HRQL and Symptom Assessment for Patients With DIPG or Recurrent and Re-irradiated Brain Tumours and Their Caregivers

Study Purpose

Although many children with brain tumours are successfully cured of their disease, a substantial proportion of patients suffer disease recurrence and require further treatment. This therapy may involve a repeat course of radiation (RT2). Based on retrospective data, re-irradiation may provide palliative and even potentially curative benefit. However, such retrospective data are subject to bias, which may over-report survival and under-report toxicity. Furthermore, we do not know how re-irradiation affects patients' HRQOL. The goal of this research is to prospectively describe the HRQOL of patients diagnosed with DIPG and recurrent brain tumors and their families before and after re-irradiation to more accurately assess the benefit versus the toxicity of this treatment. In addition, if we are able to demonstrate the feasibility of collecting HRQOL information on a routine basis we will be able to justify the need to conduct this research further and implement HRQOL screening as a standard of care for these patients. Re-irradiation for children with DIPG and recurrent brain tumours will not cure these children from their disease but may improve neurological function and wellbeing. We postulate that the opportunity of more time to say the final good bye and creating memories will facilitate bereavement and prevent psychological dysfunction of parents and siblings. A greater understanding of what helps these families may enable clinicians to better support these children and their families in this difficult disease course. Ultimately our goal is to improve the psychological experience of these patients and their families.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Observational [Patient Registry]
Eligible Ages 2 Years - 21 Years
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

1. Patient aged >2 and <21 years treated with a repeat course of radiation for DIPG or other recurrent or progressive brain tumour. 2. Radiation for the first tumour must be a primary brain neoplasm (i.e. not leukemia). 3. Enrollment within 14 days of starting re-irradiation (RT2). 4. Patients with malignant transformation of the first tumour are eligible. 5. There are no restrictions on histology or RT1/RT2 dose-fractionation or RT2 body site. In other words, RT2 may be directed at a different location to RT1. 6. The patient is treated at a site where the study is approved by the local ethics board. 7. Consent, and, if applicable, assent, has been obtained according to institutional standards.

Exclusion Criteria:

1. Inability to complete questionnaires in English or French.

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT04670016
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

University of Calgary
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Fiona Schulte, PhDDerek Tsang, MD
Principal Investigator Affiliation University of CalgaryPrincess Margaret Cancer Centre
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Recruiting
Countries Canada
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

DIPG, Brain Tumor, Pediatric, Recurrent, Brain Tumor, DIPG, Radiation Toxicity, Radiation Exposure, Brain Tumor, Pediatric
Additional Details

Many children diagnosed with brain tumours are at significant risk of disease recurrence following their initial treatment, with recurrence rates ranging from 30-100% depending on the type of brain tumour. Disease recurrence represents a serious clinical issue in brain tumour patients and when this occurs, additional treatment is needed. These treatments may result in further damage to the surrounding normal brain tissue, resulting in neurocognitive decline (brain or mental function) and reduced quality of life. A novel treatment option for these patients is to administer a second course of radiation (re-irradiation). However, the effects of re-irradiation on quality-of-life are poorly studied. This study aims to increase the knowledge surrounding re-irradiation, particularly with regards to HRQOL. The primary objective of the proposed study is to describe the HRQOL and symptoms for children diagnosed with DIPG or recurrent brain tumours treated with repeat radiation and their caregivers over time. We have four Aims. Aim 1: To describe the HRQOL trajectory and symptoms for children diagnosed with DIPG and in children treated with re-irradiation for a recurrent brain tumour and their caregivers over time. Aim 2: To identify critical time points of HRQOL difficulty across the trajectory of DIPG/recurrent brain tumour treatment and to ascertain demographic and/or medical sequelae that are related to HRQOL outcomes. Aim 3: To determine the feasibility of conducting routine assessment of HRQL in children diagnosed with DIPG/recurrent brain tumours and their caregivers based on recruitment and retention rates. Aim 4: To report the incidence of radiation necrosis (RN), local control, progression-free survival and overall survival after re-irradiation. Our goal to is enroll 25 to 30 patient/caregiver dyads diagnosed with DIPG and 32 patient/caregiver dyads treated with re-RT for a recurrent/progressive brain tumour onto the trial over the study period and to follow patients until their disease progresses again, which has been, on average, 6 months after completion of RT2. Once deemed eligible, individual patient recruitment will be the responsibility of the institution Clinical Research Assistant (CRA). Upon consenting to take part in the study, patients and families will be contacted using an online administration and scoring program. HRQOL assessments will take 15-25 minutes to complete at each time point. Baseline questionnaires will be completed at the time of recurrence or progressive DIPG or other brain tumor (+/- 7 days from start of treatment, maximum 14 days). Patients will then complete HRQOL measures at the end of re-irradiation and then again every two months. Necrosis and local tumour control will be assessed using MRI ordered as part of standard-of-care follow-up (recommended scan interval every 3-6 months until 5 years post-treatment). Necrosis and other toxicities, if present without evidence of disease recurrence, will be graded at baseline and each post-RT2 standard-of-care visit using CTCAE v5.0 (a rating scale of side effects). Steroid use and Lansky play score will be recorded at each visit. Progression and death will be collected from the health record. Re-irradiation dosimetry (in electronic RT-DICOM format) will be requested for all enrolled patients. Study measures will be available in both English and French. HRQOL measures will include: the Pediatric Quality of Life (PedsQL) General module; the PedsQL Brain Tumour module; the PedsQL Family Impact module; and the Short Form 36 (SF-36), to assess parent quality of life via physical and mental health functioning subscales. Children who require help completing questionnaires will be aided by a CRA. For those 2 to 5 years of age or those who have cognitive disability that impairs their ability to self-report as assessed by their parents, proxy-report by parent or caregiver will be used. The Symptom Screening in Pediatrics Tool (SSPedi) will also be used to screen for pediatric cancer symptoms. The Patient Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depressive Symptoms, and Pain Interference measures short forms will be administered to screen for current symptoms of anxiety, depression and assess pain interference. A linear mixed models approach will be used to compare HRQOL outcomes over time. Further, HRQOL outcomes will be compared across assessment time points and paired sample t-tests will be conducted to identify critical periods of significantly lower and/or higher HRQOL for patients and caregivers. Correlational analyses will be used to explore variables that might emerge as related to HRQL outcome scores. Recruitment rates (patients participating vs.#46; patients eligible) and retention rates (non-completion, lost to follow-up) will be examined. Finally, all incident cases of radiation necrosis without obvious tumour progression will be examined, while accounting for competing risks of disease progression and death from any cause.

