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Saillard C, Cuvelier S, Villaron-Goetgheluck C, Boher JM, Almeida-Lopez L, Le Corroller AG, Denis P, Rivieccio C, Calvin S, Vey N, Bannier-Braticevic C. Tripartite prehabilitation of patients with acute myeloid leukaemia and high-risk myelodysplastic syndromes during intensive chemotherapy before allogeneic haematopoietic stem cell transplantation (COHABILIT): protocol for an innovating prospective multicentre study. BMJ Open 2024; 14:e076321. [PMID: 38553062 PMCID: PMC10982723 DOI: 10.1136/bmjopen-2023-076321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Acute myeloid leukaemia (AML) and high-risk myelodysplastic syndromes (MDS) are often treated with intensive chemotherapy followed by allogeneic haematopoietic stem cell transplantation (allo-HSCT). The pretransplant treatment results in a general deterioration of the patient's health and quality of life. Furthermore, allo-HSCT can be responsible for significant toxicity with risks of graft-versus-host disease (GvHD). Developing strategies to prevent physical deconditioning, undernutrition and psychological distress could help maintain a satisfactory general state of health before transplantation and thus limit these deleterious effects. This protocol evaluates the feasibility and adherence to a personalised prehabilitation programme, which can be modulated and assisted by connected objects, provided from the diagnosis to the allo-HSCT. METHODS AND ANALYSIS This multicentre interventional study will include 50 patients treated for AML or high-risk MDS with intensive chemotherapy and eligible for allo-HSCT. The intervention consists of a coached, supervised or self-directed physical activity programme, organised during the hospitalisation phases and periods at home. At the same time, patients will receive a weekly dietary follow-up. The whole intervention is controlled and modulated through the use of a dedicated application and connected objects allowing adaptation and individualisation. The rate of participation in the prescribed physical activity sessions will assess the feasibility of this study. In addition, the evolution of physical capacities (Short Physical Performance Battery, grip and quadriceps strengths), psychosocial parameters (Functional Assessment of Cancer Therapy - Leukaemia, Functional Assessment of Cancer Therapy - Fatigue, subjective well-being, Hospital Anxiety and Depression Scale, self-efficacy, Coach-Athlete Relationship Questionnaire, interviews) and clinical status (weight, lean body mass, survival rate, number of infections, days of hospitalisation, GvHD) will be evaluated. ETHICS AND DISSEMINATION The study procedures have been approved by the National Ethics Committee (21.00223.000003). Consent is given in person by each participant. The information collected on the participants contains only a non-identifiable study identifier. The results of this protocol will be published in a scientific paper and communicated to the medical staff of the medical centre. TRIAL REGISTRATION NUMBER NCT03595787.
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Affiliation(s)
- Colombe Saillard
- Department of Haematology, Paoli-Calmettes Institute, Marseille, France
| | - Sarah Cuvelier
- Management Sport Cancer Laboratory, Aix-Marseille University, Marseille, France
| | | | - Jean-Marie Boher
- Department of Clinical Research and Innovations, Paoli-Calmettes Institute, Marseille, France
| | - Leonor Almeida-Lopez
- Department of Clinical Research and Innovations, Paoli-Calmettes Institute, Marseille, France
| | - Anne-Gaelle Le Corroller
- Economic and Social Sciences of Health and Medical Information Processing Laboratory (SESSTIM CANBIOS), National Institute of Health and Medical Research, Paris, France
| | - Pauline Denis
- Department of Sport, Paoli-Calmettes Institute, Marseille, France
| | - Céline Rivieccio
- Department of Sport, Paoli-Calmettes Institute, Marseille, France
| | - Sarah Calvin
- Management Sport Cancer Laboratory, Aix-Marseille University, Marseille, France
| | - Norbert Vey
- Department of Haematology, Paoli-Calmettes Institute, Marseille, France
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Humphreys L, Myers A, Frith G, Thelwell M, Pickering K, Mills GH, Kerr K, Fisher P, Kidder J, Keen C, Hodson S, Phillips G, Smith R, Evans L, Thornton S, Dale E, Maxwell L, Greenfield DM, Copeland R. The Development of a Multi-Modal Cancer Rehabilitation (Including Prehabilitation) Service in Sheffield, UK: Designing the Active Together Service. Healthcare (Basel) 2024; 12:742. [PMID: 38610164 PMCID: PMC11011813 DOI: 10.3390/healthcare12070742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer patients undergoing major interventions face numerous challenges, including the adverse effects of cancer and the side effects of treatment. Cancer rehabilitation is vital in ensuring cancer patients have the support they need to maximise treatment outcomes and minimise treatment-related side effects and symptoms. The Active Together service is a multi-modal rehabilitation service designed to address critical support gaps for cancer patients. The service is located and provided in Sheffield, UK, an area with higher cancer incidence and mortality rates than the national average. The service aligns with local and regional cancer care objectives and aims to improve the clinical and quality-of-life outcomes of cancer patients by using lifestyle behaviour-change techniques to address their physical, nutritional, and psychological needs. This paper describes the design and initial implementation of the Active Together service, highlighting its potential to support and benefit cancer patients.
