Trial Evaluating an Enhanced Physical Activity Intervention to Improve Cognitive Late Effects in Children Treated With Cranial Radiation for Brain Tumors
Conditions
Brain Tumor
Conditions: official terms
Brain Neoplasms
Conditions: Keywords
Exercise, Memory, BDNF, Zamzee, QOL
Study Type
Interventional
Study Phase
Phase 2
Study Design
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
Intervention
Name: Physical Activity
Type: Behavioral
Overall Status
Recruiting
Summary
Background:

- More children with cancer are surviving into adulthood. Some side effects from treatment go away quickly. But some problems may not go away or may only show up months or years later. These problems are called late effects. Late effects can cause difficulties in cognitive functions, such as attention and memory. Physical activity has been found to improve the attention and memory skills of children with Attention Deficit Hyperactivity Disorder (ADHD). Researchers want to see if physical activity can help with these cognitive problems in children with brain tumors.

Objectives:

- To see if physical activity can improve cognitive functions in children who had radiation therapy for a brain tumor.

Eligibility:

- Children ages 8 17 who had radiation for a brain tumor at least 2 years ago. They must have access to a computer.

Design:

- Participants will be screened with height, weight, and medical history. They will answer questions about daily physical activities. Their heart will be checked.

- Participants will go to the clinic for 2 days. They will have a fitness exam and tests about attention, memory, and concentration. They will have blood taken and answer questions. Parents will also answer questions.

- Participants will be put into 2 groups. For the first 12 weeks, the intervention group will follow a physical activity program. The control group will do their usual physical activities.

- For the second 12 weeks, the control group will follow the physical activity program. The intervention group will continue the activities on their own. All groups will track their physical activity with an activity monitor and computer.

- Participants will have a follow-up visit at the clinic after each session. They will repeat some of the tests listed above.

- The study lasts 24 weeks plus the two follow-up visits. Participants can keep their activity monitor.
Detailed Description
BACKGROUND:

- Children treated with cranial radiation therapy (CRT) for brain tumors are at high risk for developing neurocognitive late effects consisting of significant declines in overall IQ and specific cognitive impairments, particularly in attention, memory, and processing speed. Academic functioning, daily activities, and quality of life (QOL) also are impacted, and children often require special educational services.

- Despite adaptations in radiation therapy (delay of radiation, reduced dose, specialized techniques), cognitive deficits still develop. Interventions targeting cognitive rehabilitation are limited yet sorely needed.

- A potential and novel intervention for cognitive rehabilitation that has not been explored in children with cancer involves physical activity (PA). Compelling evidence from both human and animal studies indicates that PA affects the same brain mechanisms and cognitive functions damaged by CRT and chemotherapy.

- Previous PA intervention studies in children with cancer have been found to be feasible, safe, and beneficial to health but have not examined cognition outcomes. Therefore, we will conduct a randomized controlled trial to evaluate the effects of PA on the cognitive functioning of children treated with CRT for brain tumors. In addition, we will enhance the intervention by combining it with Acceptance and Commitment Therapy (ACT) techniques to maximize participants' motivation to engage in PA.

- The immediate intervention group (the intervention group ) will engage in the enhanced PA intervention program for the first 12 weeks followed by 12 weeks of PA maintenance on their own, while the delayed intervention control group (the control group ) will engage in their usual physical activity for the first 12 weeks followed by the enhanced PA intervention program for the second 12 weeks.

OBJECTIVES:

- To assess the effects of a 12-week enhanced physical activity (PA) home intervention on visual memory (CogState One Card Learning Accuracy score) in children treated with CRT for brain tumors compared to a control group engaged in usual physical activity during the first 12 weeks.

- To assess the effects of an enhanced PA intervention on specific cognitive functions (attention, processing speed, memory, executive functions), fatigue, and quality of life (QOL), in children with brain tumors treated with CRT compared to a control group.

- To measure the effects of an enhanced PA intervention on circulating growth factors (BDNF, IGF- 1, and VEGF) in plasma and serum in children with brain tumors treated with CRT compared to a control group.

- To examine the PA levels and cognitive test scores between the first (PA program) and second (PA on their own) 12 weeks in the intervention group.

- To evaluate the effects of the 12-week enhanced PA program on cognitive functioning by examining the change in test scores from pre- to post-intervention in the immediate intervention and delayed intervention control groups combined.

- To identify the relationships between PA levels, cardiorespiratory fitness, neurobehavioral outcomes (cognition, fatigue, QOL), and circulating growth factors in children with brain tumors treated with CRT.

