Results of Life Coaching in Myeloma | Rahul Banerjee, MD, FACP | IMS 2023

Hi everyone, my name is Rahul Banerjee. I'm an assistant professor of medicine at the Fred Hutchinson Cancer Center in Seattle, Washington. I'm excited to present our poster this week that actually just got published of a randomized phase two study of digital life coaching for patients with myeloma undergoing autologous stem cell transplantation. So as all of you are well aware, transplantation, so stem cell transplant, something that we do offer routinely to our patients who are younger and fitter with myeloma, it does have a very acute short-term quality of life detriment. You know, patients feel very unwell both symptomatically and in terms of fatigue, they need a lot of energy to kind of rebuild their life afterwards. A lot of patients don't return to work after transplant. You know, it's something where supportive care has come a long way, but there's more where we can go with this. And so, you know, people have studied all sorts of interventions, supportive care interventions to help support patients with myeloma during transplant. There have been randomized studies that have shown, for example, that music therapy helps, that acupuncture helps, that even program room lighting, like bright lights during the day and dim at night seem to help with actually the, you know, patient's fatigue and patient's depression and patient scores in the midst of the acute peritransplant period. Those are sometimes kind of tough because they're only hospital-based interventions that we were interested in. Is there something that we can do to support patient's quality of life, both in the hospital and when they come home afterwards? Enter digital life coaching. The idea between digital life coaching and some of you may actually in this video may have participated in some of our studies, so thank you if you did, is that patients are paired with a life coach, not a doctor, not a nurse, but a certified health coach who works with them on whatever they want to work on wellness-related. That could be physical activity, that could be diet, that could be sleep, that could be exercise, that could be stress about turning to work, whatever. We've done a previous feasibility study of it at my former institution, UCSF, when I was a fellow showing that digital life coaching was feasible for patients during transplant. In a PAL study of 15 patients, they still worked with their coach by phone or text once a week, even while hospitalized. And so, thanks to funding from ASCO, actually through a Young Investigator Award, we were actually able to do a randomized phase two study of digital life coaching, a three-month curriculum versus wellness-related handouts in patients with myeloma undergoing transplant at UCSF. I was mentored on this project with Dr. Nina Shah, who helped me a ton with this. The results, again, just got published on Monday and they're being presented at this conference as well, basically showing that compared to just wellness-related handouts that go to patients once a week, three months of digital life coaching curriculum did improve patients' physical quality of life. So if you looked, basically patients did better in terms of how they felt about their physical quality of life, how much they're able to move and walk and actually take care of daily activities compared to the handouts alone. We didn't see a benefit in terms of mental quality of life, just physical. We looked at emotional distress through the NCCN distress thermometer, some of you may have seen this before, a zero to 10 instrument of just how overwhelmed do you feel? And we saw borderline, almost a process of physical significance benefit to life coaching there. Just as an example, at the end of the study, 28% of patients in the wellness-related handout arm still felt elevated levels of distress in the life coaching arm, it was only 10%. Again, the P value is basically 0.051, just almost at the cost of significance. And life coaching, it wasn't for everybody. We did get some feedback from patients. They found the curriculum wasn't quite personalized enough for them or a little too basic for them. But a lot of our patients had positive things to say. They said that, look, the life coach helped keep me accountable. That was the biggest theme that I heard from patients again and again, that just having someone, this was a free service for patients where the coach will text me and call me and remind me that, hey, you said you're going to walk a mile today, you got to walk a mile. I know it's only been 14 days since your transplant, but this is important. And that motivation, that accountability longitudinally made a big difference. Based on that, we're now expanding digital life coaching to other settings in the myeloma field. So we have two studies open at Fred Hutch currently in Seattle. You actually don't need to be followed here to enroll. So if you're interested, please consider reaching out to me or our study team about this, where basically we pair a three month life coaching curriculum with a Fitbit with a wearable activity monitoring. The idea is that many studies have shown mixed results when it comes to just giving a patient a Fitbit and saying, here, take this. And that's often not enough because patients are literally fighting cancer, as all questions in this video know. But what if you take that Fitbit, that wearable activity tracker to count your steps and pair it with a coach who can kind of, you know, is there synergy there? Can the coach help motivate patients to walk and move and be more active? And can the step tracker be a way to do that? So that chapter is still being written right now. That study, both studies are actively accruing at Fred Hutch here in Seattle. But in terms of the randomized phase two study of digital life coaching, we found that this does work for patients. And again, it does lead to improvements in quality of life, physical quality of life, and probably a benefit in emotional distress as well. And so as patients rebuild their lives after transplant, which is a lot, I do think that interventions like digital life coaching may be a good way to promote supportive care during the time period. Thanks again for listening and I'll see you at our poster.