Effect of Mind-Body Skills Training on Quality of Life for Geographically Diverse Adults With Neurofibromatosis: A Fully Remote Randomized Clinical Trial

Author: Ana-Maria Vranceanu1,2, Heena R Manglani1,2, Nathaniel R Choukas1, Millan R Kanaya1, Ethan Lester1,2, Emily L Zale3, Scott R Plotkin4, Justin Jordan5, Eric Macklin2,6, Jafar Bakhshaie1,2
1 Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston.
2 Harvard Medical School, Boston, Massachusetts.
3 Department of Psychology, Harpur College of Arts and Sciences, Binghamton University, Binghamton, New York.
4 Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston.
5 Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston.
6 Biostatistics Center, Massachusetts General Hospital, Boston.
Conference/Journal: JAMA Netw Open
Date published: 2023 Jun 1
Other: Volume ID: 6 , Issue ID: 6 , Pages: e2320599 , Special Notes: doi: 10.1001/jamanetworkopen.2023.20599. , Word Count: 392

Neurofibromatoses (NF; NF1, NF2, and schwannomatosis) are hereditary tumor predisposition syndromes with a risk for poor quality of life (QOL) and no evidence-based treatments.

To compare a mind-body skills training program, the Relaxation Response Resiliency Program for NF (3RP-NF), with a health education program (Health Enhancement Program for NF; HEP-NF) for improvement of quality of life among adults with NF.

Design, setting, and participants:
This single-blind, remote randomized clinical trial randomly assigned 228 English-speaking adults with NF from around the world on a 1:1 basis, stratified by NF type, between October 1, 2017, and January 31, 2021, with the last follow-up February 28, 2022.

Eight 90-minute group virtual sessions of 3RP-NF or HEP-NF.

Main outcomes and measures:
Outcomes were collected at baseline, after treatment, and at 6-month and 1-year follow-up. The primary outcomes were physical health and psychological domain scores of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). Secondary outcomes were the social relationships and environment domain scores of the WHOQOL-BREF. Scores are reported as transformed domain scores (range, 0-100, with higher scores indicating higher QOL). Analysis was performed on an intention-to-treat basis.

Of 371 participants who underwent screening, 228 were randomized (mean [SD] age, 42.7 [14.5] years; 170 women [75%]), and 217 attended 6 or more of 8 sessions and provided posttest data. Participants in both programs improved from baseline to after treatment in primary outcomes of physical health QOL score (3RP-NF, 5.1; 95% CI, 3.2-7.0; P < .001; HEP-NF, 6.4; 95% CI, 4.6-8.3; P < .001) and psychological QOL score (3RP-NF, 8.5; 95% CI, 6.4-10.7; P < .001; HEP-NF, 9.2; 95% CI, 7.1-11.2; P < .001). Participants in the 3RP-NF group showed sustained improvements after treatment to 12 months; posttreatment improvements for the HEP-NF group diminished (between-group difference for physical health QOL score, 4.9; 95% CI, 2.1-7.7; P = .001; effect size [ES] = 0.3; and psychological QOL score, 3.7; 95% CI, 0.2-7.6; P = .06; ES = 0.2). Results were similar for secondary outcomes of social relationships and environmental QOL. There were significant between-group differences from baseline to 12 months in favor of the 3RP-NF for physical health QOL score (3.6; 95% CI, 0.5-6.6; P = .02; ES = 0.2), social relationships QOL score (6.9; 95% CI, 1.2-12.7; P = .02; ES = 0.3), and environmental QOL score (3.5; 95% CI, 0.4-6.5; P = .02; ES = 0.2).

Conclusions and relevance:
In this randomized clinical trial of 3RP-NF vs HEP-NF, benefits from 3RP-NF and HEP-NF were comparable after treatment, but at 12 months from baseline, 3RP-NF was superior to HEP-NF on all primary and secondary outcomes. Results support the implementation of 3RP-NF in routine care.

Trial registration:
ClinicalTrials.gov Identifier: NCT03406208.

PMID: 37378983 DOI: 10.1001/jamanetworkopen.2023.20599