ORCID Profile
0000-0002-4149-5578
Current Organisations
University of Melbourne
,
Peter MacCallum Cancer Centre
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Publisher: MDPI AG
Date: 23-08-2019
DOI: 10.3390/JCM8091288
Abstract: Background: In inoperable lung cancer, evidence is limited regarding physical activity (PA) and associations with other outcomes. Aims: in the usual care (UC) group of an RCT to (1) explore whether baseline PA was associated with improved follow-up outcomes, (2) identify baseline variables associated with higher follow-up PA and in all RCT participants, to (3) analyse patterns of objectively measured PA, and (4) report on characteristics of those who were able to maintain or increase PA levels. Methods: exploratory analyses of an assessor-blinded RCT. Outcomes, assessed at baseline, nine weeks and six months, included PA (seven-days of accelerometry), six-minute walk distance (6MWD), muscle strength, symptoms, mood and health-related quality of life (HRQoL). Results: 92 participants were randomised, 80 completed baseline accelerometry (39 intervention group (IG), 41 UC), characteristics: mean (SD) age 63.0 (12.3) years, 56% male, 51% stage IV disease. Baseline PA: median (IQR) steps/day 2859.6 (2034.0–3849.2) IG versus 3195.2 (2161.2–4839.0) UC. Associations between baseline PA and six-month outcomes were significant for HRQoL and 6MWD. PA at six months was significantly associated with baseline age, 6MWD and quadriceps strength. Between-group change score (steps/day) mean differences (95% CI) at nine weeks (174.5 (−1504.7 to 1853.7), p = 0.84) and six months (574.0 (−1162.3 to 2310.3), p = 0.52). Conclusions: further research is required to determine patient subgroups deriving the greatest benefits from PA interventions.
Publisher: Springer Science and Business Media LLC
Date: 13-04-2020
DOI: 10.1007/S00520-019-04783-4
Abstract: Exercise is important in lung cancer, yet most people do not meet the physical activity guidelines. The aim of this study was to characterise the views and experiences of participants with inoperable lung cancer who completed a home-based rehabilitation program. Ninety-two participants were recruited (45 intervention group [IG], 47 usual care). In idual semi-structured interviews were conducted with participants randomised to the IG of a trial of home-based exercise, behaviour change and symptom management. Data were independently coded by two researchers, cross-checked and analysed using content analysis with a summary of arising themes. Of the IG (25/45), 55% were interviewed: mean (SD) age 67 (13) years male 52% disease stage n (%) III = 9 (36), IV = 11 (44) radical treatment intent n (%) 13 (52). The majority of participants reported program benefits, both in the physical domain (reduced sedentary time and improved strength, fitness and function) and the mental domain (motivation to keep healthy, preventing boredom). Support to self-manage symptoms was well received and many participants reported increased confidence in managing their symptoms. Exercise enablers included having expert health professional support motivation to be stronger and better prepared for future challenges and having an achievable and familiar program that was monitored. Treatment side-effects, pain from comorbidities and the weather were exercise barriers. For the majority of participants the use of a Fitbit™ activity tracker, text message exercise reminders and an exercise diary helped to promote adherence. This home-based rehabilitation program was acceptable to most participants with multiple benefits reported including improved fitness, motivation and ability to manage symptoms.
