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Maddocks M, Brighton LJ, Connell L, Cowley A, Laird B, Peryer G, Petrasso C, Ziegler L, Harwood R. Establishing a research partnership to investigate functional loss and rehabilitation towards the end of life. Health Technol Assess 2024:1-12. [PMID: 38676412 PMCID: PMC11070894 DOI: 10.3310/pthc7598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background Functional loss, the inability to perform necessary or desired tasks, is a common consequence of life-limiting illnesses and associated symptoms (pain, fatigue, breathlessness, etc.) and causes suffering for patients and families. Rehabilitation, a set of interventions designed to address functional loss, is recognised as essential within palliative care, as it can improve quality of life and reduce care costs. However, not everyone has equal access to rehabilitation. Despite limited life expectancy or uncertain ability to benefit from interventions, palliative rehabilitation services are often absent. This is partly due to a lack of high-quality research around optimal models of rehabilitation. Research in this area is methodologically challenging and requires multidisciplinary and cross-speciality collaboration. Aim and objectives We aimed to establish and grow a United Kingdom research partnership across diverse areas, commencing with partners from Edinburgh, East Anglia, Lancashire, Leeds, London and Nottingham, around the topic area of functional loss and rehabilitation in palliative and end-of-life care. The objectives were to (1) develop a multidisciplinary, cross-speciality research partnership, (2) generate high-priority unanswered research questions with stakeholders, (3) co-design and submit high-quality competitive research proposals, including (4) sharing topic and methodological expertise, and (5) to build capacity and capability to deliver nationally generalisable studies. Activities The partnership was established with professionals from across England and Scotland with complementary areas of expertise including complex palliative and geriatric research, physiotherapy, nursing, palliative medicine and psychology. Research questions were generated through a modified version of the Child Health and Nutrition Research Initiative, which allowed for the collation and refinement of research questions relating to functional loss and rehabilitation towards the end of life. Partnership members were supported through a series of workshops to transform research ideas into proposals for submission to stage one calls by the National Institute for Health and Care Research. The partnership not only supported students, clinicians and public members with training opportunities but also supported clinicians in securing protected time from clinical duties to allow them to focus on developing local research initiatives. Reflections Through our partnership we established a network that offered researchers, clinicians, students and public members the chance to develop novel skills and explore opportunities for personal and professional development around the topic area of functional loss and rehabilitation in palliative and end-of-life care. The partnership was crucial to foster collaboration and facilitate exchange of ideas, knowledge and experiences to build joint research study proposals. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) programme as award number NIHR135171. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/PTHC7598.
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Affiliation(s)
- Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Lisa Jane Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Louise Connell
- University of Central Lancashire, Preston, Lancashire, UK
- East Lancashire Hospitals NHS Trust, Burnley, Lancashire, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS, Research & Innovation, Nottingham, UK
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Barry Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- St Columba's Hospice Care, Edinburgh, UK
| | - Guy Peryer
- University of East Anglia, Faculty of Medicine and Health Sciences, Norwich Research Park, Norwich, UK
| | - Carmine Petrasso
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Lucy Ziegler
- University of Leeds, Academic Unit of Palliative Care, School of Medicine, Leeds, UK
| | - Rowan Harwood
- Faculty of Medicine and Health Sciences, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Phillips I, Allan L, Hug A, Westran N, Heinemann C, Hewish M, Mehta A, Saxby H, Ezhil V. Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial. BMJ Support Palliat Care 2023; 13:e213-e219. [PMID: 33563774 DOI: 10.1136/bmjspcare-2020-002838] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION European Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention. METHODS In this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA), RESULTS: 96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention. CONCLUSION A large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.
