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| Name | Class |
|---|---|
| Singapore Thong Chai Medical Institution | UNKNOWN |
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The goal of this clinical trial is to evaluate the clinical effectiveness and understand the biological mechanisms of electroacupuncture (EA) in reducing cognitive toxicity among cancer survivors. The study aims are:
Researchers will compare results from the true EA arm, sham EA arm and waitlist control arm, to see if electroacupuncture can help improve cognitive issues related to cancer and its treatment, how it may work, and what factors may affect how it is delivered in cancer care.
Participants will:
Electroacupuncture (EA) is a promising, emerging intervention to manage cognitive toxicity among patients with cancer. The primary goal of the EAST-ALIGN study is to evaluate the clinical effectiveness and understand the biological mechanisms of EA in reducing cognitive toxicity among cancer survivors through a randomized, blinded sham and waitlist controlled, clinical trial. Simultaneously, the investigators will collect implementation data on engaging community Traditional Chinese Medicine (TCM) practitioners to deliver EA. This approach facilitates the early identification and resolution of implementation barriers, accelerating EA adoption into clinical practice if proven effective.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| True electroacupuncture arm | Experimental | Each participant will receive 10 electroacupuncture treatment sessions over the course of 10-12 weeks. |
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| Sham electroacupuncture arm | Sham Comparator | Each participant will receive 10 sham electroacupuncture sessions designed to mimic treatment without therapeutic stimulation over the course of 10-12 weeks. |
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| Waitlist control arm | No Intervention | Each participant will continue to receive usual care, but will not receive electroacupuncture or other acupuncture treatments. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| True electroacupuncture | Device | Electroacupuncture is administered at 13 predefined acupoints: Shenting (GV24), Baihui (DU20), Sishencong (EX-HN1), Zhongwan (CV12), Guanyuan (CV4), Neiguan (PC6, bilateral), Shenmen (HT7, bilateral), Zusanli (ST36, bilateral), Sanyinjiao (SP6, bilateral), Taixi (KI3, bilateral), Zhaohai (KI6, bilateral), Hegu (LI4, bilateral), and Taichong (LIV3, bilateral. |
| Measure | Description | Time Frame |
|---|---|---|
| Objective cognitive function - multitasking | Assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) Multitasking Test, a computerized cognitive testing software. Score ranges from 0-160, with a lower score reflecting better performance. Clinically significant improvement is defined as a Reliable Change Index (RCI) exceeding 1.96 from baseline in at least one out of five tests (including this Multitasking Test). | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Objective cognitive function - learning and memory | Assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) Paired Associates Learning Test, a computerized cognitive testing software. Score ranges from 0-70, with a lower score reflecting better performance. Clinically significant improvement is defined as a Reliable Change Index (RCI) exceeding 1.96 from baseline in at least one out of five tests (including this Paired Associates Learning Test). | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Objective cognitive function - sustained attention | Assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) Rapid Visual Information Processing Test, a computerized cognitive testing software. Score ranges from 0-1, with a higher score reflecting better performance. Clinically significant improvement is defined as a Reliable Change Index (RCI) exceeding 1.96 from baseline in at least one out of five tests (including this Rapid Visual Information Processing Test). | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Objective cognitive function - response speed | Assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) Reaction Time Test, a computerized cognitive testing software. Score ranges from 100-5100 ms, with a lower score reflecting faster reaction time. Clinically significant improvement is defined as a Reliable Change Index (RCI) exceeding 1.96 from baseline in at least one out of five tests (including this Reaction Time Test). |
| Measure | Description | Time Frame |
|---|---|---|
| Subjective cognitive function | The Functional Assessment of Cancer Therapy-Cognition (FACT-Cog) version 3 is a validated 37-item questionnaire assessing self-perceived subjective cognitive function. The total FACT-Cog score is summed from all items (range: 0-148), with higher scores indicating better subjective cognitive functioning. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
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Inclusion Criteria:
Survivor participants
Stakeholder participants
Exclusion Criteria:
Survivor participants
Stakeholder participants
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yu KE, PhD | Contact | +65 66836174 | ke.yu@nccs.com.sg | |
| Benton PT TAM, MSc | Contact | benton.tam.p.t@nccs.com.sg |
| Name | Affiliation | Role |
|---|---|---|
| Yu KE, PhD | National Cancer Centre, Singapore | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Cancer Center Singapore | Singapore | 168583 | Singapore |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24716504 | Background | Janelsins MC, Kesler SR, Ahles TA, Morrow GR. Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry. 2014 Feb;26(1):102-13. doi: 10.3109/09540261.2013.864260. | |
| Background | Wesevich A, Johnson K, Altomare I: Cancer-Related Cognitive Impairment, 2021, pp 139-152 | ||
| 32146576 |
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This is a randomized, sham- and waitlist-controlled trial.
