Promotion of Behavioral Change and the Impact on Quality of Life in Elderly Patients with Advanced Cancer: A Physical Activity Intervention of the Multimodal Nutrition and Exercise Treatment for Advanced Cancer Program

Miyamae, Takako; Naito, Tateaki; Morikawa, Ayumu; Tatematsu, Noriatsu; Miura, Satoru; Okayama, Taro; Omae, Katsuhiro; Takayama, K.

doi:10.4103/apjon.apjon_21_18

Cited by 34 publications

(40 citation statements)

References 27 publications

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“…However, ENPAL participants did not report significant declines in overall wellbeing or QOL across the intervention period (Table 2 ). Similar to past feasibility studies of PA interventions in ALC, QOL, symptom burden, and general fatigue were maintained [ 44 , 47 ]. The intervention may have contributed to clinically significant decreases in tiredness and pain (> 5%, although only tiredness was statistically significant, p = 0.015), which is promising [ 35 ].…”

Section: Discussionsupporting

confidence: 76%

“…Secondary to determining feasibility, a preliminary examination of intervention effects on PROs was performed to inform future trials. As found in previous PA interventions, participants did not report significant changes in PA, indicating that the intervention may have supported PA maintenance, counteracting usual declines in PA among advanced cancer populations [42][43][44][45]. Due to prevalent dyspnea, pain, fatigue, psychosocial challenges, and demanding treatments, PA adherence can be difficult for individuals living with ALC, which may have also impacted increased PA levels [2,3].…”

Section: Preliminary Examination Of Prosmentioning

confidence: 76%

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Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

et al. 2021

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Background Advanced lung cancer patients face significant physical and psychological burden leading to reduced physical function and quality of life. Separately, physical activity, nutrition, and palliative symptom management interventions have been shown to improve functioning in this population, however no study has combined all three in a multimodal intervention. Therefore, we assessed the feasibility of a multimodal physical activity, nutrition, and palliative symptom management intervention in advanced lung cancer. Methods Participants received an individually tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, behaviour change education, and nutrition and palliative care consultations. Patients reported symptom burden, energy, and fatigue before and after each class. At baseline and post-intervention, symptom burden, quality of life, fatigue, physical activity, dietary intake, and physical function were assessed. Post-intervention interviews examined participant perspectives. Results The multimodal program was feasible, with 44% (10/23) recruitment, 75% (75/100) class attendance, 89% (8/9) nutrition and palliative consult attendance, and 85% (17/20) assessment completion. Of ten participants, 70% (7/10) completed the post-intervention follow-up. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being. Conclusion A multimodal physical activity, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation in a larger cohort trial. Trial registration NCT04575831, Registered 05 October 2020 – Retrospectively registered.

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Section: Discussionsupporting

confidence: 76%

Section: Preliminary Examination Of Prosmentioning

confidence: 76%

Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

et al. 2021

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“…This phase I study met the primary endpoint, and we showed a high attendance rate and satisfactory safety profile for the NEXTAC program, with high compliance rates with regard to consuming the supplements, completing the diaries, and wearing the pedometers/accelerometers. Additionally, the results suggested that the NEXTAC interventions might induce behavioral changes, with consequent improvement in the patients’ QOL [17].…”

Section: Introductionmentioning

confidence: 99%

A randomized phase II study of nutritional and exercise treatment for elderly patients with advanced non-small cell lung or pancreatic cancer: the NEXTAC-TWO study protocol