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Affiliation(s)
- Liam Humphreys
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Anna Myers
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Gabriella Frith
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Michael Thelwell
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Katie Pickering
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK; (A.M.); (G.F.); (M.T.); (K.P.)
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Gary H. Mills
- Critical Care Directorate, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield S1 1WB, UK; (G.H.M.)
| | - Karen Kerr
- Critical Care Directorate, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield S1 1WB, UK; (G.H.M.)
| | - Patricia Fisher
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (P.F.); (D.M.G.)
| | - John Kidder
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Carol Keen
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Suzanne Hodson
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Gail Phillips
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
| | - Rachel Smith
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Laura Evans
- Therapeutics and Palliative Care Directorate, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (C.K.); (S.H.); (R.S.); (L.E.)
| | - Sarah Thornton
- Dietetic Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Emma Dale
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Louise Maxwell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - Diana M. Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; (P.F.); (D.M.G.)
- Department of Oncology and Metabolism, University of Sheffield, Medical School Beech Hill Road, Sheffield S10 2RX, UK
| | - Robert Copeland
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (J.K.); (G.P.); (R.C.)
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Tabacchi F, Iatridi V, Tammam J, Watson E, Coe S. Case Report on a Multidisciplinary Approach to Address Malnutrition and Improve a Patient's Fitness for Treatment. Nutr Cancer 2024:1-5. [PMID: 38425085 DOI: 10.1080/01635581.2024.2324501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
Approximately 5,700 people are diagnosed with myeloma each year in the UK. The standard of care is to receive an autologous stem cell transplant after completion of induction therapy. There are no specific dietary recommendations for people with myeloma, however they are at risk of malnutrition due to symptoms and side effects of treatments. This report describes the journey of a 73-year-old male diagnosed with immunoglobulin A (IgA) lambda myeloma in April 2021. The patient lost 23% of his body weight during 6 months of systemic anti-cancer treatment (SACT), resulting in postponing his transplant twice due to reduced fitness. This report describes an effective, although late, multidisciplinary intervention which was successful for the patient who managed to reestablish a healthy weight and good quality of life. The patient received his transplant in January 2023. This case highlights two important aspects of patient care that should not be underestimated in dietetic clinical practice: early screening and multidisciplinary collaboration. Monitoring the nutritional status of patients and providing early nutrition support can prevent hospital admissions, treatment delays and reduce the associated costs. Multidisciplinary teamwork can improve patient care and clinical outcomes, and it is fundamental to strengthen communication and collaboration among clinical disciplines.
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Affiliation(s)
- F Tabacchi
- Centre for Nutrition and Health, Faculty of Health & Life Science, Oxford Institute for Applied Health Research, Oxford Brookes University, Oxford, UK
- Department of Dietetics, Therapies, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Iatridi
- Centre for Nutrition and Health, Faculty of Health & Life Science, Oxford Institute for Applied Health Research, Oxford Brookes University, Oxford, UK
| | - J Tammam
- Centre for Nutrition and Health, Faculty of Health & Life Science, Oxford Institute for Applied Health Research, Oxford Brookes University, Oxford, UK
| | - E Watson
- Centre for Nutrition and Health, Faculty of Health & Life Science, Oxford Institute for Applied Health Research, Oxford Brookes University, Oxford, UK
| | - S Coe
- Centre for Nutrition and Health, Faculty of Health & Life Science, Oxford Institute for Applied Health Research, Oxford Brookes University, Oxford, UK
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McCourt O, Fisher A, Land J, Ramdharry G, Yong K. The views and experiences of people with myeloma referred for autologous stem cell transplantation, who declined to participate in a physiotherapist-led exercise trial: a qualitative study. Physiother Theory Pract 2023:1-13. [PMID: 37555437 DOI: 10.1080/09593985.2023.2244068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Recruitment rates to rehabilitation trials are variable among cancer survivors, and deeper investigation into the causes for declining participation is needed. The aim of this study was to qualitatively explore the experiences of people with myeloma referred for autologous stem cell transplant who were approached to take part in a physiotherapist-led exercise trial but declined. METHODS Participants were asked to participate in this qualitative study after declining to participate in a trial conducted at a UK tertiary cancer center. Semi-structured interviews were conducted. Data was analyzed inductively using reflexive thematic analysis. RESULTS Interviews from 18 myeloma patients (56% male, mean age 62 years) were analyzed. Four themes were identified: 1) Traveling to the specialist center is challenging, not just logistically; 2) Individualized approach valued but recall of research information variable; 3) Being less active has profound impact yet ameliorative support is lacking; and 4) Common side-effects of treatment are expected and endured but personal impact underestimated and unaddressed. CONCLUSION A number of barriers to participation were identified. Travel, a commonly cited reason for declining research participation, is more than a logistical issue for cancer survivors experiencing side-effects and the time burden of clinical appointments. Expectation or knowledge of the typical side-effects from myeloma and its treatment may lead to under-reporting of concerns to care providers, despite their impact upon daily activities and quality of life. Approaches used for research recruitment should consider the timing and consequences of ongoing cancer treatment to reduce potential barriers to participation.