Publisher: Springer Science and Business Media LLC
Date: 29-09-2017
Publisher: Wiley
Date: 22-03-2022
DOI: 10.1002/PMRJ.12783
Abstract: Exercise testing is essential to determine the safety and efficacy of prescribing exercise. Limited evidence exists to support remotely supervised exercise testing in oncology literature. To determine the feasibility, safety, and convergent validity of the 30-second sit-to-stand test (30STS) delivered via telehealth in an oncology population. Exploratory analyses informed remote test feasibility according to participant and treatment characteristics. Cross-sectional, observational study. Telehealth outpatient clinic, tertiary metropolitan oncology hospital. Thirty-two consecutive outpatients attending telehealth exercise appointments were screened for inclusion. Not applicable. A pre-test safety screening questionnaire included the Australia-modified Karnofsky Performance Status (AKPS) and Clinical Frailty Scale (CFS). Following one practice, one 30STS test was completed using a standardized protocol modified for telehealth assessment. Secondary measures: International Physical Activity Questionnaire-Short Form (IPAQ-SF) and pre ost-test Borg Rating of Perceived Exertion (RPE). Thirty participants were deemed as being safe using the screening questionnaire and completed the remote 30STS. Participants were a median (interquartile range [IQR]) 62.5 (51.8 to 66.5) years old, 59% male, 72% undergoing cancer treatment, 34% with metastatic disease, and 56% met current exercise guidelines. Moderate correlation was found between 30STS and IPAQ-SF (rho = 0.49, p = .006), providing evidence of convergent validity. Correlations between 30STS and AKPS (rho = 0.26, p = .161), and CFS (rho = -0.23, p = .214), were fair. Chair-height standardization was poor (range 43 to 60 cm). The clinician could visualize the participant's whole body in 2 of 30 tests. No significant difference in test performance was found for participants with metastatic disease, higher age, or body mass index. No adverse events occurred. With screening, the 30STS, performed by telehealth, is a safe and feasible measure of function and lower limb strength. Telehealth exercise testing presents challenges in standardizing the environment and ensuring participant safety. Minimal space and equipment requirements and moderate convergent validity with physical activity provide good clinical utility in this setting.
Publisher: SAGE Publications
Date: 2021
Abstract: Cancer fatigue guidelines recommend routine fatigue screening, with further assessment for people reporting moderate to severe fatigue. There is neither a gold-standard, nor a broadly accepted screening method, and knowledge about the impact of screening on care processes is limited. This study aimed to explore the feasibility of 2 fatigue screening methods and current clinical practice in cancer outpatient clinics. Hospital outpatients attending cancer clinics during 1 week completed a five-item survey: a numeric scale for current tiredness, 2 categorical pictorial scales rating tiredness last week and the impact of fatigue (Fatigue Pictogram), screening tool preference and help needed for survey completion. Participant demographics and fatigue documentation by clinical staff for that appointment were extracted from medical records. Analyses used descriptive statistics. Groups were compared using appropriate statistical tests. Over 75% of participants rated their fatigue consistently as mild or significant on both screening tools. Of 1709 eligible outpatients, 533 (31%) completed the survey. Records were audited for 430 (81%) identifiable participants. Over half of the participants reported moderate or severe tiredness either “now” (237, 57%) and/or “last week” (226, 53%). Clinician documentation of fatigue seldom matched self-reports. Fatigue was rated as severe by 103 participants (24%), yet was noted in only 21 (20%) of these in iduals’ clinical notes. Both screening tools were equally preferred. The numeric rating scale and Fatigue Pictogram are equally applicable for screening fatigue in cancer outpatient care. There is a high prevalence of clinically significant fatigue in a hospital outpatient setting that is not documented. Adequate care pathways for further management should be established alongside fatigue screening.
Publisher: Springer Science and Business Media LLC
Date: 2013
DOI: 10.1186/CC12835
Publisher: MDPI AG
Date: 27-02-2023
DOI: 10.3390/JCM12051871
Abstract: Background: Growing evidence supports exercise for people with lung cancer. This overview aimed to summarise exercise intervention efficacy and safety across the care continuum. Methods: Eight databases (including Cochrane and Medline) were searched (inception—February 2022) for systematic reviews of RCTs/quasi-RCTs. Eligibility: population—adults with lung cancer intervention: exercise (e.g., aerobic, resistance) +/− non-exercise (e.g., nutrition) comparator: usual care/non-exercise primary outcomes: exercise capacity, physical function, health-related quality of life (HRQoL) and post-operative complications. Duplicate, independent title/abstract and full-text screening, data extraction and quality ratings (AMSTAR-2) were completed. Results: Thirty systematic reviews involving between 157 and 2109 participants (n = 6440 total) were included. Most reviews (n = 28) involved surgical participants. Twenty-five reviews performed meta-analyses. The review quality was commonly rated critically low (n = 22) or low (n = 7). Reviews commonly included combinations of aerobic, resistance and/or respiratory exercise interventions. Pre-operative meta-analyses demonstrated that exercise reduces post-operative complications (n = 4/7) and improves exercise capacity (n = 6/6), whilst HRQoL findings were non-significant (n = 3/3). Post-operative meta-analyses reported significant improvements in exercise capacity (n = 2/3) and muscle strength (n = 1/1) and non-significant HRQoL changes (n = 8/10). Interventions delivered to mixed surgical and non-surgical populations improved exercise capacity (n = 3/4), muscle strength (n = 2/2) and HRQoL (n = 3). Meta-analyses of interventions in non-surgical populations demonstrated inconsistent findings. Adverse event rates were low, however, few reviews reported on safety. Conclusions: A large body of evidence supports lung cancer exercise interventions to reduce complications and improve exercise capacity in pre- and post-operative populations. Additional higher-quality research is needed, particularly in the non-surgical population, including subgroup analyses of exercise type and setting.
