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

PROJECT SUMMARY/ABSTRACT Administrative Supplements on Long-Term Cancer Survivorship. While childhood leukemia and lymphoblastic lymphoma therapies have achieved remarkable cure rates, they have created a growing population of survivors facing persistent treatment-related neurocognitive, academic, and related functional challenges into adulthood. To address these long-term effects, we developed and have iteratively refined a high-intensity intervention program (HIP) that, unlike traditional child-directed interventions (which have not yielded long-lasting improvements), takes a parent-directed approach, equipping parents with evidence-based tools to support their children’s learning and academic success. The parent randomized controlled trial (R01CA261793) evaluates our fourth iteration of HIP: HIP-eHealth, which delivers parent training remotely from a single site (City of Hope) and guides parents in supporting their children’s academic progress through use of the award-winning online learning platform IXL. In the parent study, survivors of childhood leukemia and lymphoblastic lymphoma and their parents (target: N = 166 dyads) are randomized to HIP-eHealth or a lower-intensity, single session mimicking usual care provided to survivors of pediatric brain tumors (LIP). HIP-eHealth has shown promising early results, with high completion rates and positive parent reports of increased self-efficacy and improved child academic outcomes. However, preliminary data from 133 currently enrolled parent/child dyads has revealed unexpected challenges emerging from the introduction of IXL. IXL’s curriculum-based assessments in Math and English Language Arts have revealed that 56% of children randomized to HIP-eHealth are performing at least two grades below their actual grade level. Such substantial academic gaps cannot be effectively closed without sustained practices extending well beyond active intervention, after external support concludes and families transition to independence. Unfortunately, many parents have required far more study team support than expected to facilitate consistent IXL engagement. Understanding the factors influencing sustained, independent parental engagement vs. reliance on external support is crucial for optimizing intervention effectiveness and ensuring long-term academic gains. In this project, we will conduct semi-structured interviews with 30 parent/child dyads (N = 60 total participants) who completed HIP-eHealth, strategically sampling families who required high study team support vs. those who demonstrated independent engagement in IXL. In Aim 1, we will identify parental beliefs and contextual factors influencing parents’ sustained engagement in their children’s academic support. In Aim 2, we will examine child perspectives on intervention components and factors contributing to continued use of academic strategies and practices post-intervention. This research will provide essential context for interpreting parent study findings and transforming our descriptive observations of variable parent-child engagement patterns into actionable insights critical for scaling HIP-eHealth effectively.