Re-Engaging AYA Survivors in Cancer-Related Healthcare

NCT ID: NCT07138040

Last Updated: 2025-09-10

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

RECRUITING

Clinical Phase

NA

Total Enrollment

530 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-08-01

Study Completion Date

2028-04-30

Brief Summary

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The goal of this clinical trial is to test the efficacy (how well they work) of different digital interventions that deliver information to adolescent and young adult (AYA) survivors of childhood cancer to promote re-engagement in cancer-related long-term follow-up care (LTFU). The main aims are:

* To test the efficacy of adaptive interventions (AIs) that begin with low touch intervention (LTI) as compared to written information (WI) on attending an appointment, and self-reported self-management among AYA.
* To identify the most efficacious second-stage strategy for those who initially schedule/attend an appointment (maintenance vs. step-up) and for those who do not (step-up vs. step-up maximum).
* To assess multilevel factors contributing to the effects of re-engaging AYA and how best to integrate AIs into practice.

Throughout the duration of the study, participants will complete four surveys, receive a series of interventions, and may be asked to participate in an interview (post-intervention).

Detailed Description

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Over 80% of children diagnosed with cancer become long-term survivors; however, 70% develop chronic or life-threatening late effects from treatment, and these often emerge during young adulthood. Guidelines recommend annual long-term follow-up care (LTFU) to manage and monitor for late effects, recurrence, or new cancer(s). Yet, as risk for late effects increases in young adulthood and survivors transition into adult-focused care, engagement in care plummets. Disengagement from LTFU leaves adolescent and young adult survivors (AYA) vulnerable to delayed or poorly managed diagnoses and relates to lower knowledge and self-management abilities. Thus, interventions targeting re-engagement of AYA are critical for this vulnerable population. The REACH (Re-Engaging AYA survivors in Cancer-related Healthcare) study will test a low touch intervention (LTI), consisting of reminder "nudge" text messages and informational resources for up to 4 weeks compared to an enhanced usual care group that will receive written information (WI) only.

In Stage 2, AYA will be re-randomized based on responsiveness to Stage 1 (i.e., whether or not they made an appointment) into 16 weeks of intervention. Responders will either be re-randomized to receive a continued intervention (maintenance) or a stepped-up condition, while non-responders will only receive a stepped-up condition. Step-up may include expanded LTI (more text messages) or a high touch intervention (HTI). The HTI includes text messages and digital resources, including a personalized survivorship care plan (SCP), and a mobile-friendly platform with information tailored to variables such as barriers to care, treatment history and recommendations, and a personal health goal. Additionally, social worker and/or nurse support will be available to help overcome barriers (e.g., access care).

The intervention options in Stage 2 are intended to enhance self-management beyond simply attending LTFU in order to sustain long-term engagement. Outcomes are measured after Stage 1 (T2), Stage 2 (T3) and at 36 weeks (T4).

It is expected that those who start with LTI versus WI will be more likely to attend a LTFU appointment by T4. For Stage 2, those who receive the stepped-up condition compared to those with maintenance, and those who received HTI compared to LTI, will be more likely to attend an appointment by T4. Attending an appointment by T3 and indices of self-management are secondary outcomes. The study team will assess moderators of intervention outcomes, intervention engagement, acceptability, feasibility, and cost. Qualitative interviews will assess multilevel barriers and facilitators of future implementation with stakeholders (AYA, parents/supports, providers, administrators). This trial aims to promote optimal engagement in LTFU and self-management for AYA survivors, improving outcomes and reducing disparities. For Stage 2, those who receive the stepped-up condition compared to those with maintenance, and those who received HTI compared to LTI, will be more likely to attend an appointment by T4.

Conditions

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Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Sequential Multiple Assignment Randomized Trial with 2 stages of randomization
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Written Intervention + Written Intervention (Responders)

Start with written intervention (WI) in stage 1, those who respond (schedule an appointment) in stage 1 continue receiving WI in stage 2 (maintenance).

Group Type EXPERIMENTAL

Stage 1 Written Information

Intervention Type BEHAVIORAL

Stage 1 WI: consists of a letter from the survivorship care team with information about long-term follow-up care and relevant contacts to schedule an appointment.

Stage 2 Written Information

Intervention Type BEHAVIORAL

Stage 2 WI: consists of a letter from the survivorship care team with information about what to expect at a long-term follow-up care appointment.

