Coaching Cancer Survivors Through Digital Health With Robin Lally, PhD, and Marilyn Hammer, PhD
At the recent American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Oncology Data Advisor sat down for a conversation with Robin Lally, PhD, and Marilyn Hammer, PhD, co–Principal Investigators of the COACH (Comprehensive Outcomes for After-Cancer Health) study. Dr. Lally and Dr. Hammer share the background of this study and how it is seeking to improve the cancer survivorship experience through digital health interventions and patient-reported outcomes.
Oncology Data Advisor: Today, we're at the ASCO Annual Meeting, and I'm joined by Robin Lally and Marilyn Hammer. Thank you both so much for coming on today.
Robin Lally, PhD: Thank you, it's very nice to be here.
Oncology Data Advisor: Would you like to introduce yourselves and share what your work and your research focus on?
Dr. Lally: Sure, I'm Dr. Robin Lally. I'm a Professor in the College of Nursing at the University of Nebraska Medical Center's Fred & Pamela Buffett Cancer Center. My work focuses on the psychosocial support of women with breast cancer, in particular.
Marilyn Hammer, PhD: Thank you for having us. I'm Marilyn Hammer. I'm the Director of the Cancer Center for Research and Nursing and Patient Care Services, and I'm also part of the Division of Population Sciences at Dana-Farber Cancer Institute in Boston. My program of research focuses on precision health symptom science and understanding underlying mechanisms that can help explain all of the inter-individual variability and symptom experiences.
Oncology Data Advisor: Awesome. I know you're both the principal investigators (PIs) of the COACH study. What is this study investigating?
Dr. Hammer: Yes, the COACH study is a multicenter, randomized, waitlist control trial in which we are evaluating an augmented coaching program to help patients who have completed primary therapy for cancer. It's really novel in that we're not only testing this intervention of the coaching program itself, but we're also collecting a lot of patient-reported outcome data so that we can really understand how symptoms transition over time into long-term survivorship.
We also have some novel areas of data collection, including microbiome samples, to really understand how the microbiome might change and impact symptoms over time, as well as using a wearable device so that we can collect data in real time because individuals are dynamic, not static. I think it's novel in several ways. Then the collaboration that's both interprofessional and among the different institutes is really something that is, I think, very unique. And importantly, it's a nurse-led study.
Oncology Data Advisor: Definitely. It's such an exciting and important study.
Dr. Lally: And just to add, we have six sites, and we have a collaboration with the National Cancer Institute (NCI) in doing our analysis of samples as well.
Oncology Data Advisor: Great. How many patients have enrolled so far?
Dr. Lally: So far, we have 120. We just started enrolling in June of 2022, and we hope to be done by 2024. The goal is 550 subjects all together. Each site has been contracted for around 100 patients each.
We're making good progress. In Nebraska, where I'm at, we've enrolled 64. We were the first site to start enrolling, and we've enrolled the most so far.
Oncology Data Advisor: What has the experience of the patients been so far?
Dr. Lally: The experience has been very positive. We were very excited to find that the survivors—and I'm not sure how we define survivors for this—we are enrolling individuals who have completed their primary treatment within the past year. Individuals can still be on some maintenance endocrine therapy, for example, for breast cancer, but they need to be fairly recent survivors. We were just really happy that they seem to be quite eager to sign up for the study, and our retention has been very good. We were told today that it's somewhere around 85% to 90%. Even though they are asked, as Marilyn just said, to have wearables, to provide microbiome stool samples twice, and to complete a lot of study surveys, they're hanging in there, and they seem to enjoy the coaching.
Oncology Data Advisor: That's great. Anything you'd like to add?
Dr. Hammer: Just to back up what Robin said, they are very engaged, and they're very enthused about participating. The feedback we've gotten so far is that they're really enjoying it, and we're really eager to start to see some of the data outcomes.
Oncology Data Advisor: That's amazing. Do you have any advice for centers who are interested in incorporating digital health into their programs?
Dr. Hammer: Yes, I think we're at a time where that's really important to do. You need a good supportive system, so that is really key for the institute to be able to support it. But one of the things that shows potential for this, which we're going to look at long-term, is that it's potentially cost-saving. If these coaches can help with self-management in which the patients—in this case, with survivors, but it could also be anybody undergoing cancer therapies—if they can help to self-manage their symptoms and quality of life, then that might reduce the number of phone calls to the providers. It could reduce, potentially, the number of unplanned, unscheduled visits to health care facilities.
I think it has a lot of wonderful and exciting potential moving forward. And then ultimately, if it can connect with electronic health records, that would be another huge goal so that we could help better communicate and work with patients.