et al. 2019

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Background Most advanced elderly cancer patients experience fatigue, anorexia, and declining physical function due to cancer cachexia, for which effective interventions have not been established. We performed a phase I study of a new nonpharmacological multimodal intervention called the nutritional and exercise treatment for advanced cancer (NEXTAC) program and reported the excellent feasibility of and compliance with this program in elderly patients with advanced cancer who were at risk for cancer cachexia. We report here the background, hypothesis, and design of the next-step multicenter, randomized phase II study to evaluate the efficacy of the program, the NEXTAC-TWO study. Methods Patients with chemo-naïve advanced non-small cell lung cancer or pancreatic cancer, age ≥ 70 years, performance status ≤2, with adequate organ function and without disability according to the modified Katz index will be eligible. In total, 130 participants will be recruited from 15 Japanese institutions and will be randomized into either the intervention group or a control group. Computer-generated random numbers are allocated to each participant. Stratification factors include performance status (0 to 1 vs. 2), site of primary cancer (lung vs. pancreas), stage (III vs. IV), and type of chemotherapy (cytotoxic vs. others). Interventions and assessment will be performed 4 times every 4 ± 2 weeks from the date of randomization. Interventions will consist of nutritional counseling, nutritional supplements (rich in branched-chain amino acids), and a home-based exercise program. The exercise program will include low-intensity daily muscle training and lifestyle education to promote physical activity. The primary endpoint is disability-free survival. It is defined as the period from the date of randomization to the date of developing disability or death due to any cause. This trial also plans to evaluate the improvements in nutritional status, physical condition, quality of life, activities of daily living, overall survival, and safety as secondary endpoints. Enrollment began in August 2017. The study results will demonstrate the efficacy of multimodal interventions for elderly cancer patients and their application for the maintenance of physical and nutritional conditions in patients with cancer cachexia. This work is supported by a grant-in-aid from the Japan Agency for Medical Research and Development. Discussion This is the first randomized trial to evaluate the efficacy and safety of a multimodal intervention specific for elderly patients with advanced cancer. Trial registration Registered at August 23, 2017. Registry number: UMIN000028801 . Electronic supplementary material The online version of this article (10.1186/s12885-019-5762-6) contains supplementary material, which is available to authorized users.

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“…recently reported the feasibility of a combined regimen with exercise and nutritional interventions for elderly Japanese patients with advanced cancer. [ 49 50 ] Exploratory analysis showed preservation of physical function, skeletal muscle mass, and physical activity during the study period. The promotion of these programs could lead to improved quality of end of life for elderly patients with advanced NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Days Spent at Home near the End of Life in Japanese Elderly Patients with Lung Cancer: Post hoc Analysis of a Prospective Study

Notsu

Naito

Mori

et al. 2021

Asia-Pacific Journal of Oncology Nursing

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Objective: Days spent at home (DASH) near the end of life is considered an important patient-centered goal and outcome because many patients want to stay at home toward the end of life. This study aimed to estimate the individual DASH near the end of life and identify its early predictors, including muscle mass and physical function, among elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: We conducted a post hoc analysis of the prospective observational study (UMIN000009768) that recruited patients aged ≥ 70 years who were scheduled to undergo first-line chemotherapy because of advanced NSCLC. We measured the muscle mass by bioelectrical impedance analysis at baseline. DASH was calculated as 30 days minus the number of days spent in hospitals, palliative care facilities, or nursing homes during the last 30 days of life. We performed linear regression analyses to evaluate the predictors of DASH. Results: Altogether, 16 women and 28 men with a median overall survival of 15.5 months (range: 2.9–58.9) were included. The median DASH in the last 30 days of life was 8 days (range: 0–30, interquartile range: 0–23). Men had longer DASH than women by 7.3 days. Patients who had good trunk muscle mass index and hand-grip strength had significantly longer DASH than those who did not (4.7 days per kg/m 2 increase [ P = 0.017] and 0.4 days per kg increase [ P = 0.032], respectively). Conclusions: Most elderly patients with advanced NSCLC had a limited DASH near the end of life. The risk factors for reduced DASH were women, reduced muscle mass, and poor physical function at the time of diagnosis of advanced NSCLC. Our findings would encourage early discussions about end-of-life care for patients with advanced cancers with risk factors for short DASH at the time of diagnosis, and thus, improve the quality of end-of-life care.

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Promotion of Behavioral Change and the Impact on Quality of Life in Elderly Patients with Advanced Cancer: A Physical Activity Intervention of the Multimodal Nutrition and Exercise Treatment for Advanced Cancer Program

Cited by 34 publications

References 27 publications

Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

A randomized phase II study of nutritional and exercise treatment for elderly patients with advanced non-small cell lung or pancreatic cancer: the NEXTAC-TWO study protocol

Days Spent at Home near the End of Life in Japanese Elderly Patients with Lung Cancer: Post hoc Analysis of a Prospective Study

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