Publisher: Hindawi Limited
Date: 15-08-2021
DOI: 10.1111/ECC.13501
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJRESP-2022-001571
Abstract: With treatment-related improvements in survival, rehabilitation is essential to improve function and health-related quality of life and manage the high symptom burden associated with lung cancer. Despite this, significant heterogeneity exists in the outcomes and instruments used to evaluate lung cancer rehabilitation programme impact. This study aims to develop a core set of clinically relevant lung cancer rehabilitation outcomes for use in clinical practice. An international Delphi consensus study involving consumer, healthcare professional and researcher stakeholders to determine which outcomes to include and how to measure these. Stage 1 (preliminary): mixed methods to develop the potential list of outcomes (1) overview of systematic reviews of lung cancer exercise interventions and (2) focus groups and in idual interviews with people with lung cancer. Stage 2: outcomes were grouped according to the International Classification of Functioning, Disability and Health domains. Stage 3: to determine priority outcomes for core outcome set (COS) inclusion participants will rate each outcome’s importance (one-nine-point Likert scale) over two-three survey rounds. Stage 4: following review by the steering committee, a consensus meeting will be held if agreement on the COS has not been reached. Stage 5: recommendations will be made regarding a single instrument for measuring each COS outcome by reviewing existing resources where consensus has already been reached. Where resources do not exist the quality and feasibility of potential measurement instruments will be appraised, and the Delphi consensus survey and meeting process outlined in stages 3–4 will be repeated. This protocol adheres to the COS-Standardised Protocol statement and will be conducted and reported according to the COS-Standards for Development recommendations and the COS-Standards for Reporting. Ethics approval (20/9/22, University of Melbourne ID 2022-24839-32231-3). Dissemination in peer-reviewed journals and conference presentations.
Publisher: Oxford University Press (OUP)
Date: 12-2013
DOI: 10.2522/PTJ.20120310
Abstract: Several tests have recently been developed to measure changes in patient strength and functional outcomes in the intensive care unit (ICU). The original Physical Function ICU Test (PFIT) demonstrates reliability and sensitivity. The aims of this study were to further develop the original PFIT, to derive an interval score (the PFIT-s), and to test the clinimetric properties of the PFIT-s. A nested cohort study was conducted. One hundred forty-four and 116 participants performed the PFIT at ICU admission and discharge, respectively. Original test components were modified using principal component analysis. Rasch analysis examined the unidimensionality of the PFIT, and an interval score was derived. Correlations tested validity, and multiple regression analyses investigated predictive ability. Responsiveness was assessed using the effect size index (ESI), and the minimal clinically important difference (MCID) was calculated. The shoulder lift component was removed. Unidimensionality of combined admission and discharge PFIT-s scores was confirmed. The PFIT-s displayed moderate convergent validity with the Timed “Up & Go” Test (r=−.60), the Six-Minute Walk Test (r=.41), and the Medical Research Council (MRC) sum score (rho=.49). The ESI of the PFIT-s was 0.82, and the MCID was 1.5 points (interval scale range=0–10). A higher admission PFIT-s score was predictive of: an MRC score of ≥48, increased likelihood of discharge home, reduced likelihood of discharge to inpatient rehabilitation, and reduced acute care hospital length of stay. Scoring of sit-to-stand assistance required is subjective, and cadence cutpoints used may not be generalizable. The PFIT-s is a safe and inexpensive test of physical function with high clinical utility. It is valid, responsive to change, and predictive of key outcomes. It is recommended that the PFIT-s be adopted to test physical function in the ICU.
