 10.1097/AJP.0000000000000672.
Reference Type
BACKGROUND
Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol. 2014 Jun 1;32(16):1739-47. doi: 10.1200/JCO.2013.52.4629. Epub 2014 May 5.
Reference Type
BACKGROUND
Chen CX, Kroenke K, Stump TE, Kean J, Carpenter JS, Krebs EE, Bair MJ, Damush TM, Monahan PO. Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials. Pain. 2018 Apr;159(4):775-782. doi: 10.1097/j.pain.0000000000001121.
Reference Type
BACKGROUND
Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016 Jul;66(4):271-89. doi: 10.3322/caac.21349. Epub 2016 Jun 2.
Reference Type
BACKGROUND
Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, Mohr DC, Berendsen MA, Jacobsen PB. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol. 2012 Feb 10;30(5):539-47. doi: 10.1200/JCO.2011.37.0437. Epub 2012 Jan 17.
Reference Type
BACKGROUND
Johannsen M, Farver I, Beck N, Zachariae R. The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis. Breast Cancer Res Treat. 2013 Apr;138(3):675-90. doi: 10.1007/s10549-013-2503-4. Epub 2013 Apr 4.
Reference Type
BACKGROUND
Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain. 1995 Nov;63(2):189-198. doi: 10.1016/0304-3959(95)00039-U.
Reference Type
BACKGROUND
Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014 Jun 1;32(16):1703-11. doi: 10.1200/JCO.2013.54.4825. Epub 2014 May 5.
Reference Type
BACKGROUND
Heathcote LC, Eccleston C. Pain and cancer survival: a cognitive-affective model of symptom appraisal and the uncertain threat of disease recurrence. Pain. 2017 Jul;158(7):1187-1191. doi: 10.1097/j.pain.0000000000000872. No abstract available.
Reference Type
BACKGROUND
Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007 Nov;22(11):1596-602. doi: 10.1007/s11606-007-0333-y. Epub 2007 Sep 14.
Reference Type
BACKGROUND
Arain M, Campbell MJ, Cooper CL, Lancaster GA. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010 Jul 16;10:67. doi: 10.1186/1471-2288-10-67.
Reference Type
BACKGROUND
Katz L, Patterson L, Zacharias R. Evaluation of an interdisciplinary chronic pain program and predictors of readiness for change. Can J Pain. 2019 Apr 12;3(1):70-78. doi: 10.1080/24740527.2019.1582296. eCollection 2019.
Reference Type
BACKGROUND
Borrelli B. The Assessment, Monitoring, and Enhancement of Treatment Fidelity In Public Health Clinical Trials. J Public Health Dent. 2011 Winter;71(s1):S52-S63. doi: 10.1111/j.1752-7325.2011.00233.x.
Reference Type
BACKGROUND
Tariman JD, Berry DL, Halpenny B, Wolpin S, Schepp K. Validation and testing of the Acceptability E-scale for web-based patient-reported outcomes in cancer care. Appl Nurs Res. 2011 Feb;24(1):53-8. doi: 10.1016/j.apnr.2009.04.003. Epub 2009 Sep 18.
Reference Type
BACKGROUND
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013 Sep;15(3):398-405. doi: 10.1111/nhs.12048. Epub 2013 Mar 11.
Reference Type
BACKGROUND
Cook KF, Jensen SE, Schalet BD, Beaumont JL, Amtmann D, Czajkowski S, Dewalt DA, Fries JF, Pilkonis PA, Reeve BB, Stone AA, Weinfurt KP, Cella D. PROMIS measures of pain, fatigue, negative affect, physical function, and social function demonstrated clinical validity across a range of chronic conditions. J Clin Epidemiol. 2016 May;73:89-102. doi: 10.1016/j.jclinepi.2015.08.038. Epub 2016 Mar 4.
Reference Type
BACKGROUND
Askew RL, Cook KF, Revicki DA, Cella D, Amtmann D. Evidence from diverse clinical populations supported clinical validity of PROMIS pain interference and pain behavior. J Clin Epidemiol. 2016 May;73:103-11. doi: 10.1016/j.jclinepi.2015.08.035. Epub 2016 Feb 27.
Reference Type
BACKGROUND
Douma KF, Aaronson NK, Vasen HF, Gerritsma MA, Gundy CM, Janssen EP, Vriends AH, Cats A, Verhoef S, Bleiker EM. Psychological distress and use of psychosocial support in familial adenomatous polyposis. Psychooncology. 2010 Mar;19(3):289-98. doi: 10.1002/pon.1570.
Reference Type
BACKGROUND
Heitzmann CA, Merluzzi TV, Jean-Pierre P, Roscoe JA, Kirsh KL, Passik SD. Assessing self-efficacy for coping with cancer: development and psychometric analysis of the brief version of the Cancer Behavior Inventory (CBI-B). Psychooncology. 2011 Mar;20(3):302-12. doi: 10.1002/pon.1735.
Reference Type
BACKGROUND
Groenvold M, Petersen MA, Aaronson NK, Arraras JI, Blazeby JM, Bottomley A, Fayers PM, de Graeff A, Hammerlid E, Kaasa S, Sprangers MA, Bjorner JB. EORTC QLQ-C15-PAL: the new standard in the assessment of health-related quality of life in advanced cancer? Palliat Med. 2006 Mar;20(2):59-61. doi: 10.1191/0269216306pm1133xx. No abstract available.
Reference Type
BACKGROUND
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524-532. https://doi.org/10.1037/1040-3590.7.4.524
Reference Type
BACKGROUND
Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales. (2nd. Ed.) Sydney: Psychology Foundation.
Reference Type
BACKGROUND
Canadian Pain Task Force. (June, 2019). Chronic pain in Canada: Laying a foundation for action.https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/publicengagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-forceJune-2019-report-en.pdf
Reference Type
BACKGROUND
Cancer Care Ontario. (April, 2012). Cancer-related pain management. Cancer Care Ontario: Toronto, ON.
Reference Type
BACKGROUND
Other Identifiers
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16187
Identifier Type: -
Identifier Source: org_study_id
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