Psycho-Educational and Rehabilitative Intervention to Manage Cancer Cachexia (PRICC) for Advanced Patients and Their Caregivers: Lessons Learned from a Single-Arm Feasibility Trial

Abstract

Background: Key elements in cancer cachexia (CC) management are personalized and multimodal interventions, but it is hard for some patients to follow programs based on several components. We examined the feasibility of a bimodal intervention, including a psycho-educational component and exercises, to support patients and their caregivers in managing CC; Methods: Prospective mixed-methods pilot study explored feasibility data, changes in patient-reported outcomes, and performance outcomes over time in a convenient sample of 30 consecutive CC patients and their caregivers. Results: Twenty-four dyads consented to participate. Twenty dyads received at least two psycho-educational sessions, so the psycho-educational component was feasible for 83.3% of the sample. Six dyads participated in at least fourteen out of twenty-seven rehabilitation sessions, so the exercise program was feasible for 25.0% of the sample. Six dyads showed compliance greater than 50% for both components of the bimodal intervention. Conclusions: While we did not meet our primary feasibility endpoint and had mixed acceptability, our experience provides insight into the challenges and lessons learned in implementing a primary palliative care intervention for CC. More robust studies are needed to help clinicians understand the best exercise program for CC patients, to be included in a multimodal intervention.

Cancer cachexia: A scoping review on non-pharmacological interventions

“…These articles correspond to 15 original studies because, in 2015 and 2019, Grundmann and Yoon wrote two articles on the same studies, respectively, on the prospective feasibility pilot study 18 , 19 and the randomized, single-blind pilot study. 20 , 21 The articles cover five continents: five studies conducted in Europe, 22 , 23 , 24 , 25 , 26 two in North America, 18 , 19 four in Asia, 27 , 28 , 29 , 30 one in Africa, 31 one in Australia, 32 and one in two different sites in Australia and Hong Kong. 33 Overall, the randomized controlled trial was the most common study design, accounting for 58% of the studies.…”

“… 20 , 21 , 22 , 23 , 24 , 27 , 29 , 30 , 31 , 33 Other authors chose pre-post intervention design ( n = 2), 18 , 19 retrospective observational study ( n = 2), 32 , 34 prospective cohort study ( n = 1), 25 and prospective pilot study. 26 …”

“… 22 , 31 , 33 , 34 The criteria to define the presence of cachexia were also quite different. The authors included mainly patients with a weight loss > 5% in the last 6 months, 18 , 19 , 20 , 23 , 26 , 27 , 28 , 31 according to Fearon's definition. 4 Other characteristics used to describe the sample included the risk of malnutrition, which was generally high, and the Karnofsky Performance Status (KPS) scores.…”

“…The presence of active treatments during the interventions was also highly variable between studies. Ten studies included the population under active treatment; 18 , 19 , 20 , 21 , 22 , 25 , 26 , 29 , 30 , 34 one included patients waiting to start the first line of chemotherapy; 24 two included patients who had to be out of any treatment plans (chemo-radiotherapy) during the period required for the intervention. 18 , 19 Four authors did not state whether patients were under cancer treatment.…”

“…Six interventions were multimodal (35.3%). 23 , 26 , 31 , 32 , 33 , 34 In three studies, the non-pharmacological intervention was the control arm of the randomized controlled trial (RCT). 18 , 20 , 25 Latenstein aimed to assess dietetic consultation alone for patients with pancreatic cancer and its effect on survival and patient-reported outcome measures (PROMs).…”