A randomized, feasibility trial of an exercise and nutrition‐based rehabilitation programme (ENeRgy) in people with cancer

Abstract

Background Despite rehabilitation being increasingly advocated for people living with incurable cancer, there is limited evidence supporting efficacy or component parts. The progressive decline in function and nutritional in this population would support an approach that targets these factors. This trial aimed to assess the feasibility of an exercise and nutrition based rehabilitation programme in people with incurable cancer. Methods We randomized community dwelling adults with incurable cancer to either a personalized exercise and nutrition based programme (experimental arm) or standard care (control arm) for 8 weeks. Endpoints included feasibility, quality of life, physical activity (step count), and body weight. Qualitative and health economic analyses were also included. Results Forty‐five patients were recruited (23 experimental arm, 22 control arm). There were 26 men (58%), and the median age was 78 years (IQR 69–84). At baseline, the median BMI was 26 kg/m2 (IQR: 22–29), and median weight loss in the previous 6 months was 5% (IQR: −12% to 0%). Adherence to the experimental arm was >80% in 16/21 (76%) patients. There was no statistically significant difference in the following between trial arms: step count − median % change from baseline to endpoint, per trial arm (experimental −18.5% [IQR: −61 to 65], control 5% [IQR: −32 to 50], P = 0.548); weight − median % change from baseline to endpoint, per trial arm (experimental 1%[IQR: −3 to 3], control −0.5% [IQR: −3 to 1], P = 0.184); overall quality of life − median % change from baseline to endpoint, per trial arm (experimental 0% [IQR: −20 to 19], control 0% [IQR: −23 to 33], P = 0.846). Qualitative findings observed themes of capability, opportunity, and motivation amongst patients in the experimental arm. The mean incremental cost of the experimental arm versus control was £‐319.51 [CI −7593.53 to 6581.91], suggesting the experimental arm was less costly. Conclusions An exercise and nutritional rehabilitation intervention is feasible and has potential benefits for people with incurable cancer. A larger trial is now warranted to test the efficacy of this approach.

Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study

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Optimising Outcomes in Non Small Cell Lung Cancer: Targeting Cancer Cachexia

“…This also combines well with the publication of the ENERGY trial, a multi-modal intervention study in palliative cancer patients that has shown an adherence to a physical and nutrition intervention of greater than 80%. It also suggests that this intervention showed a lower mean incremental cost, suggesting it saved money compared to standard care [79].…”

Impact of Cancer Cachexia on Cardiac and Skeletal Muscle: Role of Exercise Training

“…A multimodal approach seems feasible in patients with advanced cancer, as addressed by some studies. Combinations of physical exercise (ET and/or RT) with nutritional supplements containing omega-3 fatty acids (EPA or docosahexaenoic acid) [ 80 , 81 ] or branched-chain amino acids [ 82 , 83 ] or just nutritional counselling and dietary adjustments as needed [ 84 ] were safe approaches in this population, with some positive results in improving protein intake and muscle strength and reducing symptoms like nausea e vomiting. These results must yet be confirmed in more robust and phase III trials.…”