Publisher: Wiley
Date: 19-01-2017
DOI: 10.1111/RESP.12975
Abstract: Physical activity (PA) levels are low in patients with lung cancer. Emerging evidence supports the use of interventions to increase PA in this population. We aimed to (1) identify and synthesize outcome measures which assess PA levels in patients with lung cancer and (2) to evaluate, synthesize and compare the psychometric properties of these measures. A systematic review of articles from searches was conducted of five electronic databases and personal records. Eligible studies were those which assessed PA using either performance-based or patient-reported measures. For aim 2, studies identified in aim 1 reporting on at least one psychometric property (validity, reliability, responsiveness or measurement error) were included. Two independent reviewers assessed eligibility and risk of bias with the COnsensus-based Standards for the selection of health status Measurement INstruments. Thirty-four studies using 21 different measures of PA were identified. Seventeen studies used performance-based measures. The Godin Leisure Time Exercise Questionnaire (GLTEQ) was the most frequently used patient-reported measure. Psychometric properties were reported for 13 of these measures and most frequently for movement sensors. Two studies reported on properties of the GLTEQ. Quality ratings for risk of bias were low. There is significant heterogeneity amongst studies regarding method of PA measurement along the lung cancer continuum. Greater consensus could be achieved by using a consensus approach such as a Delphi process. Future studies should include assessment of psychometric properties of the measurement tool being used. Currently, it is recommended where feasible, both performance-based and patient-reported measurements of PA should be undertaken.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.JCRC.2017.04.006
Abstract: Primary aims were: (1) objectively quantify levels of physical activity with the sensewear armband mini-fly motion sensor (SWA-MF), (2) evaluate the correlation of SWA-MF measurement of active and resting energy expenditure against the ICU Mobility scale (IMS) and indirect calorimetry respectively. Adults mechanically ventilated ≥48h and anticipated to remain in ICU≥5days were included. Physical activity (PA) was measured using a SWA-MF (over the first five days) energy expenditure was measured with both the SWA-MF and the Deltatrac II metabolic cart on day three highest level of mobility was assessed on the IMS. Fifty-five participants performed median [IQR] 16.8 [0.6-152.4] minutes of PA per day (defined as >1.0 metabolic equivalent). A strong correlation between active energy expenditure and highest level of mobility (IMS), r=0.76, p=0.00 was observed on day 5. The SWA-MF demonstrated moderate to good agreement with the Deltatrac II metabolic cart (n=20), intra-class correlation co-efficient=0.71 (p=0.00) for the measurement of energy expenditure on day 3. Participants demonstrated low levels of PA. Motion sensors may be a promising non-invasive measure of energy expenditure and further investigation is warranted.
