CanWalk: a feasibility study with embedded randomised controlled trial pilot of a walking intervention for people with recurrent or metastatic cancer

Abstract

ObjectivesWalking is an adaptable, inexpensive and accessible form of physical activity. However, its impact on quality of life (QoL) and symptom severity in people with advanced cancer is unknown. This study aimed to assess the feasibility and acceptability of a randomised controlled trial (RCT) of a community-based walking intervention to enhance QoL in people with recurrent/metastatic cancer.DesignWe used a mixed-methods design comprising a 2-centre RCT and nested qualitative interviews.ParticipantsPatients with advanced breast, prostate, gynaecological or haematological cancers randomised 1:1 between intervention and usual care.InterventionThe intervention comprised Macmillan's ‘Move More’ information, a short motivational interview with a recommendation to walk for at least 30 min on alternate days and attend a volunteer-led group walk weekly.OutcomesWe assessed feasibility and acceptability of the intervention and RCT by evaluating study processes (rates of recruitment, consent, retention, adherence and adverse events), and using end-of-study questionnaires and qualitative interviews. Patient-reported outcome measures (PROMs) assessing QoL, activity, fatigue, mood and self-efficacy were completed at baseline and 6, 12 and 24 weeks.ResultsWe recruited 42 (38%) eligible participants. Recruitment was lower than anticipated (goal n=60), the most commonly reported reason being unable to commit to walking groups (n=19). Randomisation procedures worked well with groups evenly matched for age, sex and activity. By week 24, there was a 45% attrition rate. Most PROMs while acceptable were not sensitive to change and did not capture key benefits.ConclusionsThe intervention was acceptable, well tolerated and the study design was judged acceptable and feasible. Results are encouraging and demonstrate that exercise was popular and conveyed benefit to participants. Consequently, an effectiveness RCT is warranted, with some modifications to the intervention to include greater tailoring and more appropriate PROMs selected.Trial registration numberISRCTN42072606.

Psychosocial interventions for advanced cancer patients: A systematic review

“…We classified seven studies as testing psychosocial interventions that are counselling based but do not fit into the three previous categories. Two studies were focused on improving marital outcomes, while the other interventions focused on financial and legal counselling, managing weight‐ and eating‐related distress, addressing emesis, increasing physical activity through walking, and individually tailoring therapeutic approaches to meet the needs of patients …”

“…For instance, a number of studies, especially those that were underpowered for between-group comparisons, reported improved patient outcomes when comparing preintervention to postintervention scores. 15,21,23 A few studies also found improved patient outcomes in secondary outcomes 40,47,58 or at secondary time points. 21,26,67 Next, we acknowledge that our review only includes studies from the past 10 years.…”

Effectiveness of palliative care interventions offering social support to people with life-limiting illness-A systematic review

“…Group interventions may have a temporary effect on quality of life (Clark et al., ); however, three studies (Roulston, Bickerstaff, Haynes, Rutherford, & Jones, ; Rummans et al., ; Tsianakas et al., ) reported that quality of life measures remained stable. Social support was not used as an outcome measure.…”

“…A pilot study with mixed methods (Roulston et al, 2012) appeared to have positive effects on mood and perceived health; all five participants cited social support as a useful component of the intervention. Tsianakas et al (2017) reported that questionnaires used were not sufficiently sensitive, and draws from qualitative insights to suggest that a specific social support measure be used in future work. was not identified; however, the difference in resource use appeared to be larger for participants with higher distress at baseline.…”

Ankle loading ameliorates bone loss from breast cancer–associated bone metastasis

“…A variety of reports show that physical activity can reduce cancer-related morbidity and offers an important role in rehabilitation (37)(38)(39). The skeleton is sensitive to its mechanical environment, and physical stimulation contributes to maintaining bone mass.…”