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| Sham electroacupuncture | Device | Electroacupuncture is administered at predefined non-disease related acupoints: Pianli (LI6) bilateral, Wenliu (LI7) bilateral, Futu (ST32) bilateral, Xiajuxu (ST39) bilateral, Daheng (SP15) bilateral, and Jiaosun (TE20) bilateral. |
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| Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Objective cognitive function - working memory | Assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) Spatial Working Memory Test, a computerized cognitive testing software. Score ranges from 0-153, with a lower score reflecting better performance. Clinically significant improvement is defined as a Reliable Change Index (RCI) exceeding 1.96 from baseline in at least one out of five tests (including this Spatial Working Memory Test). | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Fatigue | The Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) is a validated questionnaire that comprises 30 items and contains 5 subscales, each with 6 items: general fatigue, physical fatigue, emotional fatigue, mental fatigue, and vigor. The total MFSI-SF score is obtained by subtracting the vigor subscale from the sum of all items (range: 24-96), with a higher score indicating higher fatigue level. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Symptom burden | The Rotterdam Symptom Checklist (RSCL) is a validated self-report measure of quality of life in patients with cancer. It includes 30 symptom items, 8 activity items, and 1 overall quality-of-life item. The symptom distress score combines the physical symptom distress scale (23 items, range 23-92) and, psychological distress scale (7 items, range 7-28), for a total range of 30-120. Higher scores indicate greater symptom burden, distress, or quality of life. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Work productivity | The Work Productivity and Activity Impairment (WPAI) questionnaire is a patient-reported outcome measure that assesses the impact of health problems on work productivity and regular activities, including absenteeism, presenteeism, overall work impairment, and activity impairment. Scores in each of these four areas are expressed as a percentage from 0% to 100%, with higher scores indicating greater impairment and worse productivity. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Health utility | EuroQOL Group 5-Dimension (EQ-5D-5L) contains a 5-item descriptive system measuring 5 dimensions: mobility, self-care, usual activities, pain/ discomfort, anxiety/ depression; a visual analogue scale (VAS) measuring overall health status. EQ-5D Index Value (Utility Score) ranges from 0 to 1.0 with higher value indicating better health-related quality of life. The VAS ranges from 0 to 100, with higher scores reflecting better self-rated health. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Biomarkers - plasma BDNF | Plasma brain-derived neurotropic factor levels at each time point will be analyzed from blood samples collected. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Biomarkers - plasma cytokines (IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-alpha) | Plasma concentrations of interleukin-1 beta (IL-1β), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha) will be measured from blood samples. Each cytokine will be reported in picograms per milliliter (pg/mL). Higher values indicate higher plasma cytokine concentrations. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Biomarkers - epigenetic ageing | Epigenetic ageing will be assessed using DNA methylation-based biological age metrics derived from blood samples. | Baseline, 13 weeks after baseline, and 17 weeks after baseline. |
| Safety assessment | Participants will be monitored for adverse events and the severity will be graded according to the Common Terminology Criteria for Adverse Events (CTCAE). | 13 weeks after baseline and 17 weeks after baseline. |
| Implementation - acceptability of electroacupuncture treatment | Participants in the true and sham EA arms will complete a questionnaire evaluating their perceptions towards the true/sham EA treatment. Participants will be asked if they are satisfied and benefited from the treatment, and whether they would consider undergoing treatment again outside of a trial setting. | 13 weeks after baseline. |
