A Randomized Controlled Trial of Families Addressing Cancer Together (FACT): Effects of a web-based, individually tailored, psychosocial intervention for parents with cancer

Friday, November 8, 2024

11:05 AM – 12:20 PM EST

Location: Miami Lecture Hall

Presenting Author(s)

Zev M. Nakamura, MD

Assistant Professor
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina

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Co-Author(s)

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Allison Deal, MS

Senior Biostatistician
University of North Carolina Lineberger Comprehensive Cancer
Chapel Hill, North Carolina
Justin M. Yopp, PhD

Associate Professor
University of North Carolina
Raleigh, North Carolina
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Alexis Wardell, MS

Biostatistician
University of North Carolina Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina
Phoebe Yubin Pak

Research Technician
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
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Michelle Manning, MPH

Deputy Director of Administration, Comprehensive Cancer Support Program
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Eliza M. Park, MD, FACLP, FAPOS

Owner
Park Psychiatry, PLLC
Cary, North Carolina
Donald L. Rosenstein, MD, FACLP

Division Head, General Adult Psychiatry
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina

Abstract: Background and Significance: Hundreds of thousands of US families include a parent with cancer [1]. Nearly 60% of parents with advanced cancer meet screening criteria for anxiety and/or depression [2,3]. A major, and potentially modifiable, stressor for parents is difficulty discussing their cancer with their children. The objectives of this study were to evaluate the efficacy of Families Addressing Cancer Together (FACT) to improve communication between parents with cancer and their children and, secondarily, to improve symptoms of depression and anxiety in parents.

Methods: Parents with stage I-IV solid tumors who had children ages 3-17 were randomized to 6 weeks of FACT vs. waitlist control (NCT05377749). Measures of communication self-efficacy, communication beliefs and behaviors, depression, and anxiety were completed at pre-intervention baseline (T0), mid-intervention (T1), and post-intervention (T2). Generalized estimating equation methods examined differences in communication self-efficacy, depression, and anxiety scores over time and Fisher’s Exact tests explored differences in individual communication beliefs and behaviors.

Results: Among the 47 enrolled participants, the mean age was 44 years old and, on average, participants had 2 to 3 children. Eighty-one percent of participants were female, 65% were White, and 43% were working full-time. The most common cancers were breast (47%), head and neck (17%), and gynecologic (13%), and more than half of the sample had metastatic disease. In the FACT group, the estimated change in communication self-efficacy scores from T0 to T2 was both clinically significant (improvement ≥0.5 SD) and statistically significant (p=0.004) with no change observed in controls. FACT participants were more likely to have told their children that they have cancer (83.3% vs. 52.2%, p=0.03) and reported feeling more prepared to answer their children’s questions (p=0.02). No differences were observed in depression or anxiety.

Discussion: Our study is among the first randomized controlled trials focused on facilitating communication between parents with cancer and their children. FACT addresses several major gaps in the existing landscape of prior communication support interventions for parents with cancer and/or existing resources, including: 1) content that is customized to patients’ specific cancer, treatment, and prognosis; 2) language that is tailored to the specific age of patients’ minor children; and 3) since it is web-based and self-administered, FACT can be deployed anywhere patients receive cancer care. Important limitations of our study include the small sample size, brief period of observation, and outcomes restricted to the parent with cancer.

Conclusions: FACT demonstrated benefits in communication self-efficacy and multiple communication beliefs and behaviors. A large scale randomized controlled trial is needed to confirm these improvements in communication self-efficacy and to evaluate if FACT may also improve psychological outcomes in patients as well as improve outcomes in their children and other family members.