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Lally P, Kennedy F, Smith S, Beeken RJ, Buck C, Thomas C, Counsell N, Wyld L, Martin C, Williams S, Roberts A, Greenfield DM, Gath J, Potts HWW, Latimer N, Smith L, Fisher A. The feasibility and acceptability of an app-based intervention with brief behavioural support (APPROACH) to promote brisk walking in people diagnosed with breast, prostate and colorectal cancer in the UK. Cancer Med 2024; 13:e7124. [PMID: 38529687 DOI: 10.1002/cam4.7124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Increased moderate to vigorous physical activity (MVPA) can improve clinical and psychosocial outcomes for people living with and beyond cancer (LWBC). This study aimed to assess the feasibility and acceptability of trial procedures in a pilot randomised controlled trial (RCT) of a theory-driven app-based intervention with behavioural support focused on promoting brisk walking (a form of MVPA) in people LWBC (APPROACH). METHODS Participants diagnosed with breast, prostate or colorectal cancer were recruited from a single UK hospital site. Assessments at baseline and 3 months included online questionnaires, device-measured brisk walking (activPAL accelerometer) and self-reported weight and height. Participants were randomised to intervention or control (care as usual). The intervention comprised a non-cancer-specific app to promote brisk walking (National Health Service 'Active 10') augmented with print information about habit formation, a walking planner and two behavioural support telephone calls. Feasibility and acceptability of trial procedures were explored. Initial estimates for physical activity informed a power calculation for a phase III RCT. A preliminary health economics analysis was conducted. RESULTS Of those medically eligible, 369/577 (64%) were willing to answer further eligibility questions and 90/148 (61%) of those eligible were enrolled. Feasibility outcomes, including retention (97%), assessment completion rates (>86%) and app download rates in the intervention group (96%), suggest that the trial procedures are acceptable and that the intervention is feasible. The phase III RCT will require 472 participants to be randomised. As expected, the preliminary health economic analyses indicate a high level of uncertainty around the cost-effectiveness of the intervention. CONCLUSIONS This pilot study demonstrates that a large trial of the brisk walking intervention with behavioural support is both feasible and acceptable to people LWBC. The results support progression onto a confirmatory phase III trial to determine the efficacy and cost-effectiveness of the intervention.
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Affiliation(s)
- Phillippa Lally
- Department of Psychological Sciences, University of Surrey, Guildford, Surrey, UK
| | - Fiona Kennedy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Susan Smith
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Caroline Buck
- Department of Behavioural Science and Health, University College London, London, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nicholas Counsell
- Cancer Research UK & Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Sarah Williams
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anna Roberts
- Department of Behavioural Science and Health, University College London, London, UK
| | - Diana M Greenfield
- Sheffield Teaching Hospitals NHS FT, Weston Park Hospital, Sheffield, UK
| | - Jacqui Gath
- Independent Cancer Patients' Voice (ICPV), London, UK
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Nicholas Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lee Smith
- The Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, UK
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Smith S, Lally P, Steptoe A, Chavez-Ugalde Y, Beeken RJ, Fisher A. Prevalence of loneliness and associations with health behaviours and body mass index in 5835 people living with and beyond cancer: a cross-sectional study. BMC Public Health 2024; 24:635. [PMID: 38419011 PMCID: PMC10903019 DOI: 10.1186/s12889-024-17797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A cancer diagnosis and its treatment may be an especially isolating experience. Despite evidence that positive health behaviours can improve outcomes for people living with and beyond cancer (LWBC), no studies have examined associations between loneliness and different health behaviours in this population. This study aimed to describe the prevalence of loneliness in a large sample of UK adults LWBC and to explore whether loneliness was associated with multiple health behaviours. METHODS Participants were adults (aged ≥ 18 years) diagnosed with breast, prostate or colorectal cancer who completed the Health and Lifestyle After Cancer Survey. Loneliness was reported using the UCLA loneliness score, dichotomised into higher (≥ 6) versus lower (< 6) loneliness. Engagement in moderate-to-vigorous physical activity, dietary intake, smoking status, alcohol use, and self-reported height and weight were recorded. Behaviours were coded to reflect meeting or not meeting the World Cancer Research Fund recommendations for people LWBC. Logistic regression analyses explored associations between loneliness and health behaviours. Covariates were age, sex, ethnicity, education, marital status, living situation, cancer type, spread and treatment, time since treatment, time since diagnosis and number of comorbid conditions. Multiple imputation was used to account for missing data. RESULTS 5835 participants, mean age 67.4 (standard deviation = 11.8) years, completed the survey. 56% were female (n = 3266) and 44% (n = 2553) male, and 48% (n = 2786) were living with or beyond breast cancer, 32% (n = 1839) prostate, and 21% (n = 1210) colorectal. Of 5485 who completed the loneliness scale, 81% (n = 4423) of participants reported lower and 19% (n = 1035) higher loneliness. After adjustment for confounders, those reporting higher levels of loneliness had lower odds of meeting the WCRF recommendations for moderate-to-vigorous physical activity (Odds Ratio [OR] 0.78, 95% Confidence Internal [CI], 0.67, 0.97, p =.028), fruit and vegetable intake (OR 0.81, CI 0.67, 1.00, p =.046), and smoking (OR 0.62, 0.46, 0.84, p =.003). No association was observed between loneliness and the other dietary behaviours, alcohol, or body mass index. CONCLUSIONS Loneliness is relatively common in people LWBC and may represent an unmet need. People LWBC who experience higher levels of loneliness may need additional support to improve their health behaviours.