| Implementation - adoption of EA | Adoption will be evaluated by tracking study enrollment logs, including the number of eligible individuals approached, the number recruited, and documented reasons for non-participation when available. | From commencement of study recruitment till the end of recruitment, assessed up to 3 years. |
| Implementation - treatment fidelity | Treatment fidelity will be assessed from standardized treatment logs for each true/sham EA session by the TCM practitioners. For blinding assessment, participants in the true and sham EA arms will be asked to guess their treatment arm allocation (True EA/ Sham EA/ Don't know). | 13 weeks after baseline. |
| Implementation - feasibility | Semi-structured interviews conducted using an interview guide developed based on the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with key stakeholders (TCM practitioners, tertiary healthcare providers, clinical operations staff) to identify barriers and facilitators to integrating EA into routine oncology care. | 17 weeks after baseline, through study completion, estimated as up to 3 years. |
| Implementation - implementation cost | Implementation cost will be assessed using a time-driven activity-based costing approach. A structured activity log will be maintained by study personnel to document the time and resources required for each implementation activity, including personnel effort and fixed consumable resources. | From commencement of study recruitment, through study completion, estimated as up to 3 years. |
| Background |
| Cerulla Torrente N, Navarro Pastor JB, de la Osa Chaparro N. Systematic review of cognitive sequelae of non-central nervous system cancer and cancer therapy. J Cancer Surviv. 2020 Aug;14(4):464-482. doi: 10.1007/s11764-020-00870-2. Epub 2020 Mar 7. |
| 22396443 | Background | Cheung YT, Shwe M, Tan YP, Fan G, Ng R, Chan A. Cognitive changes in multiethnic Asian breast cancer patients: a focus group study. Ann Oncol. 2012 Oct;23(10):2547-2552. doi: 10.1093/annonc/mds029. Epub 2012 Mar 6. |
| Background | Moreno AM, Hamilton RA, Currier MB: Chapter 20 - Cancer-Related Cognitive Impairment: Diagnosis, Pathogenesis, and Management, in Cristian A (ed): Breast Cancer and Gynecologic Cancer Rehabilitation. St. Louis, Elsevier, 2021, pp 211-223 |
| 30048158 | Background | Bolton G, Isaacs A. Women's experiences of cancer-related cognitive impairment, its impact on daily life and care received for it following treatment for breast cancer. Psychol Health Med. 2018 Dec;23(10):1261-1274. doi: 10.1080/13548506.2018.1500023. Epub 2018 Jul 26. |
| 39260437 | Background | Yang Y, Von Ah D. Cancer-related cognitive impairment: updates to treatment, the need for more evidence, and impact on quality of life-a narrative review. Ann Palliat Med. 2024 Sep;13(5):1265-1280. doi: 10.21037/apm-24-70. Epub 2024 Sep 9. |
| 28681478 | Background | Dorland HF, Abma FI, Roelen CAM, Stewart RE, Amick BC, Ranchor AV, Bultmann U. Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study. Int J Cancer. 2017 Nov 1;141(9):1751-1762. doi: 10.1002/ijc.30876. Epub 2017 Jul 19. |
| 36973688 | Background | Xie L, Ng DQ, Heshmatipour M, Acharya M, Coluzzi P, Guerrero N, Lee S, Malik S, Parajuli R, Stark C, Tain R, Zabokrtsky K, Torno L, Chan A. Electroacupuncture for the management of symptom clusters in cancer patients and survivors (EAST). BMC Complement Med Ther. 2023 Mar 27;23(1):92. doi: 10.1186/s12906-023-03926-9. |
| 32791039 | Background | Liu S, Wang ZF, Su YS, Ray RS, Jing XH, Wang YQ, Ma Q. Somatotopic Organization and Intensity Dependence in Driving Distinct NPY-Expressing Sympathetic Pathways by Electroacupuncture. Neuron. 2020 Nov 11;108(3):436-450.e7. doi: 10.1016/j.neuron.2020.07.015. Epub 2020 Aug 12. |
| 20622480 | Background | Hwang IK, Chung JY, Yoo DY, Yi SS, Youn HY, Seong JK, Yoon YS. Effects of electroacupuncture at Zusanli and Baihui on brain-derived neurotrophic factor and cyclic AMP response element-binding protein in the hippocampal dentate gyrus. J Vet Med Sci. 2010 Nov;72(11):1431-6. doi: 10.1292/jvms.09-0527. Epub 2010 Jul 7. |
| 29426666 | Background | O'Leary OF, Ogbonnaya ES, Felice D, Levone BR, C Conroy L, Fitzgerald P, Bravo JA, Forsythe P, Bienenstock J, Dinan TG, Cryan JF. The vagus nerve modulates BDNF expression and neurogenesis in the hippocampus. Eur Neuropsychopharmacol. 2018 Feb;28(2):307-316. doi: 10.1016/j.euroneuro.2017.12.004. |