Written Intervention + Low Touch Intervention (Responders)

Start with written intervention (WI) in stage 1, those who respond (schedule an appointment) in stage 1, step up to receive low touch intervention (LTI) in stage 2.

Group Type EXPERIMENTAL

Stage 1 Written Information

Intervention Type BEHAVIORAL

Stage 1 WI: consists of a letter from the survivorship care team with information about long-term follow-up care and relevant contacts to schedule an appointment.

Stage 2 Low Touch Intervention

Intervention Type BEHAVIORAL

Stage 2 LTI: consists of the WI stage 2 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and two to three non-tailored (generic) text messages per week related to scheduling an appointment, overcoming barriers to follow-up care, and health self-management.

Written Intervention + Low Touch Intervention (Non-Responders)

Start with written intervention (WI) in stage 1, those who don't respond (do no schedule an appointment in stage 1), step up to receive low touch intervention (LTI) in stage 2.

Group Type EXPERIMENTAL

Stage 1 Written Information

Intervention Type BEHAVIORAL

Stage 1 WI: consists of a letter from the survivorship care team with information about long-term follow-up care and relevant contacts to schedule an appointment.

Stage 2 Low Touch Intervention

Intervention Type BEHAVIORAL

Stage 2 LTI: consists of the WI stage 2 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and two to three non-tailored (generic) text messages per week related to scheduling an appointment, overcoming barriers to follow-up care, and health self-management.

Written Intervention + High Touch Intervention (Non-Responders)

Start with written intervention (WI) in stage 1, those who don't respond (schedule and appointment) in stage 1, step up (maximum) to receive high touch intervention (HTI) in stage 2.

Group Type EXPERIMENTAL

Stage 1 Written Information

Intervention Type BEHAVIORAL

Stage 1 WI: consists of a letter from the survivorship care team with information about long-term follow-up care and relevant contacts to schedule an appointment.

Stage 2 High Touch Intervention

Intervention Type BEHAVIORAL

Stage 2 HTI: consists of personalized mobile-friendly dashboard containing the WI letters, their treatment summary, survivorship care plan, and a growing discover section with helpful tailored resources. They will also receive four to six text messages per week with personalized messages related to their chosen health goal, personal barriers to attending cancer-related follow-up care, treatment-related risks, information about scheduling their long-term follow-up appointments, health self-management, and fun texts consisting of celebrity quotes, memes, and altruistic messages.

Low Touch Intervention + Low Touch Intervention (Responders)

Start with low touch intervention (LTI) in stage 1, those who respond (schedule an appointment in stage 1), continue receiving LTI in stage 2 (maintenance).

Group Type EXPERIMENTAL

Stage 1 Low Touch Intervention

Intervention Type BEHAVIORAL

Stage 1 LTI: consists of the WI stage 1 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and one text message per week with information to schedule a follow-up care appointment.

Stage 2 Low Touch Intervention

Intervention Type BEHAVIORAL

Stage 2 LTI: consists of the WI stage 2 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and two to three non-tailored (generic) text messages per week related to scheduling an appointment, overcoming barriers to follow-up care, and health self-management.

Low Touch Intervention + High Touch Intervention (Responders)

Start with low touch intervention (LTI) in stage 1, those who respond (schedule an appointment in stage 1), step up to receive high touch intervention (HTI) in stage 2.

Group Type EXPERIMENTAL

Stage 1 Low Touch Intervention

Intervention Type BEHAVIORAL

Stage 1 LTI: consists of the WI stage 1 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and one text message per week with information to schedule a follow-up care appointment.

Stage 2 High Touch Intervention

Intervention Type BEHAVIORAL

Stage 2 HTI: consists of personalized mobile-friendly dashboard containing the WI letters, their treatment summary, survivorship care plan, and a growing discover section with helpful tailored resources. They will also receive four to six text messages per week with personalized messages related to their chosen health goal, personal barriers to attending cancer-related follow-up care, treatment-related risks, information about scheduling their long-term follow-up appointments, health self-management, and fun texts consisting of celebrity quotes, memes, and altruistic messages.

Low Touch Intervention + High Touch Intervention (Non-Responders)

Start with low touch intervention (LTI) in stage 1, those who don't respond (don't schedule an appointment) in stage 1, step up to receive high touch intervention (HTI) in stage 2.

Group Type EXPERIMENTAL

Stage 1 Low Touch Intervention

Intervention Type BEHAVIORAL

Stage 1 LTI: consists of the WI stage 1 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and one text message per week with information to schedule a follow-up care appointment.