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Affiliation(s)
- Orla McCourt
- Therapies and Rehabilitation, University College London Hospitals NHS Foundation Trust, London, UK
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - Abigail Fisher
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Joanne Land
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Gita Ramdharry
- Queens Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust/UCL Institute of Neurology, University College London, London, UK
| | - Kwee Yong
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
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McCourt O, Fisher A, Ramdharry G, Land J, Roberts AL, Rabin N, Yong K. Exercise prehabilitation for people with myeloma undergoing autologous stem cell transplantation: results from PERCEPT pilot randomised controlled trial. Acta Oncol 2023; 62:696-705. [PMID: 36794394 DOI: 10.1080/0284186x.2023.2178326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Autologous stem cell transplant (ASCT) is first line treatment for newly diagnosed patients with myeloma but often results in functional deficits and reduced quality of life (QOL). Physically active myeloma patients have better QOL, less fatigue and reduced morbidity. This trial aimed to investigate the feasibility of a physiotherapist-led exercise intervention delivered across the continuum of the myeloma ASCT pathway at a UK centre. Initially designed and delivered as a face-to-face trial, the study protocol was adapted to virtual delivery in response to the COVID-19 pandemic. MATERIAL AND METHODS A pilot randomised controlled trial of a partly supervised exercise intervention with incorporated behaviour change techniques delivered before, during and for 3 months following ASCT compared to usual care. Face-to-face delivery of the pre-ASCT supervised intervention was adapted to virtually-supervised group classes via video conferencing. Primary outcomes related to feasibility; recruitment rate, attrition and adherence. Secondary outcomes included patient reported measures of QOL (EORTC C30, FACT-BMT, EQ5D), and fatigue (FACIT-F), measures of functional capacity (six-minute walk test (6MWT), timed sit-to-stand (TSTS), hand grip strength, self-reported and objective physical activity (PA). RESULTS Over 11 months 50 participants were enrolled and randomised. Overall, uptake to the study was 46%. The attrition rate was 34%, mainly related to failure to undergo ASCT. Loss of follow-up for other reasons was low. Secondary outcomes demonstrate potential for the benefit of exercise prior to, during and after ASCT with improvements in QOL, fatigue, functional capacity and PA evident on admission for ASCT and 3 months post-ASCT. DISCUSSION Results indicate acceptability and feasibility of delivering exercise prehabilitation, in person and virtually within the ASCT pathway in myeloma. The effects of prehabilitation and rehabilitation provision as a component of the ASCT pathway warrants further investigation.