Publisher: Hindawi Limited
Date: 04-10-2019
DOI: 10.1111/ECC.12946
Abstract: To explore patient experiences of, and preferences for, physical activity after a lung cancer diagnosis. This was a qualitative study involving seven patients who had been treated for lung cancer within the previous 2 years. Participants attended a focus group interview. Conventional content analysis methodology was used to analyse the text by two independent researchers. Eight major themes emerged from the data. These were as follows: the influence of past lifestyle and chronic disease the perceived benefits of physical activity using physical activity to facilitate return to activities of daily living the impact of symptoms, capacity and motivation family and peer support access to services health professionals and enjoyment of different types of physical activity. Patients suggested several factors that could improve their healthcare experience. These include access to exercise professionals particularly after cancer treatment access to information about physical activity in different formats supervision from health professionals and peer support and use of behaviour change strategies to achieve sustainable increases in physical activity. Our results should be considered in the improvement of lung cancer care pathways as we strive to implement physical activity services into routine clinical care.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.CLNU.2022.03.024
Abstract: The Global Leadership Initiative on Malnutrition (GLIM) criteria require validation in various clinical populations. This study determined the prevalence of malnutrition in people with cancer using all possible diagnostic combinations of GLIM etiologic and phenotypic criteria and determined the combinations that best predicted mortality and unplanned hospital admission within 30 days. The GLIM criteria were applied, in a cohort of participants from two cancer malnutrition point prevalence studies (N = 2801), using 21 combinations of the phenotypic (≥5% unintentional weight loss, body mass index [BMI], subjective assessment of muscle stores [from PG-SGA]) and etiologic (reduced food intake, inflammation [using metastatic disease as a proxy]) criteria. Machine learning approaches were applied to predict 30-day mortality and unplanned admission. We analysed 2492 participants after excluding those with missing data. Overall, 19% (n = 485) of participants were malnourished. The most common GLIM combinations were weight loss and reduced food intake (15%, n = 376), and low muscle mass and reduced food intake (12%, n = 298). Machine learning models demonstrated malnutrition diagnosis by weight loss and reduced muscle mass plus either reduced food intake or inflammation were the most important combinations to predict mortality at 30-days (accuracy 88%). Malnutrition diagnosis by weight loss or reduced muscle mass plus reduced food intake was most important for predicting unplanned admission within 30-days (accuracy 77%). Machine learning demonstrated that the phenotypic criteria of weight loss and reduced muscle mass combined with either etiologic criteria were important for predicting mortality. In contrast, the etiologic criteria of reduced food intake in combination with weight loss or reduced muscle mass was important for predicting unplanned admission. Understanding the phenotypic and etiologic criteria contributing to the GLIM diagnosis is important in clinical practice to identify people with cancer at higher risk of adverse outcomes.
Publisher: SAGE Publications
Date: 2020
Abstract: To assess the feasibility, safety, and preliminary effect of a 12-week multi-modal rehabilitation program targeted at improving health-related quality of life and physical activity levels of patients with lung cancer following treatment. Patients with stage I to IIIA non-small cell lung cancer were included 6 to 12 weeks following completion of treatment. The intervention comprised of aerobic exercise (brisk walking), resistance training and 8-style Tai Chi. The 12-week program included 2 supervised center-based sessions per week of 90 minutes duration and home-based exercise. The primary outcomes were the feasibility and safety of the intervention. Secondary outcomes (assessed pre and post program) were physical and patient-reported outcomes. Seventy-eight patients were approached during the 6-month recruitment period and 17 (22%) consented to the study. Eight participants (47%) met the definition of adherence to the program (attending at least 70% of supervised sessions). No serious adverse events occurred. A significant reduction in anxiety and depression was observed post-program. In addition, improvements in respiratory function, sleep quality, and some health-related quality of life domains were observed post-program. There were no significant differences in functional capacity or physical activity levels. This multi-modal exercise training program was safe, although the feasibility of the program in its current state is not supported given the low consent rate and low adherence to the intervention.
Publisher: MDPI AG
Date: 09-03-2023
DOI: 10.3390/JCM12062146
Abstract: Background: Moderate- to high-certainty evidence supports the benefits of pre- and post-operative exercise for people undergoing surgical resection for lung cancer. Despite this, exercise programs are not commonly provided. Previous data regarding exercise practices are a decade old. Therefore, this study aimed to understand current exercise practices in surgical lung cancer care in Australia and New Zealand. Methods: An online cross-sectional survey of Australian and New Zealand allied health professionals specialising in exercise-based interventions was carried out. Survey development and reporting adhered to CHERRIES and CROSS checklists. Institutions with thoracic surgery departments were invited to participate via email, and additional responses were sought via snowballing. Results: The response rate was 81%, with a total of 70 health services responding. A total of 18 (26%) pre-operative services, 59 (84%) inpatient post-operative services, and 39 (55%) community/outpatient post-operative services were identified. Only eight (11%) services provided a pre-operative exercise program. Half of the respondents referred less than 25% of patients to community/outpatient exercise programs on hospital discharge. Respondents reported that their clinical management was predominantly influenced by established workplace practices and personal experience rather than evidence. Conclusions: The availability and uptake of pre- and post-operative exercise remain low, and work should continue to make pre ost-operative exercise training usual practice.
Publisher: JMIR Publications Inc.
