Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial

Abstract

Background: Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care.

Objective: The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL).

Methods: This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES's impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation.

Results: Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES.

Conclusions: This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention's effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention's uptake in and impact on an oncology care setting or nonprofit organizations.

Trial registration: ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449.

International registered report identifier (irrid): DERR1-10.2196/39996.

Keywords: cancer survivorship; digital interventions; oral cancer; quality of life.

Figure 1

Heuristic framework for Empowered Survivor (ES). QOL: quality of life.

Figure 2

Sample page from Calm and Connect Empowered Survivor (1).

Figure 3

Sample page from Calm and Connect Empowered Survivor (2).

Figure 4

Sample page from Calm and Connect Empowered Survivor (3).

Figure 5

Sample page from Calm and Connect Empowered Survivor (4).

Figure 6

Sample Maintenance module screenshot (1).

Figure 7

Sample Maintenance module screenshot (2).

Figure 8

Sample Maintenance module screenshot (3).

Figure 9

Study flowchart.

Figure 10

Sample page from Springboard Beyond Cancer (1).

Figure 11

Sample page from Springboard Beyond Cancer (2).

Figure 12

Sample page from Springboard Beyond Cancer (3).

Figure 13

Sample page from Springboard Beyond Cancer (4).