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Affiliation(s)
- Orla McCourt
- Therapies & Rehabilitation, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - Abigail Fisher
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Gita Ramdharry
- Queens Square Centre for Neuromuscular Diseases, National Hospital for Neurology & Neurosurgery, UCLH NHS Trust/UCL Institute of Neurology, University College London, London, UK
| | - Joanne Land
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Anna L Roberts
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kwee Yong
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
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McCourt O, Fisher A, Land J, Ramdharry G, Roberts AL, Bekris G, Yong K. "What I wanted to do was build myself back up and prepare": qualitative findings from the PERCEPT trial of prehabilitation during autologous stem cell transplantation in myeloma. BMC Cancer 2023; 23:348. [PMID: 37069548 PMCID: PMC10107576 DOI: 10.1186/s12885-023-10799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The addition of qualitative methodology to randomised controlled trials evaluating complex interventions allows better understanding of contextualised factors and their potential influence on trial delivery and outcomes, as well as opportunities for feedback on trial participation to improve future trial protocols. This study explored the experiences of participation in cancer rehabilitation research during active cancer treatment. Participants were people living with haematological cancer myeloma, undergoing autologous stem cell transplantation (ASCT) recruited to the PERCEPT myeloma pilot trial. METHODS A qualitative semi-structured interview study, embedded within a pilot randomised controlled trial of a physiotherapist-led exercise intervention delivered before, during and after ASCT among people living with myeloma. Transcripts were analysed using reflexive thematic analysis. RESULTS Interviews from 16 trial participants (n = 8 intervention group; n = 8 control group; mean age 61 years, 56% male) were analysed. Four main themes were identified: (1) "It's not just beneficial for me, it's for people after me as well"; (2) Disparities in experience of recovery - expectations, feeling prepared and support; (3) "What I wanted to do was build myself back up and prepare"; (4) Active ingredients - participants' experience of the trial intervention. Participants reported both altruistic and perceived personal gain as motivators for enrolling in the trial. Disappointment caused by allocation to control arm may have led to participants seeking exercise elsewhere, indicating possible contamination of control condition. Disparities in experience of recovery from transplant were evident with intervention participants reporting greater trajectory of recovery. CONCLUSIONS The findings from this embedded qualitative study highlight numerous considerations required when designing pilot and efficacy trials of complex interventions. The addition of qualitative investigation offers greater understanding of motivations for participation, intervention mechanisms at play as well as effects of participation that may impact interpretation of quantitative outcomes. TRIAL REGISTRATION Qualitative findings from a prospectively registered pilot trial (ISRCTN15875290), registered 13/02/2019.
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Affiliation(s)
- Orla McCourt
- Therapies & Rehabilitation, Inpatient Therapy Office, University College London Hospitals NHS Foundation Trust, University College Hospital, T-1/Lower Ground Floor, 235 Euston Road, London, NW1 2BU, UK.
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK.
| | - Abigail Fisher
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Joanne Land
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Gita Ramdharry
- Queens Square Centre for Neuromuscular diseases, National Hospital for Neurology & Neurosurgery, UCL Institute of Neurology, UCLH NHS Trust, University College London, London, UK
| | - Anna L Roberts
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Georgios Bekris
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Kwee Yong
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
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Potiaumpai M, Schmitz KH, Mineishi S, Naik S, Wirk B, Rakszawski K, Ehmann WC, Claxton D, Nickolich M, Zemel BS, Zheng H. IMPROVE-BMT: a protocol for a pilot randomised controlled trial of prehabilitation exercise for adult haematopoietic stem cell transplant recipients. BMJ Open 2023; 13:e066841. [PMID: 36657760 PMCID: PMC9853231 DOI: 10.1136/bmjopen-2022-066841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Haematopoietic stem cell transplant (HSCT) in adults is an intensive medical procedure for a variety of haematological malignancies. Although there is a large body of evidence demonstrating the negative effects of HSCT on physical function and psychosocial parameters, there is limited evidence on the impact of HSCT on body composition and bone health. Further, aerobic and resistance-training exercise interventions aimed at improving physical function and patient-reported outcomes largely take place during the peritransplant and post-transplant period. Prehabilitative exercise, or exercise prior to medical treatment, has been successfully deployed in presurgical candidates and other tumour sites, yet there is a paucity of evidence on the effect of prehabilitation in HSCT patients. The aim of this study is to investigate the feasibility, acceptability and safety of a resistance training exercise programme in patients with haematological malignancies prior to HSCT. METHODS AND ANALYSIS IMpact of PRehabilitation in Oncology Via Exercise-Bone Marrow Transplant is a single-site, pilot randomised controlled trial of an exercise intervention compared with usual care. The primary aim is to assess the feasibility, acceptability and safety of the resistance-training exercise intervention prior to HSCT. Secondary aims include evaluating the differences in physical function, body composition, bone mineral density and patient-reported outcomes between the exercise group and usual care control group. Outcome measurements will be assessed: prior to HSCT, on/around day of HSCT admission, +30 days post-HSCT and +100 days post-HSCT. The exercise intervention is a home-based resistance training exercise programme that incorporates resistance band and body weight exercises. The primary outcomes will be reported as percentages and/or mean values. The secondary outcomes will be analysed using appropriate statistical methods to portray within-group and between-group differences. ETHICS AND DISSEMINATION The study has Penn State College of Medicine approval. Results will be disseminated through scientific publication and presentation at exercise-related and oncology-related scientific meetings. TRIAL REGISTRATION NUMBER NCT03886909.
