A randomised, phase II, unblinded trial of an Exercise and Nutrition-based Rehabilitation programme (ENeRgy) versus standard care in patients with cancer: feasibility trial protocol

Hall, Charlie; Norris, Lucy; Dixon, Liz; Cook, Jane; Maddocks, Matthew; Graham, Catriona; Tuck, Sharon; Haraldsdottir, Erna; Brown, Duncan; Lloyd, Anna; Finucane, Anne; Hall, Peter; Diernberger, Katharina; Skipworth, Richard J E; Fallon, Marie; Laird, Barry

doi:10.1186/s40814-018-0381-6

Cited by 7 publications

(6 citation statements)

References 31 publications

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“…Although the hospice does not at present have a formal rehabilitation service, part of its ethos is person-centred care and enablement and this theme runs through both inpatient and outpatient services. Furthermore, a phase two Randomised Control Trial of a rehabilitation intervention for outpatients living with incurable cancer was underway at the time of the study37 potentially influencing staff members’ understanding or interpretation of rehabilitation. Finally, we acknowledge that some staff members (eg, physiotherapists) would have a more comprehensive understanding of rehabilitation than others potentially influencing the findings.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation in palliative care: a qualitative study of team professionals

Harding

Hall

Lloyd³

2019

BMJ Support Palliat Care

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ObjectivesThere has been a recent drive to embed rehabilitation within palliative care. The concept of rehabilitative palliative care has been advocated to help patients preserve function and independence, through greater patient enablement and self-management. Such an approach requires engagement from all members of the palliative care team. There is a lack of understanding of such viewpoints. The objective of this research was to explore hospice-based palliative care professionals’ understanding and perceptions of rehabilitation.MethodsQualitative semi-structured interviews were conducted. Eighteen hospice-based healthcare professionals were recruited from a hospice in central Scotland. Interviews were audio-recorded, transcribed and thematically analysed.ResultsOverall, participants clearly articulated the underlying values and benefits of rehabilitative palliative care. Emphasis was placed on ensuring that rehabilitation was appropriately tailored to each individual patient. There was more ambiguity regarding the pragmatic implementation of rehabilitative palliative care, with a number of barriers and facilitators identified.ConclusionsThe findings suggest that hospice-based palliative care professionals would be receptive to further implementation of rehabilitative palliative care. A lack of conceptual clarity among palliative care professionals may be a barrier to the effective implementation of rehabilitative palliative care. At an organisational level, this would require clarification of the approach, and additional training involving all members of the multidisciplinary team.

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Section: Discussionmentioning

confidence: 99%

Rehabilitation in palliative care: a qualitative study of team professionals

Harding

Hall

Lloyd³

2019

BMJ Support Palliat Care

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“…Strategies to stabilise patient fitness and reduce systemic inflammation/cachexia may have important roles alongside SACT in the holistic management of patients with cancer (18, 43). Recently published guidelines in the UK have recommended integrating pre-treatment rehabilitation, i.e., prehabilitation, into established clinical pathways for patients with cancer (44). Interventions to optimise physical functional and nutritional status may be employed based on the needs of the patient (18, [43][44][45][46].…”

Section: Discussionmentioning

confidence: 99%

“…Recently published guidelines in the UK have recommended integrating pre-treatment rehabilitation, i.e., prehabilitation, into established clinical pathways for patients with cancer (44). Interventions to optimise physical functional and nutritional status may be employed based on the needs of the patient (18, [43][44][45][46]. Patients with metastatic NSCLC often have multiple pre-existing comorbidities and a high cancer-symptom burden (47).…”