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Affiliation(s)
- Iain Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Adele Hug
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Naomi Westran
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Claudia Heinemann
- Department of Nutrition and Dietetics, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Madeleine Hewish
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Ajay Mehta
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Helen Saxby
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Veni Ezhil
- St Lukes Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Abstract
PURPOSE OF REVIEW Systemic therapy for lung cancer is increasing in intensity and duration. European nutrition guidelines suggest screening for weight loss and malnutrition, however acknowledges there is a lack of evidence. We discuss current data round this issue and identify opportunities for further research. RECENT FINDINGS International guidelines now exist to aid the definition of weight loss in cancer, including cachexia, sarcopenia and malnutrition. These allow consistent definition of overlapping, but distinct clinical syndromes. Nutritional status can be assessed in a range of ways including questionnaires, functional assessments, blood markers, physical activity, weight and BMI. Weight loss is commonly associated with a proinflammatory state. Future treatment is likely to be a combination of dietetic support and pharmacological treatment of cachexia. SUMMARY There is a paucity of data on dietetic intervention. It is potentially quick, inexpensive and patient specific, using a holistic approach to aid patients who are malnourished or at risk of malnutrition. Lung cancer-related weight loss is common, further strategies are needed to effectively assess and intervene. Dietetic intervention has the potential to improve patients' quality of life and outcomes.
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Wilcock A, Hussain A, Maddocks M. Holistic Needs of People with Thoracic Cancer Identified by the Sheffield Profile for Assessment and Referral to Care Questionnaire ©. J Palliat Med 2019; 22:1120-1123. [PMID: 30848688 DOI: 10.1089/jpm.2018.0540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: A holistic needs assessment is recommended in people with cancer at key stages, including soon after diagnosis. For people with thoracic cancer, there is a lack of data obtained routinely at this time point. Objective: To identify the most common and/or distressing supportive and palliative needs present soon after diagnosis using a specifically developed questionnaire. Methods: As part of a local rehabilitation service, patients within three to six weeks of a diagnosis of thoracic cancer were invited to complete the Sheffield Profile for Assessment and Referral to Care (SPARC©) questionnaire. Results: For a 26-month period, 738 patients completed the questionnaire, representing about 70% of all patients diagnosed with thoracic cancer during this time. Respondents had a median [interquartile range] of 15 (11-21) symptoms or issues, with 2 (0-5), 4 (2-7), and 7 (5-11) causing "very much," "quite a bit," and "a little" distress or bother, respectively. The top five most frequent needs causing any degree of distress or bother were physical, present in 68%-80% of patients: feeling tired, shortness of breath, cough, feeling sleepy in the day, changes in weight. Two psychological issues followed: worrying about effects of the illness on others, feeling anxious, both present in 67%. Despite most patients reporting talking to health professionals about their condition, 20%-30% wanted further information. Conclusions: These findings represent the largest cohort of patients with thoracic cancer completing the SPARC questionnaire soon after diagnosis, and provide detailed information on the high level of need that thoracic oncology services must be able to respond to.
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Affiliation(s)
- Andrew Wilcock
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Asmah Hussain
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Matthew Maddocks
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Spexoto MCB, Serrano SV, Halliday V, Maroco J, Wilcock A, Campos JADB. Cross-cultural psychometric assessment of an appetite questionnaire for patients with cancer. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:152-159. [PMID: 29768529 DOI: 10.1590/2237-6089-2017-0093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties, along with cross-cultural invariance analysis, of the Cancer Appetite and Symptom Questionnaire (CASQ). METHOD Data from 555 United Kingdom (UK) cancer patients were used to evaluate the psychometric properties of the CASQ. Construct validity was assessed through factorial and convergent validity. We conducted a confirmatory factor analysis using as indices the chi-square ratio by degrees of freedom (χ2/df), the comparative fit index (CFI), the goodness of fit index (GFI), and the root mean square error of approximation (RMSEA). Convergent validity was estimated by the items' average variance extracted (AVE). Reliability was estimated by composite reliability and internal consistency. Factorial invariance analysis of the CASQ was evaluated by multigroup analysis (∆χ2) using the UK and Brazilian samples. RESULTS All items showed adequate psychometric sensitivity in the UK sample. One item was removed and four correlations were included between errors with an appropriate fit of the model (χ2/df = 2.674, CFI = 0.966, GFI = 0.964, RMSEA = 0.055). The reliability of the CASQ was adequate and the convergent validity was low. The factorial structure of the CASQ differed across countries, and a lack of measurement invariance for the two countries was observed (λ: ∆χ2 = 64.008, p < 0.001; i: ∆χ2 = 3515.047, p < 0.001; Res: ∆χ2 = 4452.504, p < 0.001). CONCLUSION The CASQ showed adequate psychometric properties in the UK sample. The ability to estimate loss of appetite and the presence of symptoms was different between UK and Brazilian patients.