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Affiliation(s)
- Melanie Potiaumpai
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kathryn H Schmitz
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shin Mineishi
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Seema Naik
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Baldeep Wirk
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Kevin Rakszawski
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - W Christopher Ehmann
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - David Claxton
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Myles Nickolich
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Babette S Zemel
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hong Zheng
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
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Zhou X, Yang Y, Li C, Gu S, Hou W, Lai X, Zhai L, Zhu Y. What information can we gain from the quality appraisal of guidelines with physical activity recommendations for cancer patients?A systematic review using the AGREE II and AGREE-REX tools. Support Care Cancer 2023; 31:97. [PMID: 36598576 PMCID: PMC9811039 DOI: 10.1007/s00520-022-07567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE There has been growing amount of evidence supporting the benefits of physical activity (PA) on oncological patients' cancer-related health outcomes. Although guidelines on cancer rehabilitation are widely available, the varying quality and practical applicability limited the clinical application of PA recommendations. To assist the future development of guidelines, in this systematic review, we evaluated the quality and applicability of current cancer rehabilitation guidelines with PA recommendations and synthesized PA recommendations for the oncological population. METHODS A systematic search was conducted in PubMed, CINAHL, PEDro, EMBASE, and guideline repositories to identify guidelines with PA recommendations for cancer patients from 1 May 2016 to 1 June 2022. The quality of included guidelines was appraised using the tools "Appraisal of Guidelines for Research and Evaluation II" (AGREE II) and AGREE-REX (Recommendation Excellence). PA recommendations were synthesized from the guidelines. RESULTS Sixteen guidelines were extracted. The AGREE II domain "clarity of presentation" obtained the highest score, while "applicability" received the lowest, ranging from 33.33% to 98.58%. The AGREE-REX domains "values and preferences" and "implementability" generally scored lower and ranged from 45.83% to 74.17% and 55% to 88.33%, respectively. Eight high-quality guidelines were identified, and the included PA recommendations were extracted. CONCLUSION There were some disparities in the quality of the included guidelines. Methodological weaknesses were commonly observed in domains "applicability," "values and preferences," and "implementability"; particular attention should be given to these domains when developing future guidelines. Furthermore, this analysis indicated that more rigorous, high-quality studies are needed to generate evidence for supporting PA recommendations and provide guidance on research gaps in the field of cancer rehabilitation.
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Affiliation(s)
- Xue Zhou
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000 Henan China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000 Henan China
| | - Yujie Yang
- University of Health and Rehabilitation Sciences, Qingdao, 266000 Shandong China
| | - Conghui Li
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000 Henan China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000 Henan China
| | - Shanshan Gu
- Department of Physical Therapy, University of Toronto, Toronto, Ontario Canada
| | - Weiqian Hou
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000 Henan China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000 Henan China
| | - Xigui Lai
- Department of Kinesiology, Shanghai University of Sport, Shanghai, 200438 China
| | - Liwen Zhai
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000 Henan China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, 450000 Henan China
| | - Yi Zhu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000 Henan China
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Pawlyn C, Khan AM, Freeman CL. Fitness and frailty in myeloma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:337-348. [PMID: 36485137 PMCID: PMC9820647 DOI: 10.1182/hematology.2022000346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As the aging population grows, so too does the number of well-tolerated antimyeloma therapies. Physicians will see an increasing volume of patients for subsequent lines of therapy, which could now extend this relationship for over a decade. For younger patients, treatment choices are infrequently impacted by concerns of fitness, but instead about effecting the deepest, most durable response. Older adults, in contrast, are more likely to experience under- than overtreatment, and therefore more objective (and ideally straightforward) ways to evaluate their fitness and ability to tolerate therapy will increasingly assist in decision-making. Post hoc analyses categorizing the fitness of trial patients in the modern treatment era globally demonstrate that even in highly selected populations, those that are recategorized as less fit or frail are consistently at higher risk of inferior outcomes and increased toxicities. Real-world data are comparatively lacking but do demonstrate that most patients with myeloma are not representative of those enrolled on clinical trials, generally more heavily burdened by comorbidities and more likely to be categorized as "less than fit." Simultaneously, the number of therapeutic options open to patients in the relapsed setting continues to grow, now including T-cell engagers and cellular therapies, with their unique toxicity profiles. The aim of this review is to summarize the available data, highlight some of the approaches possible to easily assess fitness and how results might inform treatment selection, and illustrate ways that patients' condition can be optimized rather than lead to exclusion from the more complex therapies newly available.