Date: 18-10-2023
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.PHYSIO.2015.10.007
Abstract: To investigate in non-surgically and surgically treated non-small cell lung cancer (NSCLC): (1) changes in physical activity, function, health-related quality of life (HRQoL) and symptoms after diagnosis and (2) the association between physical activity and outcomes. Prospective observational study. Three acute tertiary hospitals. Sixty-nine in iduals (43 male, median [IQR] age 68 [61 to 74] years) with stage I-IV NSCLC. The primary outcome (Physical Activity Scale for the Elderly) and secondary outcome (six-minute walk test and questionnaires assessing HRQoL, function, symptoms, mood) were measured at diagnosis (pre-treatment), and eight to ten weeks post-diagnosis (post-operative and/or during chemotherapy/radiotherapy). In iduals treated surgically (n=27) experienced a deterioration in physical activity levels (baseline median [IQR]=74 [51 to 135] follow-up median [IQR]=29 [24 to 73] median difference=45, effect size=0.3). At follow-up physical activity was inversely related to depression, pain and appetite loss (rho>0.5, p 0.5, p<0.05). Surgically treated in iduals experienced a reduction in physical activity levels after diagnosis, which was not seen in the non-surgical group. Lower physical activity levels were associated with poorer outcomes, particularly in non-surgically treated in iduals. Further research is required to establish the optimal intervention to improve physical activity levels in these cohorts.
Publisher: MDPI AG
Date: 29-03-2022
Abstract: Cancer-related sarcopenia is a complex condition however, no cancer-specific clinical model is available to guide clinical practice. This study aims to (1) develop an evidence-based care pathway for the management of cancer-related sarcopenia (“sarc-pathway”) and (2) pilot test the feasibility (reach, intervention fidelity, patient and clinician acceptability) of the sarc-pathway in an inpatient cancer ward. The sarc-pathway was developed using a care pathway format and informed by the current literature. Patients admitted to a 32-bed inpatient cancer ward were recruited to receive sarc-pathway care and the feasibility outcomes were assessed. Of the 317 participants admitted, 159 were recruited over 3.5-months (median age 61 years 56.0% males). Participant consent was high (99.4% of those approached) and 30.2% were at risk of/had sarcopenia. The sarc-pathway screening, assessment and treatment components were delivered as intended however, low completion of clinical assessment measures were observed for muscle mass (bioimpedance spectroscopy, 20.5%) and muscle function (5-times chair stand test, 50.0%). The sarc-pathway was demonstrated to be acceptable to patients and multidisciplinary clinicians. In an inpatient cancer ward, the sarc-pathway is a feasible and acceptable clinical model and method to deliver and adhere to the sarcopenia clinical parameters specified, albeit with further exploration of appropriate clinical assessment measures.
Publisher: Oxford University Press (OUP)
Date: 12-2012
DOI: 10.2522/PTJ.20110411
Abstract: Promotion of increased physical activity is advocated for survivors of an intensive care unit (ICU) admission to improve physical function and health-related quality of life. The primary aims of this study were: (1) to measure free-living physical activity levels and (2) to correlate the measurements with scores on a self-reported activity questionnaire. A secondary aim was to explore factors associated with physical activity levels. This was a prospective cohort study. Nested within a larger randomized controlled trial, participants were block randomized to measure free-living physical activity levels. Included participants wore an accelerometer for 7 days during waking hours at 2 months after ICU discharge. At completion of the 7 days of monitoring, participants were interviewed using the Physical Activity Scale for the Elderly (PASE) questionnaire. Factors associated with physical activity were explored using regression analysis. The ICU survivors (median age=59 years, interquartile range=49–66 mean Acute Physiologic Chronic Health Evaluation [APACHE II] score=18, interquartile range=16–21) were inactive when quantitatively measured at 2 months after hospital discharge. Participants spent an average of 90% of the time inactive and only 3% of the time walking. Only 37% of the s le spent 30 minutes or more per day in the locomotion category (more than 20 steps in a row). Activity reported using the PASE questionnaire was lower than that reported in adults who were healthy. The PASE scores correlated only fairly with activity measured by steps per day. The presence of comorbidities explained one third of the variance in physical activity levels. Accelerometer overreading, patient heterogeneity, selection bias, and s le size not reached were limitations of the study. Survivors of an ICU admission greater than 5 days demonstrated high levels of inactivity for prolonged periods at 2 months after ICU discharge, and the majority did not meet international recommendations regarding physical activity. Comorbidity appears to be a promising factor associated with activity levels.