Stage 2 High Touch Intervention

Intervention Type BEHAVIORAL

Stage 2 HTI: consists of personalized mobile-friendly dashboard containing the WI letters, their treatment summary, survivorship care plan, and a growing discover section with helpful tailored resources. They will also receive four to six text messages per week with personalized messages related to their chosen health goal, personal barriers to attending cancer-related follow-up care, treatment-related risks, information about scheduling their long-term follow-up appointments, health self-management, and fun texts consisting of celebrity quotes, memes, and altruistic messages.

Interventions

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Stage 1 Written Information

Stage 1 WI: consists of a letter from the survivorship care team with information about long-term follow-up care and relevant contacts to schedule an appointment.

Intervention Type BEHAVIORAL

Stage 1 Low Touch Intervention

Stage 1 LTI: consists of the WI stage 1 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and one text message per week with information to schedule a follow-up care appointment.

Intervention Type BEHAVIORAL

Stage 2 Written Information

Stage 2 WI: consists of a letter from the survivorship care team with information about what to expect at a long-term follow-up care appointment.

Intervention Type BEHAVIORAL

Stage 2 Low Touch Intervention

Stage 2 LTI: consists of the WI stage 2 letter, a copy of their treatment summary with instructions for creating their own survivorship care plan, and two to three non-tailored (generic) text messages per week related to scheduling an appointment, overcoming barriers to follow-up care, and health self-management.

Intervention Type BEHAVIORAL

Stage 2 High Touch Intervention

Stage 2 HTI: consists of personalized mobile-friendly dashboard containing the WI letters, their treatment summary, survivorship care plan, and a growing discover section with helpful tailored resources. They will also receive four to six text messages per week with personalized messages related to their chosen health goal, personal barriers to attending cancer-related follow-up care, treatment-related risks, information about scheduling their long-term follow-up appointments, health self-management, and fun texts consisting of celebrity quotes, memes, and altruistic messages.

Intervention Type BEHAVIORAL

Other Intervention Names

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S1 WI S1 LTI S2 WI S2 LTI S2 HTI HTI

Eligibility Criteria

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Inclusion Criteria

1. 15-29 years old
2. History of a childhood cancer diagnosis, diagnosed prior to age 22
3. Has not had a cancer-related follow-up visit in at least 15 months (or is 3 months past recommended follow-up)
4. U.S. resident (not international patient)
5. Has previously attended a cancer-related appointment at Children's Hospital of Philadelphia, or Nationwide Children's Hospital or Penn
6. At least 2 years from end of treatment and 5 years from diagnosis
7. English proficient
8. For AYA under age 18, must have a caregiver to provide informed consent



1. Primary caregiver or other support person (e.g. partner, sibling, other caregiver)
2. At least 18 years old
3. U.S. resident
4. English proficient

Exclusion Criteria

1. Cognitive impairment limiting participation
2. Received surgery only treatment
3. Transferred to primary care
4. Currently living with cancer diagnosis (either new, metastatic, recurrence, or relapse)
5. Absence of documentation of treatment history

1. No involvement in the AYA's healthcare
2. AYA Decline support person's participation
Minimum Eligible Age

15 Years

Maximum Eligible Age

29 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Nationwide Children's Hospital

OTHER

Sponsor Role collaborator

University of Pennsylvania

OTHER

Sponsor Role collaborator

National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Children's Hospital of Philadelphia

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Nationwide Children's Hospital

Columbus, Ohio, United States

Site Status NOT_YET_RECRUITING

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Penn Medicine

Philadelphia, Pennsylvania, United States

Site Status NOT_YET_RECRUITING

Countries

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United States

Central Contacts

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Lisa Schwartz, PhD

Role: CONTACT

(267) 426-0355

Sara King-Dowling, PhD

Role: CONTACT

(267) 426-5562

Facility Contacts

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Ahna Pai, PhD

Role: primary

614-938-1601

Sarah Drake, MA

Role: backup

(614) 938-2252

Lisa Schwartz, PhD

Role: primary

267-426-0355

Sara King-Dowling, PhD

Role: backup

(267) 426-5562

Chrisine Hill-Kayser, MD

Role: primary

215-615-6767

Kelsey Woodard, MA

Role: backup

9089383329

Other Identifiers

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R01CA273328

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB 22-020668

Identifier Type: -

Identifier Source: org_study_id

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