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Affiliation(s)
- Charlotte Pawlyn
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Abdullah M Khan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ciara L Freeman
- H. Lee Moffitt Cancer Centre & Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
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Morales Rodríguez E, Lorenzo Calvo J, Granado-Peinado M, Pérez-Bilbao T, San Juan AF. Effects of Exercise Programs on Psychoemotional and Quality-of-Life Factors in Adult Patients with Cancer and Hematopoietic Stem Cell Transplantation or Bone Marrow Transplantation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315896. [PMID: 36497971 PMCID: PMC9735672 DOI: 10.3390/ijerph192315896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 05/31/2023]
Abstract
This review analyzed the effects of an exercise program on psychoemotional and quality-of-life (QoL) factors in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). Studies were identified from the PubMed and Web of Science databases (from inception to 24 August 2022), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based in turn on the Delphi list. A total of 20 randomized controlled studies were included with 1219 participants. The main result of this systematic review is that exercise program interventions produce improvements on psychoemotional and QoL factors in adult patients with cancer and HSCT or BMT. Moreover, exercise programs may have a beneficial effect on health, maintaining or increasing the patient's QoL. Further, it has a positive effect on the prevention and control of transplant complications in combination with medical treatment.
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Affiliation(s)
- Erica Morales Rodríguez
- Sports Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Jorge Lorenzo Calvo
- Sports Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Miriam Granado-Peinado
- Faculty of Education and Psychology, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Txomin Pérez-Bilbao
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Alejandro F. San Juan
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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11
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Denehy L, Edbrooke L. The Role of Exercise Before Cancer Treatment. Semin Oncol Nurs 2022; 38:151330. [PMID: 36008200 DOI: 10.1016/j.soncn.2022.151330] [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: 11/25/2022]
Abstract
OBJECTIVES We aim to describe on the role of exercise in preparation for cancer treatments (prehabilitation) that include surgery and neoadjuvant or nonsurgical approaches. We discuss the evidence for the role of exercise and provide guidelines to exercise prescription and examples of the structure of prehabilitation exercise programs. DATA SOURCE We use peer-reviewed articles obtained through PubMed searches with search terms: exercise, oncology, cancer surgery, exercise physiology, respiratory exercises, prehabilitation, and behavior change. CONCLUSION The emergence of prehabilitation in preparing patients for cancer care has followed a rapidly upward trajectory over the past 20 years. Exercise prehabilitation remains the cornerstone of management, particularly in patients attending for major surgery. Multimodal approaches to supporting patients before cancer treatment are now well accepted and include screening and individualized treatments of functional, nutritional, and psychological impairments. Respiratory training before surgery and the addition of behavior change strategies to improve adherence to interventions and promote improved longer-term outcomes are now included in many prehabilitation programs. For exercise to be an effective treatment in improving fitness and strength, supervised aerobic and resistance exercises at moderate intensity are recommended. There remains debate regarding the use of higher-intensity exercise, the appropriate outcome to measure efficacy, and the mechanisms driving the efficacy of exercise. IMPLICATIONS FOR NURSING PRACTICE We provide background evidence and knowledge pertaining to the role and provision of exercise prehabilitation. Understanding screening, risk factors, and potential efficacy assists in knowing who to refer for prehabilitation and what the programs include. This enables more effective com munication with patients attending for cancer treatments.
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Affiliation(s)
- Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences; Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences; Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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McCourt O, Fisher A, Ramdharry G, Roberts AL, Land J, Rabin N, Rowe K, Yong K. Adaptation of the PERCEPT myeloma prehabilitation trial to virtual delivery: changes in response to the COVID-19 pandemic. BMJ Open 2022; 12:e059516. [PMID: 35396313 PMCID: PMC8995568 DOI: 10.1136/bmjopen-2021-059516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Research activity was impacted by the novel COVID-19 pandemic, the PERCEPT myeloma trial was no exception. This pilot randomised trial delivered a face-to-face exercise intervention prior to and during autologous stem cell transplantation (ASCT) in myeloma patients, as a consequence of COVID-19 it required significant adaptions to continue. This brief communication describes how the previously published study protocol was adapted for virtual delivery. In addition, we highlight the challenge of continuing the study which was embedded within a clinical pathway also impacted by the pandemic. SUMMARY The original trial protocol was amended and continued to recruit and deliver an exercise prehabilitation intervention virtually. Continued delivery of the intervention was deemed important to participants already enrolled within the trial and the adapted virtual version of the trial was acceptable to the research ethics committee as well as participants. Development of effective, remotely delivered rehabilitation and physical activity programmes are likely to benefit people living with myeloma. The COVID-19 pandemic provided an opportunity to explore the feasibility of a virtual programme for ASCT recipients, however, continued changes to the clinical pathway within which the study was embedded posed the greatest challenge and ultimately led to early termination of recruitment. TRIAL REGISTRATION NUMBER ISRCTN15875290; pre-results.
