Leveraging Digital Health Solutions to Reduce Learning and Functional Disparities in Children with Cancer

PROJECT SUMMARY/ABSTRACT As the population of childhood cancer survivors grows, the impact of long-term treatment-related side effects also grows. Cancer treatments for children with leukemia and lymphoblastic lymphoma (LL) have long-lasting toxic effects on the developing brain, known as neurocognitive late effects, which can impact the children’s

learning, function, and ability to achieve independence as adults. However, these problems are often untreated in leukemia and LL survivors, creating a medically underserved population. Recognizing the impact of familial factors on survivor outcomes, we designed a parent-directed training intervention (the high-intensity intervention

program, HIP), which teaches parents about brain development and neurocognitive late effects; trains them on tools to improve their child’s behavior and cognitive functioning; provides tips for establishing better learning environments and effective study habits; and helps them to manage stress for themselves and their children.

Pilot trials of the HIP in English- and Spanish-speaking families demonstrated efficacy but also revealed critical barriers to success, including travel time and scheduling challenges. Digital health technologies offer transformative solutions to improve the efficiency, quality, and convenience of healthcare delivery. However,

“eHealth” has not been applied to a parent-directed intervention to improve educational outcomes for children. Therefore, we propose to test a new eHealth version of our English/Spanish intervention (HIP-eHealth) in a randomized clinical trial of 180 parent/child dyads from 4 sites in California. HIP-eHealth addresses the remaining

barriers to HIP access and incorporates improvements recommended by parents in our earlier trials. We will deliver HIP-eHealth from a single central site (City of Hope) through a HIPAA-compliant study website that hosts Zoom videoconferencing for HIP sessions; digitized study content; supplemental multimedia content; links to the

award-winning IXL learning environment; gamification features and automated reminders to increase engagement; and robust user analytics. Other advances include a streamlined 4-session program, an enhanced booster phase, and greater inclusion of the children. We hypothesize that HIP-eHealth will produce greater

improvements in child and parent outcomes than a lower-intensity program (LIP) that mimics the usual care provided to survivors of pediatric brain tumors (i.e., a single meeting to discuss the child’s neuropsychological testing results and provide recommendations for optimal learning). Our study aims to: (1) Evaluate the

effectiveness of HIP-eHealth on the learning and school performance of pediatric cancer survivors; (2) Evaluate

the effectiveness of HIP-eHealth on the “pro-learning” efficacy of their parents; (3) Investigate the extent to which

the parents’ efficacy and/or children’s use of online learning activities is associated with changes in the children’s school performance; and (4) Assess factors that impact the parents’ ability to complete the intervention. We anticipate this study will help shape a scalable and effective therapy that is easily integrated into standard care.