Arms & Interventions

Arms

: Patient/Caregiver dyad diagnosed with DIPG

All of these criteria must be met for a patient to be eligible for this study: Patient aged >2 and <21 years treated with a repeat course of radiation for DIPG Radiation for the first tumour must be a primary brain neoplasm (i.e. not leukemia). Enrollment within 14 days of starting re-irradiation (RT2). Patients with malignant transformation of the first tumour are eligible. There are no restrictions on histology or RT1/RT2 dose-fractionation or RT2 body site. In other words, RT2 may be directed at a different location to RT1. The patient is treated at a site where the study is approved by the local ethics board Consent, and, if applicable, assent, has been obtained according to institutional standards

: Patient/Caregiver dyad with re-RT for a recurrent brain tumour

All of these criteria must be met for a patient to be eligible for this study: Patient aged >2 and <21 years treated with a repeat course of radiation for a recurrent or progressive brain tumour (stratum 2). Radiation for the first tumour must be a primary brain neoplasm (i.e. not leukemia). Enrollment within 14 days of starting re-irradiation (RT2). Patients with malignant transformation of the first tumour are eligible. There are no restrictions on histology or RT1/RT2 dose-fractionation or RT2 body site. In other words, RT2 may be directed at a different location to RT1. The patient is treated at a site where the study is approved by the local ethics board Consent, and, if applicable, assent, has been obtained according to institutional standards

Interventions

Other: - This study does not include an intervention.

This study does not include an intervention.

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

International Sites

Alberta Children's Hospital, Calgary, Alberta, Canada

Status

Recruiting

Address

Alberta Children's Hospital

Calgary, Alberta, T3B 6A8

Site Contact

Caitlin Forbes

[email protected]

403-955-7831

Stollery Children's Hospital, Edmonton, Alberta, Canada

Status

Not yet recruiting

Address

Stollery Children's Hospital

Edmonton, Alberta, T6G 2B7

Site Contact

David Eisenstat, MD

[email protected]

403-955-7831

British Columbia Children's Hospital, Vancouver, British Columbia, Canada

Status

Not yet recruiting

Address

British Columbia Children's Hospital

Vancouver, British Columbia, V6H 3N1

Site Contact

Juliette Hukin, MB

[email protected]

403-955-7831

CancerCare Manitoba, Winnipeg, Manitoba, Canada

Status

Not yet recruiting

Address

CancerCare Manitoba

Winnipeg, Manitoba, R3E 0V9

Site Contact

Magimairajan Issai Vanan, MD

[email protected]

403-955-7831

IWK Health Centre, Halifax, Nova Scotia, Canada

Status

Recruiting

Address

IWK Health Centre

Halifax, Nova Scotia, B3K 6R8

Site Contact

Craig Erker, MD

[email protected]

403-955-7831

McMaster Children's Hospital, Hamilton, Ontario, Canada

Status

Recruiting

Address

McMaster Children's Hospital

Hamilton, Ontario, L8N 3Z5

Site Contact

Adam Fleming, MD

[email protected]

403-955-7831

Children's Hospital, London, Ontario, Canada

Status

Not yet recruiting

Address

Children's Hospital

London, Ontario, N6A 5W9

Site Contact

Shayna Zelcer, MD

[email protected]

403-955-7831

London Health Sciences Centre, London, Ontario, Canada

Status

Not yet recruiting

Address

London Health Sciences Centre

London, Ontario, N6A 5W9

Site Contact

Glenn Bauman, MD

[email protected]

403-955-7831

Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

Status

Recruiting

Address

Children's Hospital of Eastern Ontario

Ottawa, Ontario, K1H 8L1

Site Contact

Donna Johnston, MD

[email protected]

403-955-7831

The Hospital for Sick Children, Toronto, Ontario, Canada

Status

Recruiting

Address

The Hospital for Sick Children

Toronto, Ontario, M5G 1X8

Site Contact

Ute Bartels, MD, MSc

[email protected]

403-955-7831

Princess Margaret Cancer Centre, Toronto, Ontario, Canada

Status

Not yet recruiting

Address

Princess Margaret Cancer Centre

Toronto, Ontario, M5G 2M9

Site Contact

Derek Tsang, MD, MSc

[email protected]

403-955-7831

Montréal, Quebec, Canada

Status

Not yet recruiting

Address

Centre hospitalier de l'Université de Montréal

Montréal, Quebec, H3T 1C5

Site Contact

Anne-Marie Charpentier, MD

[email protected]

403-955-7831

CHU de Quebec-Universite Laval, Quebec, Canada

Status

Recruiting

Address

CHU de Quebec-Universite Laval

Quebec, , G1V 4G2

Site Contact

Valérie Larouche, MD

[email protected]

403-955-7831

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