Purpose: Older adults with intra-thoracic malignancy are often frail and unfit due to their cancer and co-morbidities. This may affect ability to tolerate or receive cancer treatments. Irrespective of whether they are eligible for treatment or are having best supportive care, these people experience poorer quality of life (QoL) than younger counterparts and other cancer groups. Evidence suggests that engaging lifestyle behaviours, such as physical activity (PA) and healthy diet, offer significant improvements in QoL among people with a cancer diagnosis before, during, and post-treatment. These behaviours may also positively impact treatment completion rates, which may improve survival rates. However, older, frailer lung cancer populations tend to be excluded from this type of research under the assumption they are too high a risk to participate. As such, there is very little existing research to inform an intervention among this population. Our aim was to assess the acceptability, usefulness, and practicality of delivering a tailored wellbeing programme for older adults with lung cancer before, during, and after cancer treatment. 

Methods: People with lung cancer ≥70 years of age, their informal carers, and Multidisciplinary Team (MDT) members were invited to participate in semi-structured interviews with the intention of determining acceptability, usefulness, and practicality of tailored wellbeing programme and specific feedback on individual components to be included. Participants were identified by a clinician in the clinic; informal carers were also invited to participate if they were interested. Topic guides were developed and used for all interviews. 

Results: Thirteen interviews have been conducted and transcribed to date. Thematic coding is underway though preliminary assessment indicates patients, carers, and MDT members would welcome a holistic wellbeing programme designed to improve quality of life. Initial feedback on whom should deliver, what content should be, and how to frame the intervention included ensuring it was individually tailored, incremental, and focused on maintaining daily activities was incorporated into subsequent protocols. Remaining interviews will be completed by 30 November 2019.

Conclusions: Preliminary results from this study have highlighted important considerations and components in developing a tailored wellbeing programme for people with lung cancer. 

Purpose:

To optimize outcomes of exercise and dietary interventions, it is important that these interventions are specifically tailored to comorbidities, disease- and treatment-related adverse effects that patients with a specific type of cancer face. Tailoring such interventions is complex and requires adequate clinical reasoning by health professionals. The i3-S strategy may be useful to develop a framework to support these clinical decisions, particularly in understudied cancer populations such as ovarian cancer patients. The aim of this lecture is to describe the methodology of the i3-S strategy and its recent application in patients with ovarian cancer.

Methods:

The i3-S strategy includes four steps, via which relevant information on the specific disease is collected from literature, guidelines and expert meetings: 1) creation of an inventory of comorbidities and adverse effects of ovarian cancer and its treatment.  2) Extension of the inventory with contraindications and restrictions. 3) Extension with potential adaptations to the exercise and dietary intervention in ovarian cancer specific comorbidities and adverse effects.  4) Integration of information from previous steps into a framework by translating adverse effects to clinical parameters and symptoms to monitor during the intervention.

Results:   

Step 1 and 2 led to the following ovarian cancer specific comorbidities and adverse effects, including disorders of the thyroid gland, ascites, gastro-intestinal symptoms (e.g. anorexia) and an abdominal wound after surgery. Strategies to adapt the exercise intervention (step 3) included monitoring of brady-/tachycardia and related symptoms as a consequence of disorders of the thyroid gland, adjusting exercise to a comfortable intensity or posture in case of discomfort due to ascites, and replacing eccentric exercises by isometric exercises to avoid pressure on the abdominal wound in the post-operative period. These strategies for adapting the intervention to ovarian cancer specific comorbidities and adverse effects were integrated into a framework (step 4).

Conclusions:

The i3-S strategy has been applied successfully to tailor exercise interventions to patients with breast or ovarian cancer and to tailor dietary interventions to patients with ovarian cancer. It provided clinical guidance to physiotherapists or exercise physiologists delivering exercise interventions to patients with cancer.

Purpose:

The single blind randomized controlled ‘Physical Activity and Dietary intervention in OVArian cancer’ (PADOVA) study evaluates the effectiveness of a combined supervised exercise and dietary intervention in patients with ovarian cancer during chemotherapy treatment compared with a usual care control group that receives exercise and dietary advice after completion of chemotherapy treatment. The second aim of this study is to conduct a process evaluation to examine why and how the intervention is (in)effective.

Methods:

Participation rates were calculated as the proportion of eligible patients that were willing to participate. Reasons for declining participation were registered. Adherence to the exercise and dietary counselling sessions and the number of times the counsellors (i.e. physical therapist or dietitian) adjusted the intervention as well as reasons for adjustments were registered. Patients were considered adherent when they attended >80% of prescribed sessions.

Results:

The first 25% of participants have completed the trial. On average, 29% of the patients who were eligible  were willing to participate. Main reasons for declining participation were too much burden practically, physically or emotionally (35%) or not willing/able to conduct study measurements (31%).

Mean attendance in the group receiving the intervention during chemotherapy was 76% for the exercise sessions and 92% for the dietary consultations. Of these participants 55% were adherent to the exercise sessions and 80% to the dietary consultations. In 91% of the participants one or multiple exercise sessions were adjusted because they were too ill to follow the prescribed protocol. Being too ill was reported in most participants (55%) as one of the reasons for nonattendance. In total, 66% of the dietary consultations focused on energy and protein intake recommendations, while a healthy diet according to the WCRF guidelines was discussed in 34%.

Of patients in the usual care control group, 25% were interested in exercise, 50% in dietary consultations and 13% in a combined intervention after treatment.      

Conclusions:  

The attendance for exercise sessions was reasonable and the attendance for dietary consultations during chemotherapy was good. Patients preferred receiving exercise and dietary support during chemotherapy treatment instead of after chemotherapy completion.