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Affiliation(s)
- Orla McCourt
- Therapies & Rehabilitation, University College London Hospitals NHS Foundation Trust, London, UK
- Research Department of Haematology, Cancer Institute, University College London, London, UK
| | - Abigail Fisher
- Research Department of Behavoural Science and Health, University College London, London, UK
| | - Gita Ramdharry
- Queen Square Centre for Neuromuscular Diseases, National Hosital for Neurology and Neurosurger, London, UK
| | - Anna L Roberts
- Research Department of Behavoural Science and Health, University College London, London, UK
| | - Joanne Land
- Research Department of Behavoural Science and Health, University College London, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Katie Rowe
- Research Department of Haematology, Cancer Institute, University College London, London, UK
| | - Kwee Yong
- Research Department of Haematology, Cancer Institute, University College London, London, UK
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Lally P, Miller N, Roberts A, Beeken RJ, Greenfield DM, Potts HWW, Counsell N, Latimer N, Thomas C, Smith L, Gath J, Kennedy F, Martin C, Wyld L, Fisher A. An app with brief behavioural support to promote physical activity after a cancer diagnosis (APPROACH): study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2022; 8:74. [PMID: 35351187 PMCID: PMC8961486 DOI: 10.1186/s40814-022-01028-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background There are multiple health benefits from participating in physical activity after a cancer diagnosis, but many people living with and beyond cancer (LWBC) are not meeting physical activity guidelines. App-based interventions offer a promising platform for intervention delivery. This trial aims to pilot a theory-driven, app-based intervention that promotes brisk walking among people living with and beyond cancer. The primary aim is to investigate the feasibility and acceptability of study procedures before conducting a larger randomised controlled trial (RCT). Methods This is an individually randomised, two-armed pilot RCT. Patients with localised or metastatic breast, prostate, or colorectal cancer, who are aged 16 years or over, will be recruited from a single hospital site in South Yorkshire in the UK. The intervention includes an app designed to encourage brisk walking (Active 10) supplemented with habit-based behavioural support in the form of two brief telephone/video calls, an information leaflet, and walking planners. The primary outcomes will be feasibility and acceptability of the study procedures. Demographic and medical characteristics will be collected at baseline, through self-report and hospital records. Secondary outcomes for the pilot (assessed at 0 and 3 months) will be accelerometer measured and self-reported physical activity, body mass index (BMI) and waist circumference, and patient-reported outcomes of quality of life, fatigue, sleep, anxiety, depression, self-efficacy, and habit strength for walking. Qualitative interviews will explore experiences of participating or reasons for declining to participate. Parameters for the intended primary outcome measure (accelerometer measured average daily minutes of brisk walking (≥ 100 steps/min)) will inform a sample size calculation for the future RCT and a preliminary economic evaluation will be conducted. Discussion This pilot study will inform the design of a larger RCT to investigate the efficacy and cost-effectiveness of this intervention in people LWBC. Trial registration ISRCTN registry, ISRCTN18063498. Registered 16 April 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01028-w.
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Affiliation(s)
- P Lally
- Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - N Miller
- Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - A Roberts
- Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - R J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - D M Greenfield
- Sheffield Teaching Hospitals NHS FT, Weston Park Hospital, Sheffield, S10 2SJ, UK
| | - H W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - N Counsell
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - N Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - C Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - L Smith
- The Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - J Gath
- Yorkshire and Humberside Consumer Research Panel
| | - F Kennedy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - C Martin
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| | - A Fisher
- Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
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Hevroni G, Korde N. Examining health related quality of life outcomes in multiple myeloma: Past and future perspectives. Semin Oncol 2022; 49:94-102. [DOI: 10.1053/j.seminoncol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 01/02/2022] [Indexed: 11/11/2022]
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Lecat CSY, McCourt O, Land J, Yong K, Fisher A. Multiple myeloma and physical activity. BMC Res Notes 2021; 14:171. [PMID: 33962674 PMCID: PMC8103584 DOI: 10.1186/s13104-021-05591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Physical activity has been shown to improve quality of life in cancer patients with some evidence in multiple myeloma. This study aimed to determine myeloma patients' exercise levels, their perception of physical activity, and to explore correlations with quality of life. Myeloma outpatients were invited to complete a number of questionnaires, including the Godin leisure-time exercise questionnaire (GLTEQ) to determine their exercise levels, the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire to assess health related quality of life, and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire to assess fatigue. RESULTS Of the 65 respondents, 75% would like to increase their exercise level. Weakness, fatigue and pain were the most commonly perceived barriers to physical activity. 59% would like to receive physical activity advice. Only 25% were deemed active based on their GLTEQ scores. Finally, there was a significant positive correlation between the GLTEQ score and the FACT-G score (p < 0.001). Results highlight an unmet exercise need in myeloma patients. Current practice should be reviewed to develop a more holistic care model that incorporates tailored exercise advice or programme.