- To assess the feasibility of various components of the intervention (e.g., ACT, activity monitors) based on the post-study questionnaire and explore relationships between the use of these components and PA outcomes.

ELIGIBILITY:

- Children ages 8 - 17 years previously diagnosed with a brain tumor who are at least 2 years postcompletion of CRT and who are not on an active anti-tumor treatment will be eligible.

- Children should have reported or documented cognitive difficulties in attention, learning and memory, or processing speed per the child s parent or legal guardian.

DESIGN:

-This is a prospective single-institution trial. Children will be randomized to one of two groups: Group 1 (n=30): The immediate intervention group (the intervention group ) will participate in the enhanced PA home intervention group for the first 12 weeks; followed by 12 weeks of PA maintenance on their own.

Group 2 (n=30): The delayed intervention control group (the control group ) will engage in their usual physical activity (no intervention) for 12 weeks; followed by the enhanced PA home intervention for 12 weeks.

- Neurobehavioral, circulating growth factors, and cardiorespiratory evaluations will be conducted at baseline (T0) and after the first 12 weeks at home (T2) in both the intervention and control groups. The acute effects of the in-lab PA will be assessed immediately following the baseline treadmill fitness test (T1) using selected cognitive measures in both groups. PA for both groups will be measured throughout the period at home via activity monitors.

- After the completion of the first 12 week period at home and the follow-up evaluations (T2), the intervention group will be asked to maintain their PA levels on their own for the next 12 weeks while the control group will participate in the enhanced PA intervention at home for 12 weeks. A final cognitive evaluation will be conducted in both groups after the completion of the second 12- week period (T3). The primary outcome measure is the Cogstate One Card Learning Accuracy Score. The effects of PA on other neurobehavioral outcomes and circulating growth factors also will be examined.
Criteria for eligibility
Healthy Volunteers: No
Maximum Age: 17 Years
Minimum Age: 8 Years
Gender: Both
Criteria: - ELIGIBILITY CRITERIA:

INCLUSION CRITERIA:

1. Children ages 8 - 17 years of age, diagnosed with brain tumor.

2. Must be at least 2 years post completion of radiation therapy to the brain or brain and spine.

3. Must be off anti-neoplastic therapy for at least 2 weeks and all therapy-related toxicities should return to baseline or Grade 1 if previously nonexistent.

4. Have parent-reported or documented difficulties in attention, processing speed, memory, or learning as assessed by the screening questions (a score of at least 3 on any one of the 4 questions or the participant having > (Omega) SD decline in test scores, scores < 85, or special education services or accommodations).

5. Must have a parent or legal guardian willing to complete the parent proxy behavioral questionnaires and help their child participate in the study procedures at home.

6. Ability to read and understand the English language.

7. Have regular access to a computer (either PC or Mac with a built-in USB port).

8. Must be willing to register on the Zamzee website, which will include sharing some personal identifiable information, to allow the participant to use the Zamzee meter and website to monitor activity levels.

9. Ability of subject or Legally Authorized Representative (LAR) to understand and willingness to sign a written informed consent document.

EXCLUSION CRITERIA

1. A child with diffuse intrinsic pontine glioma (DIPG) or recurrent high grade brain tumors will be excluded due to the poor prognosis, making participation for the length of this study difficult.

2. Significant medical problems, such as severe uncontrolled illnesses (as listed in Appendix II C), or physical impairments that prohibit the child from exercising at moderate to vigorous levels based on the clinical judgment of the examining physician or nurse practitioner.

3. Currently engaging in > 3 hours of moderate to vigorous physical activity per week, as reported in the exercise screening questions completed at the pre-study screening evaluation.

4. Significant cognitive, behavioral, or emotional impairments as judged by an investigator that would prevent the child from understanding or completing the intervention or assessment measures.

5. A child has plans to start a new treatment for attention/memory problems in the next 3 months.

6. Currently on or planning to begin active neoplastic therapy, as the side effects may significantly impair ability to participate in physical activity.

7. Unable to travel to NIH for the evaluations.
Location
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States
Status: Recruiting
Contact: For more information at the NIH Clinical Center contact National Cancer Institute Referral Office - 888-624-1937
Start Date
May 2014
Completion Date
April 2018
Sponsors
National Cancer Institute (NCI)
Source
National Institutes of Health Clinical Center (CC)
Record processing date
ClinicalTrials.gov processed this data on July 28, 2015
ClinicalTrials.gov page