Pilot Randomized Controlled Trial of an Educational Video for CAR T-Cell Therapy Recipients

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P. Connor Johnson Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Tejaswini Dhawale Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Richard A. Newcomb Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Ana Barata Harvard Medical School, Boston, MA
Department of Psychiatry, Massachusetts General Hospital, Boston, MA

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Kyle Karpinski Department of Psychiatry, Massachusetts General Hospital, Boston, MA

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Mitchell W. Lavoie UMass Chan Medical School, Worchester, MA

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Dagny Vaughn University of Tennessee Health Science Center College of Medicine, Memphis, TN

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Kathleen Hennessey Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA

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David Schneider Department of Psychiatry, Massachusetts General Hospital, Boston, MA

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Hermioni L. Amonoo Harvard Medical School, Boston, MA
Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA

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Angelo Volandes Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Areej El-Jawahri Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Background: CAR T-cell therapy has transformed the treatment of hematologic malignancies, but it is complex and challenging to convey to patients. Educational video interventions are efficacious for improving patient knowledge about cancer therapeutics and informing their care preferences, yet no educational videos have been evaluated in CAR T-cell therapy. Methods: We conducted a randomized controlled trial comparing an educational video versus usual care in adults (age ≥18 years) with hematologic malignancies receiving CAR T-cell therapy at Massachusetts General Hospital. Intervention participants watched a 13-minute video depicting how CAR T-cell therapy works, logistics, toxicities, prognosis, recovery, and approaches for dealing with prognostic uncertainty. The primary outcome was feasibility (≥60% enrollment rate). Secondary outcomes included acceptability (≥80% reporting comfort with the video), patients’ knowledge about CAR T-cell therapy (10-item test), and self-efficacy (Communication and Attitudinal Self-Efficacy Scale–Cancer), decision satisfaction (Decision Conflict Scale), psychological distress (Hospital Anxiety and Depression Scale), and preference for CAR T-cell therapy. Results: We enrolled 79% (80/101) of eligible patients. Of that group, 91% (30/33) reported being very or somewhat comfortable watching the video, and 94% (31/33) would definitely or probably recommend the video. At 1 month, participants in the video arm reported higher self-efficacy (mean difference [MD], 9.2 [95% CI, –4.0 to 22.3]; Cohen’s d, 0.32), decision satisfaction (MD, 2.5 [95% CI, 0.7–4.2]; Cohen’s d, 0.67), and lower anxiety (MD, –0.8 [95% CI, –2.5 to 0.7]; Cohen’s d, 0.26) compared with participants in the usual care arm. At 1 week, both arms reported high preferences for CAR T-cell therapy (video arm, 94% [33/35]; usual care, 84% [27/32]). Conclusions: We found that an educational video for patients receiving CAR T-cell therapy was feasible and acceptable. The educational video demonstrated promising preliminary effects on patient self-efficacy and decision satisfaction and warrants further study.

Submitted April 4, 2023; final revision received September 6, 2023; accepted for publication September 6, 2023. Published online February 27, 2024.

Author contributions: Study concept and design: Johnson, El-Jawahri. Data collection: Karpinski, Lavoie. Statistical analysis: Johnson, El-Jawahri. Data analysis and interpretation: Johnson, El-Jawahri. Funding acquisition: El-Jawahri. Investigation: El-Jawahri. Methodology: Volandes, El-Jawahri. Project administration: Karpinski, Lavoie, Vaughn, El-Jawahri. Resources: Volandes, El-Jawahri. Software: El-Jawahri. Supervision: El-Jawahri. Validation: El-Jawahri. Visualization: El-Jawahri. Writing—original draft: Johnson, El-Jawahri. Writing—review and editing: All authors. Final approval of manuscript: All authors.

Data availability statement: For original data, please contact pcjohnson@mgh.harvard.edu. For access to the educational video, please contact angelo@acpdecisions.org.

Disclosures: Dr. Johnson has disclosed serving as a consultant for AstraZeneca, Bristol Myers Squibb, Seagen, ADC Therapeutics, AbbVie, and Incyte; and receiving grant/research support from AstraZeneca, Incyte, and Medically Home. Dr. Barata has disclosed owning stock in Grifols and Almirall, LLC. Dr. Newcomb has disclosed owning equity in Timedoc and Vertex Pharmaceutics. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: The research reported in this publication was supported by the American Society of Clinical Oncology (7633684844, P.C. Johnson).

Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.70011. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.

Correspondence: P. Connor Johnson, MD, Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 9A, Boston, MA 02114. Email: pcjohnson@mgh.harvard.edu

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