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Affiliation(s)
- Catherine S Y Lecat
- University College London Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK.
| | - Orla McCourt
- University College London Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
- University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Joanne Land
- University College London Behavioural Science and Health, Institute of Epidemiology & Health, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Kwee Yong
- University College London Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
| | - Abigail Fisher
- University College London Behavioural Science and Health, Institute of Epidemiology & Health, 1-19 Torrington Place, London, WC1E 6BT, UK
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Grimmett C, Bradbury K, Dalton SO, Fecher-Jones I, Hoedjes M, Varkonyi-Sepp J, Short CE. The Role of Behavioral Science in Personalized Multimodal Prehabilitation in Cancer. Front Psychol 2021; 12:634223. [PMID: 33664701 PMCID: PMC7921482 DOI: 10.3389/fpsyg.2021.634223] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
Multimodal prehabilitation is increasingly recognized as an important component of the pre-operative pathway in oncology. It aims to optimize physical and psychological health through delivery of a series of tailored interventions including exercise, nutrition, and psychological support. At the core of this prescription is a need for considerable health behavior change, to ensure that patients are engaged with and adhere to these interventions and experience the associated benefits. To date the prehabilitation literature has focused on testing the efficacy of devised exercise and nutritional interventions with a primary focus on physiological and mechanistic outcomes with little consideration for the role of behavioral science, supporting individual behavior change or optimizing patient engagement. Changing health behavior is complex and to maximize success, prehabilitation programs should draw on latest insights from the field of behavioral science. Behavioral science offers extensive knowledge on theories and models of health behavior change to further advance intervention effectiveness. Similarly, interventions developed with a person-centered approach, taking into consideration individual needs and preferences will increase engagement. In this article, we will provide an overview of the extent to which the existing prehabilitation literature incorporates behavioral science, as well as studies that have explored patient's attitudes toward prehabilitation. We will go on to describe and critique ongoing trials in a variety of contexts within oncology prehabilitation and discuss how current scientific knowledge may be enhanced from a behavioral science perspective. We will also consider the role of “surgery schools” and detail practical recommendations that can be embedded in existing or emerging clinical settings.
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Affiliation(s)
- Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Suzanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Services, Zealand University Hospital, Næstved, Denmark
| | - Imogen Fecher-Jones
- Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Meeke Hoedjes
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, Netherlands
| | - Judit Varkonyi-Sepp
- NIHR Southampton Biomedical Research Center, University Hospital Southampton, Southampton, United Kingdom
| | - Camille E Short
- Faculty of Medicine, Dentistry, and Health Sciences, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Abstract
Multiple myeloma is the second most common haematological malignancy in high-income countries, and typically starts as asymptomatic precursor conditions-either monoclonal gammopathy of undetermined significance or smouldering multiple myeloma-in which initiating genetic abnormalities, such as hyperdiploidy and translocations involving the immunoglobulin heavy chain, are already present. The introduction of immunomodulatory drugs, proteasome inhibitors, and CD38-targeting antibodies has extended survival, but ultimately the majority of patients will die from their disease, and some from treatment-related complications. Disease progression and subsequent relapses are characterised by subclonal evolution and increasingly resistant disease. Patients with multiple myeloma usually have hypercalcaemia, renal failure, anaemia, or osteolytic bone lesions-and a detailed diagnostic investigation is needed to differentiate between symptomatic multiple myeloma that requires treatment, and precursor states. Risk stratification using both patient-specific (eg, performance status) and disease-specific (eg, presence of high-risk cytogenetic abnormalities) is important for prognosis and to define the best treatment strategy. Current research strategies include the use of minimal residual disease assays to guide therapy, refining immunotherapeutic approaches, and intercepting disease early in smouldering multiple myeloma.
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Affiliation(s)
- Niels W C J van de Donk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Charlotte Pawlyn
- The Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kwee L Yong
- University College London Cancer Institute, London, UK.
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