| 33204250 | Background | Hou Z, Qiu R, Wei Q, Liu Y, Wang M, Mei T, Zhang Y, Song L, Shao X, Shang H, Chen J, Sun Z. Electroacupuncture Improves Cognitive Function in Senescence-Accelerated P8 (SAMP8) Mice via the NLRP3/Caspase-1 Pathway. Neural Plast. 2020 Nov 4;2020:8853720. doi: 10.1155/2020/8853720. eCollection 2020. |
| 35232269 | Background | Jiang J, Liu H, Wang Z, Tian H, Wang S, Yang J, Li Z. Effects of electroacupuncture on DNA methylation of the TREM2 gene in senescence-accelerated mouse prone 8 mice. Acupunct Med. 2022 Oct;40(5):463-469. doi: 10.1177/09645284221077103. Epub 2022 Mar 2. |
| 35154573 | Background | Hou Z, Yang X, Li Y, Chen J, Shang H. Electroacupuncture Enhances Neuroplasticity by Regulating the Orexin A-Mediated cAMP/PKA/CREB Signaling Pathway in Senescence-Accelerated Mouse Prone 8 (SAMP8) Mice. Oxid Med Cell Longev. 2022 Feb 4;2022:8694462. doi: 10.1155/2022/8694462. eCollection 2022. |
| 22310560 | Background | Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012 Mar;50(3):217-26. doi: 10.1097/MLR.0b013e3182408812. |
| Background | Cheng X: Chinese acupuncture and moxibustion. Beijing, China, Foreign Language Press, 1987 |
| Background | Jianqiao F, Baixiao Z: Acupuncture and Moxibustion (ed 3rd). China, People's Medical Publishing House, 2021. |
| 31484559 | Background | Kim JH, Cho MR, Park GC, Lee JS. Effects of different acupuncture treatment methods on mild cognitive impairment: a study protocol for a randomized controlled trial. Trials. 2019 Sep 4;20(1):551. doi: 10.1186/s13063-019-3670-3. |
| 19204011 | Background | Lim S. WHO Standard Acupuncture Point Locations. Evid Based Complement Alternat Med. 2010 Jun;7(2):167-8. doi: 10.1093/ecam/nep006. Epub 2009 Feb 24. |
| 22476439 | Background | Cheung YT, Tan EH, Chan A. An evaluation on the neuropsychological tests used in the assessment of postchemotherapy cognitive changes in breast cancer survivors. Support Care Cancer. 2012 Jul;20(7):1361-75. doi: 10.1007/s00520-012-1445-4. Epub 2012 Apr 5. |
| 17974553 | Background | Vardy J, Wefel JS, Ahles T, Tannock IF, Schagen SB. Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop. Ann Oncol. 2008 Apr;19(4):623-9. doi: 10.1093/annonc/mdm500. Epub 2007 Oct 31. |
| 21354373 | Background | Wefel JS, Vardy J, Ahles T, Schagen SB. International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol. 2011 Jul;12(7):703-8. doi: 10.1016/S1470-2045(10)70294-1. Epub 2011 Feb 25. |
| 24656406 | Background | Cheung YT, Foo YL, Shwe M, Tan YP, Fan G, Yong WS, Madhukumar P, Ooi WS, Chay WY, Dent RA, Ang SF, Lo SK, Yap YS, Ng R, Chan A. Minimal clinically important difference (MCID) for the functional assessment of cancer therapy: cognitive function (FACT-Cog) in breast cancer patients. J Clin Epidemiol. 2014 Jul;67(7):811-20. doi: 10.1016/j.jclinepi.2013.12.011. Epub 2014 Mar 18. |
| 10146874 | Background | Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993 Nov;4(5):353-65. doi: 10.2165/00019053-199304050-00006. |
| 32370752 | Background | Cidav Z, Mandell D, Pyne J, Beidas R, Curran G, Marcus S. A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implement Sci. 2020 May 5;15(1):28. doi: 10.1186/s13012-020-00993-1. |
| Background | Guest G, Bunce A, Johnson L: How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods 18:59-82, 2006 |
| 24339912 | Background | Cheung YT, Lim SR, Ho HK, Chan A. Cytokines as mediators of chemotherapy-associated cognitive changes: current evidence, limitations and directions for future research. PLoS One. 2013 Dec 5;8(12):e81234. doi: 10.1371/journal.pone.0081234. eCollection 2013. |
| 25922060 | Background | Cheung YT, Ng T, Shwe M, Ho HK, Foo KM, Cham MT, Lee JA, Fan G, Tan YP, Yong WS, Madhukumar P, Loo SK, Ang SF, Wong M, Chay WY, Ooi WS, Dent RA, Yap YS, Ng R, Chan A. Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study. Ann Oncol. 2015 Jul;26(7):1446-51. doi: 10.1093/annonc/mdv206. Epub 2015 Apr 28. |
| 38963018 | Background | Sayer M, Ng DQ, Chan R, Kober K, Chan A. Current evidence supporting associations of DNA methylation measurements with survivorship burdens in cancer survivors: A scoping review. Cancer Med. 2024 Jul;13(13):e7470. doi: 10.1002/cam4.7470. |
| 36309746 | Background | Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022 Oct 29;17(1):75. doi: 10.1186/s13012-022-01245-0. |
| ID | Term |
|---|---|
| D009369 | Neoplasms |
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