Dr. Lally: I'll just add that we know that the number of survivors is growing and growing. They project that by 2024 there will be 22 million cancer survivors. Self-management of symptoms, maintaining health, and reducing recurrences and all of that are key, because we're looking at variables having to do with physical, psychological, and social health. We're enrolling this wide variety of individuals with a wide variety of cancers that will provide data for years to come.
Oncology Data Advisor: Awesome. It's a really impressive trial, and I'm looking forward to hearing more about it as it all plays out. More of a general question for you—do you also have any advice for people who are interested in becoming involved in nursing research?
Dr. Hammer: Yes. First of all, we encourage people to become involved in nursing research, but we need more PhD-prepared nurse scientists. Just be passionate, I would say, with an area of research. A lot of our questions come from clinical practice, so just follow your instincts in terms of what to study. But importantly, form strong mentorship teams and strong research teams, and be very collaborative.
Then you can also figure out the best setting. Some prefer the academic setting, some prefer a clinical setting, or you can do a combination of both. But I think once you get into the area of nursing science, which is less than 1% of the nursing profession, there are just a lot of opportunities. Importantly, there's a really large opportunity to improve the lives of people affected by or at risk for cancer.
Dr. Lally: I could just add, something also unique about this study is that at Nebraska, we have a co-PI relationship. I am the PhD researcher from the university side of things, and then medical side of things has our Director of Cancer Survivorship. The survivorship department is key to identifying these individuals for the study. Dr. Rachael Schmidt is a DNP, a Doctor of Nursing Practice–prepared person. We need people to do PhDs; they're the research experts. But we also need to do these collaborations with our clinical expert partners. That is the best way to do research and be a nurse scientist, by having that collaboration and the interdisciplinary collaborations with our medical teams as well.
Oncology Data Advisor: Absolutely. That's great to know. One final question I'll ask both of you is, since the theme of ASCO this year is "Partnering with Patients," obviously, this study is a prime example of how that can be done. Do you have any other advice for people who are trying to partner with patients more in their practice?
Dr. Lally: It's absolutely essential. I think that for way too long, nursing and medicine have been in a vacuum, doing our science, but having those community collaborations is so important. In Nebraska, we have 500 miles across our state, and our patients have special needs. They're rural, and they travel hundreds of miles to our only NCI-designated cancer center in the state. We really need to understand what is important to them and what they want to see in a program like this. We need to find out, can they and do they want to have distant-type coaching for their health? Especially for our rural folks, they're very embedded in their own communities. That's a question that we have at our site—how is this going to look when we look at the data? What is the feasibility for our rural participants?
Dr. Hammer: I would also just echo that it's essential to have the input of patients. We have patients who need to be part of our studies as part of the study team. We have patient advocates that will weigh in with us, and the community partnerships are absolutely essential. We need to better reach underserved populations, which, historically, we have not done very well at. It's time to really get out there. It's all about the community partnerships. Working with patients themselves as we design our studies is absolutely essential.
Oncology Data Advisor: Absolutely. Well, this was fantastic. It was great to talk with both of you, so thanks so much for stopping by.
Dr. Hammer: All right, thank you.
Dr. Lally: Thank you. Thank you very much.
About Dr. Lally and Dr. Hammer
Robin Lally, PhD, RN, AOCN, FAAN, is the Bertha L. Pankratz Professor in Nursing at the University of Nebraska Medical Center (UNMC) College of Nursing, Omaha Division. She has been an oncology nurse for two decades, with a specialty in breast cancer and psycho-oncology. Dr. Lally's research interests include psychological adjustments for people newly diagnosed with and surviving cancer, reduction of distress and depressive symptoms, Internet-based psychoeducation in breast cancer, and understanding women's immediate post–breast cancer diagnosis experiences.
Marilyn Hammer, PhD, DC, RN, FAAN, is the Director of the Cancer Center for Research and Nursing and Patient Care Services at Dana-Farber Cancer Institute. Her research focuses on understanding the associations of glycemic status, metabolism, and immune function in cancer, particularly how these mechanisms are linked to symptoms and outcomes. Dr. Hammer has presented her work on precision health and associated ethical, legal, and social implications at conferences within the US and around the globe.
For More Information
Lally RM, Schmidt R, Tlusty G, et al (2023). Comprehensive outcomes for after cancer health: COACH. J Clin Oncol, 41(suppl_16). Abstract TPS12141. DOI:10.1200/JCO.2023.41.16_suppl.TPS12141
Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor