JMIR Publications

ABSTRACT

Background:

For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized wellbeing-related support via phone calls and text messages, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period which is generally characterized by symptomatic peaks and 2-week hospitalizations.

Objective:

We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period.

Methods:

We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning at Day -5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to wellbeing. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations (by phone, text, and/or email) occurring at least once every four weeks during the study period. Secondary endpoints were electronic patient-reported outcome (ePRO) assessments of QOL, distress, and sleep disturbances. Our study was registered as clinicaltrials.gov identifier NCT04432818.

Results:

Of 20 screened patients, 17 patients chose to enroll and 15 underwent SCT as planned. Of these 15 patients (median age 65, range 50-81), 73% demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during 3-month study period was once per 6.2 days. During index peri-SCT hospitalizations (median length of stay 16 days, range 14-31), the median frequency of conversations was once per 5.3 days. ePRO assessments (94% adherence) demonstrated an expected QOL nadir during the second week following SCT. However, rates of elevated emotional distress were highest immediately prior to SCT.

Conclusions:

DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous stem cell transplantation for multiple myeloma. Limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC usage. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is under way to investigate its efficacy with regard to patient wellbeing. Clinical Trial: Our study was registered as clinicaltrials.gov identifier NCT04432818.