Section: Discussionmentioning

confidence: 99%

Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer

et al. 2021

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Introduction: Despite significant advances in systemic anticancer therapy (SACT) for non-small cell lung cancer (NSCLC), many patients still fail to respond to treatment or develop treatment resistance. Albumin, a biomarker of systemic inflammation and malnutrition, predicts survival in many cancers. We evaluated the prognostic significance of albumin in patients receiving first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC.Methods: All patients treated with first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC at a regional Scottish cancer centre were identified. Serum albumin at pre-treatment, after 12-weeks of treatment, and at the time of progressive disease were recorded. The relationship between albumin (≥ 35g/L v <35g/L) and overall survival (OS) was examined.Results: Data were available for 389 patients of both targeted therapy cohort (n = 159) and immunotherapy-based therapy cohort (n = 230). Pre-treatment albumin was predictive of OS in each cohort at HR1.82 (95%CI 1.23–2.7) (p =0.003) and HR2.55 (95%CI 1.78–3.65) (p < 0.001), respectively. Pre-treatment albumin <35 g/L was associated with a significantly higher relative risk of death within 12 weeks in each cohort at RR9.58 (95%CI 2.20–41.72, p = 0.003) and RR3.60 (95%CI 1.74–6.57, p < 0.001), respectively. The 12-week albumin was predictive of OS in each cohort at HR1.88 (95%CI 1.86–4.46) (p < 0.001) and HR2.67 (95%CI 1.74–4.08) (p < 0.001), respectively. 46 out of 133 (35%) evaluable patients treated with targeted therapy and 43 out of 169 (25%) treated with immunotherapy-based therapy crossed over albumin prognostic groups between pre-treatment and 12-week. The prognostic value of 12-week albumin was independent of pre-treatment albumin status. A majority of patients had albumin <35g/L at the time of progressive disease when it was also predictive of survival following progressive disease at HR2.48 (95%CI 1.61–3.82) (p < 0.001) and HR2.87 (95%CI 1.91–4.31) (p < 0.001) respectively).Conclusions: Albumin is a reliable prognostic factor in patients with metastatic NSCLC, predicting survival independent of the class of drug treatment at various time points during the patient journey. Tracking albumin concentrations during systemic therapy may indicate disease activity or treatment response over time.

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“…With the increasing integration of oncology and palliative care this is likely to remain an important part of the assessment of the patient with advanced cancer. It may be that other objective measurements of "real life" performance status will more consistently reflect ECOG-PS, such as activity trackers (e.g., Fitbit) [33][34][35]. With reference to the mGPS there has been in recent years extensive validation of its use in patients with advanced care, and routine assessment is now advocated [36,37].…”

Section: Discussionmentioning

confidence: 99%

The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer

Dolan

Daly

Simmons

et al. 2020

Cancers

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Cancer remains one of the leading causes of mortality worldwide and the associated reduction in physical function has a marked impact on both quality of life and survival. The aim of the present study was to examine the relationship between Eastern Cooperative Oncology Group-Performance status (ECOG-PS), modified Glasgow Prognostic Score (mGPS), Body Mass Index/Weight Loss grade (BMI/WL grade), and Computerised Tomography (CT)-derived body composition measurement and physical function in patients with advanced cancer. Nine sites contributed prospective data on patient demographics, ECOG-PS, mGPS, physical function tests, and CT-derived body composition. Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2-by-2 tables. Associations were analysed using binary logistic regression. A total of 523 cancer patients (266 males, 257 females) were included in the final analysis and most had metastatic disease (83.2%). The median overall survival was 5.6 months. On multivariate binary logistic regression analysis, a high ECOG-PS remained independently associated with a low skeletal muscle index (p < 0.001), low skeletal muscle density (p < 0.05), and timed up and go test failure (p < 0.001). A high mGPS remained independently associated with a low skeletal muscle density (p < 0.05) and hand grip strength test failure (p < 0.01). A high BMI/WL grade remained independently associated with a low subcutaneous fat index (p < 0.05), low visceral obesity (p < 0.01), and low skeletal muscle density (p < 0.05). In conclusion, a high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer body composition and physical function in patients with advanced cancer.

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A randomised, phase II, unblinded trial of an Exercise and Nutrition-based Rehabilitation programme (ENeRgy) versus standard care in patients with cancer: feasibility trial protocol

Cited by 7 publications

References 31 publications

Rehabilitation in palliative care: a qualitative study of team professionals

Rehabilitation in palliative care: a qualitative study of team professionals

Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer

The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer

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