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Affiliation(s)
- Maria Claudia Bernardes Spexoto
- Departamento de Alimentos e Nutrição, Faculdade de Ciências Farmacêuticas de Araraquara, Universidade Estadual Paulista (UNESP), Araraquara, SP, Brazil
| | | | - Vanessa Halliday
- Public Health, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - João Maroco
- William James Center for Research (WJCR), Instituto Universitário de Ciências Psicológicas, Sociais e da Vida (ISPA), Lisboa, Portugal
| | - Andrew Wilcock
- Reader in Palliative Medicine and Medical Oncology, Hayward House Macmillan Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Juliana Alvares Duarte Bonini Campos
- Departamento de Alimentos e Nutrição, Faculdade de Ciências Farmacêuticas de Araraquara, Universidade Estadual Paulista (UNESP), Araraquara, SP, Brazil
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Sealy MJ, Nijholt W, Stuiver MM, van der Berg MM, Roodenburg JL, van der Schans CP, Ottery FD, Jager-Wittenaar H. Content validity across methods of malnutrition assessment in patients with cancer is limited. J Clin Epidemiol 2016; 76:125-36. [DOI: 10.1016/j.jclinepi.2016.02.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/01/2016] [Accepted: 02/22/2016] [Indexed: 12/30/2022]
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Madeddu C, Mantovani G, Gramignano G, Macciò A. Advances in pharmacologic strategies for cancer cachexia. Expert Opin Pharmacother 2015; 16:2163-77. [PMID: 26330024 DOI: 10.1517/14656566.2015.1079621] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Cancer cachexia is a severe inflammatory metabolic syndrome accounting for fatigue, an impairment of normal activities and, eventually, death. The loss of muscle mass associated with body weight loss is the main feature of this syndrome. AREAS COVERED The present review aims to describe the advances in the pharmacological approaches for cancer cachexia, highlighting the impact on weight loss, muscle wasting and related outcomes. EXPERT OPINION Among the pharmacological agents, attention should yet be given to the currently most widely studied drugs, such as progestogens and NSAIDs. Emerging drugs, such as ghrelin and selective androgen receptor modulators, have obtained promising results in recent randomized clinical trials. Larger sample sizes and more robust data on the effectiveness of anti-cytokine agents are needed. Any pharmacological approach to counteract cancer cachexia should always be associated with an adequate caloric intake, obtained by diet or through enteral or parenteral supplementation, if indicated. Finally, we can currently state that a combined approach that simultaneously targets the fundamental pathways involved in the pathogenesis of cancer cachexia is likely to be the most effective in terms of improvements in body weight as well as muscle wasting, function, physical performance and quality of life.
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Affiliation(s)
- Clelia Madeddu
- a 1 University of Cagliari, AOU Cagliari, Department of Medical Sciences M. Aresu , Cagliari, Italy
| | - Giovanni Mantovani
- b 2 University of Cagliari, AOU Cagliari, Department of Medical Sciences M. Aresu , Via Catalani 1b, 09100 Cagliari, Italy
| | - Giulia Gramignano
- c 3 N.S. Bonaria Hospital, Medical Oncology Unit , San Gavino, Italy
| | - Antonio Macciò
- d 4 A. Businco Hospital, Regional Referral Center for Cancer Diseases, Department of Gynecologic Oncology , Cagliari, Italy
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Aapro M, Arends J, Bozzetti F, Fearon K, Grunberg S, Herrstedt J, Hopkinson J, Jacquelin-Ravel N, Jatoi A, Kaasa S, Strasser F. Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol 2014; 25:1492-9. [DOI: 10.1093/annonc/mdu085] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Balstad TR, Solheim TS, Strasser F, Kaasa S, Bye A. Dietary treatment of weight loss in patients with advanced cancer and cachexia: A systematic literature review. Crit Rev Oncol Hematol 2014; 91:210-21. [DOI: 10.1016/j.critrevonc.2014.02.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/30/2014] [Accepted: 02/28/2014] [Indexed: 11/29/2022] Open
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