Publisher: BMJ
Date: 02-05-2019
DOI: 10.1136/THORAXJNL-2018-212996
Abstract: Lung cancer is associated with poor health-related quality of life (HRQoL) and high symptom burden. This trial aimed to assess the efficacy of home-based rehabilitation versus usual care in inoperable lung cancer. A parallel-group, assessor-blinded, allocation-concealed, randomised controlled trial. Eligible participants were allocated (1:1) to usual care (UC) plus 8 weeks of aerobic and resistance exercise with behaviour change strategies and symptom support (intervention group (IG)) or UC alone. Assessments occurred at baseline, 9 weeks and 6 months. The primary outcome, change in between-group 6 min walk distance (6MWD), was analysed using intention-to-treat (ITT). Subsequent analyses involved modified ITT (mITT) and included participants with at least one follow-up outcome measure. Secondary outcomes included HRQoL and symptoms. Ninety-two participants were recruited. Characteristics of participants (UC=47, IG=45): mean (SD) age 64 (12) years men 55% disease stage n (%) III=35 (38) and IV=48 (52) radical treatment 46%. There were no significant between-group differences for the 6MWD (n=92) at 9 weeks (p=0.308) or 6 months (p=0.979). The mITT analyses of 6MWD between-group differences were again non-significant (mean difference (95% CI): 9 weeks: −25.4 m (−64.0 to 13.3), p=0.198 and 6 months: 41.3 m (−26.7 to 109.4), p=0.232). Significant 6-month differences, favouring the IG, were found for HRQoL (Functional Assessment of Cancer Therapy–Lung: 13.0 (3.9 to 22.1), p=0.005) and symptom severity (MD Anderson Symptom Inventory–Lung Cancer: −2.2 (−3.6 to –0.9), p=0.001). Home-based rehabilitation did not improve functional exercise capacity but there were improvements in patient-reported exploratory secondary outcomes measures observed at 6 months. Australian New Zealand Clinical Trials Registry (ACTRN12614001268639).
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/15347354211069885
Abstract: Endometrial cancer is associated with the highest comorbid disease burden of any cancer. The aim of this trial was to assess the feasibility and safety of an allied health intervention during adjuvant treatment. A mixed-methods pilot randomized (2:1) controlled trial with concealed allocation and assessor-blinding. Eligibility criteria: adjuvant endometrial cancer treatment scheduled, disease stage I-IIIC1, ECOG 0-2 and able to perform unsupervised physical activity (PA). Participants received usual care and 8 sessions of weekly, in idualized, lifestyle education (diet and PA) with behavior change and social support (intervention group), delivered predominantly by telehealth, or usual care alone. Feasibility outcomes: recruitment and consent rates, decline reasons, program acceptability, intervention adherence and retention. 22/44 eligible patients (50%, 95%CI: 36%, 64%) were recruited over 10 months (14 intervention, 8 usual care). The recruitment rate was 2.2 patients/month (95%CI: 1.4, 3.3). Patients who declined had too much going on (7/22, 32%) or were not interested (6/22, 27%). Mean (SD) age and BMI were 63.2 years (6.8) and 31.9 kg/m 2 (6.7). A majority were FIGO stage I (15/22, 68%) and received vaginal brachytherapy (14/22, 64%). Adherence was high, 11/14 (79%, 95%CI: 52%, 92%) participants attended % of scheduled sessions. Retention was 100% (95%CI: 85%, 100%) at 9 weeks, however completion of objective measures was impacted by COVID-19 restrictions. Telehealth and online questionnaires enabled participation. No serious adverse events occurred. The intervention was acceptable to participants with high levels of adherence and retention. Trial findings will be used to design a future RCT. The trial was registered on www.anzctr.org.au (ACTRN12619000631101) 29/04/2019.
No related grants have been discovered for Lara Edbrooke.