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Randomized phase 2 study of digital life coaching during transplantation for myeloma

Bone Marrow Transplantation volume 58, pages 1406–1409 (2023)Cite this article

Myeloablative chemotherapy followed by autologous stem cell transplantation (ASCT) in multiple myeloma (MM) is associated with acute life disruptions that may lead to prolonged quality of life (QOL) deficits, reduced rates of return to work, and long-term prescriptions for benzodiazepines [1,2,3,4]. Digital life coaching (DLC), also known as digital health coaching, may be able to address some of these unmet needs in supportive care. DLC platforms are designed to help patients achieve wellness-related goals using phone calls and text messages through a longitudinal partnership with a certified life coach. We previously demonstrated the feasibility of DLC in a pilot study of patients with MM undergoing ASCT, which demonstrated that patients interacted with their coach an average of once per week even while hospitalized [5]. Based on these feasibility data, we proceeded to a randomized Phase 2 study of DLC in this population.

Our trial was approved by the UCSF Institutional Review Board and was registered at clinicaltrials.gov (NCT04589286). Eligibility criteria included age ≥18, MM diagnosis, planned ASCT at our institution following induction, English proficiency, and cellphone ownership (smartphones not required). Participants were randomized 1:1 using “attention control” methodology [6] to either brief wellness handouts alone (control arm) or to these brief handouts plus a 4-month coaching curriculum (DLC arm). DLC methods were identical to those of our pilot study [5], apart from beginning at Day –10 instead of Day –5 before ASCT. Life coaches did not have access to the wellness handouts, our electronic medical record, or to patients’ treatment teams. Patient-reported outcome (PRO) assessments of QOL (PROMIS Global Health) and emotional distress (NCCN Distress Thermometer) were collected weekly for 8 weeks beginning at Day –10 and then biweekly through Day + 95 for a total of 12 assessments. Participants also received an end-of-study survey to solicit comments and to rate study interventions on a 0–10 Likert scale in terms of recommendation-worthiness.

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Fig. 1: Patient-reported outcomes.

Data availability

These data are not publicly available due to patient-identifying information but are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors wish to acknowledge funding from an ASCO Conquer Cancer Foundation Young Investigator Award (awardee: RB) as well as the UCSF Stephen & Nancy Grand Multiple Myeloma Translational Initiative. The authors also wish to acknowledge protocol development assistance from the ASTCT Clinical Research Training Course and ASCO/AACR Methods in Clinical Cancer Research workshop. Most importantly, the authors wish to acknowledge study participants and caregivers for their time and feedback. Prior presentation: None (presented at the 2023 International Myeloma Society Meeting in September 2023).

Funding

2020 Young Investigator Award, ASCO Conquer Cancer Foundation.

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA

    Rahul Banerjee

  2. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Chiung-Yu Huang

  3. Be the Match, National Marrow Donor Program, Minneapolis, MN, USA

    Chloe Ryan

  4. School of Medicine, University of California San Diego, San Diego, CA, USA

    Albert Lee

  5. Pack Health, A Quest Diagnostics Company, Birmingham, AL, USA

    Kelly J. Brassil & Jasmine Moore

  6. Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Shagun Arora, Alfred Chung, Sandy W. Wong, Jeffrey Wolf, Thomas Martin, Anand Dhruva & Nina Shah

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Contributions

RB, AD, and NS conceptualized the research. RB, CR, and C-YH performed data collection and analysis. All authors contributed substantially to critical interpretation and approved the final manuscript.

Corresponding author

Correspondence to Rahul Banerjee.

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Competing interests

CR, AL, SA, and AD: no competing interests. RB: consulting for BMS, Caribou Biosciences, Genentech/Roche, Janssen, Sanofi Pasteur, SparkCures; research support from Pack Health (not for this study). KJB: employment by Pack Health, A Quest Diagnostics Company; research support from Gilead, Genentech, AbbVie, Daiichi Sankyo, GSK, Sanofi. JM: employment by Pack Health. AC: research support from AbbVie, BMS, CARSgen, Celgene, Caelum, Cellectis, Janssen, Merck; honoraria from Sanofi. SWW: consulting for Amgen, Sanofi; research support: BMS, Caelum, Genentech, Fortis, GSK, Janssen. JW: consulting for Amgen, Celgene, Janssen, Novartis, Takeda. TM: consulting for GlaxoSmithKline, Juno, Roche; research support from Amgen, Janssen, Sanofi, Seattle Genetics. NS: employment by AstraZeneca; consulting for Amgen, BMS, Celgene, CareDx, GSK, Indapta Therapeutics, Karyopharm, Kite, Sanofi; research support from Bluebird Bio, BMS, Janssen, Nektar, Poseida, Sutro Biopharma, TeneoBio.

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Banerjee, R., Huang, CY., Ryan, C. et al. Randomized phase 2 study of digital life coaching during transplantation for myeloma. Bone Marrow Transplant 58, 1406–1409 (2023). https://doi.org/10.1038/s41409-023-02091-4

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