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Affiliation(s)
- Susan Smith
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Phillippa Lally
- Department of Psychological Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Yanaina Chavez-Ugalde
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, Box 285, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, LS2 9JT, Leeds, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK.
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Jones G, Bailey L, Beeken RJ, Brady S, Cooper C, Copeland RJ, Crosland S, Dawson S, Faires M, Gilbody S, Haynes H, Hill A, Hillison E, Horspool M, Lee E, Li J, Machaczek KK, Parrott S, Quirk H, Stubbs B, Tew GA, Traviss-Turner G, Turton E, Walker L, Walters S, Weich S, Wildbore E, Peckham E. Supporting physical activity through co-production in people with severe mental ill health (SPACES): protocol for a randomised controlled feasibility trial. Pilot Feasibility Stud 2024; 10:32. [PMID: 38368380 PMCID: PMC10873949 DOI: 10.1186/s40814-024-01460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Severe mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways. METHOD This is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation. DISCUSSION This study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention. TRIAL REGISTRATION ISRCTN: ISRCTN83877229. Registered on 09.09.2022.
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Affiliation(s)
- Gareth Jones
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK.
- Sport and Physical Activity Research Centre, Health and Wellbeing Department, Sheffield Hallam University, Sheffield, UK.
| | - Laura Bailey
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Samantha Brady
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Cindy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Robert J Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK
| | - Suzanne Crosland
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sam Dawson
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Matthew Faires
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Holly Haynes
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Andrew Hill
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Emily Hillison
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Michelle Horspool
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Ellen Lee
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Katarzyna K Machaczek
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Helen Quirk
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, WC2R 2LS, UK
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, YO31 7EX, UK
| | | | - Emily Turton
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Lauren Walker
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Ellie Wildbore
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Emily Peckham
- School of Medical and Health Sciences, Bangor University, Gwynedd, LL57 2DG, UK
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Smith S, Fisher A, Lally PJ, Croker HA, Roberts A, Conway RE, Beeken RJ. Perceiving a need for dietary change in adults living with and beyond cancer: A cross-sectional study. Cancer Med 2024; 13:e7073. [PMID: 38457197 PMCID: PMC10922024 DOI: 10.1002/cam4.7073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Many people living with and beyond cancer (LWBC) do not meet dietary recommendations. To implement a healthier diet, people LWBC must perceive a need to improve their diet. METHODS Participants included people diagnosed with breast, prostate or colorectal cancer in the UK. Two binary logistic regression models were conducted with perceived need for dietary change as the outcome (need to improve vs. no need). Predictor variables included demographic and clinical characteristics, receipt of dietary advice, and either body mass index (BMI) or adherence to seven relevant World Cancer Research Fund (WCRF) dietary recommendations. RESULTS The sample included 5835 responses. Only 31% perceived a need to improve their diet. Being younger (odds ratio [OR] 0.95, 95% confidence interval [CI] = 94-0.95), female (OR = 1.33, 95% CI = 1.15-1.53), not of white ethnicity (OR = 1.8, 95% CI = 1.48-2.27), not married/cohabiting (OR = 1.32, 95% CI = 1.16-1.52) and having received dietary advice (OR = 1.36, 95% CI = 1.43-1.86) was associated with an increased odds of perceiving a need to improve diet. This association was also seen for participants with two or more comorbidities (OR = 1.31, 95% CI = 1.09-1.57), those not meeting the recommendations for fruit and vegetables (OR = 0.47, 95% CI = 0.41-0.55), fat (OR = 0.67, 95% CI = 0.58-0.77), and sugar (OR = 0.86, 95% CI = 0.75-0.98) in the dietary components model and those who had a higher BMI (OR = 1.53, 95% CI = 1.32-1.77) in the BMI model. CONCLUSIONS Most of this sample of people LWBC did not perceive a need to improve their diet. More research is needed to understand the reasons for this and to target these reasons in dietary interventions.
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Affiliation(s)
- Susan Smith
- Department of Behavioural Science and Health, University College London, London, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, UK
| | - Phillippa J Lally
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Psychology, University of Surrey, Surrey, UK
| | - Helen A Croker
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anna Roberts
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rana E Conway
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Taylor C, Munro J, Goodman W, Russell S, Oliphant R, Beeken RJ, Hubbard G. Hernia Active Living Trial (HALT): an exercise intervention in people with a parastomal hernia or bulge. Br J Nurs 2023; 32:S4-S11. [PMID: 38060393 DOI: 10.12968/bjon.2023.32.22.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Parastomal hernias are a common consequence of stoma surgery and can occur in up to 50% of patients. They are mangaged either conservatively, through support hosiery, or surgically. A patient feasibility study called the Hernia Active Living Trial (HALT) was designed to examine if a clinical pilates-based exercise programme offers an alternative approach to managing a parastomal hernia or bulge. METHOD Adults with an ileostomy or colostomy who perceived they had a bulge around their stoma were included in the study. The intervention included up to 12 online sessions of an exercise booklet and videos with an exercise specialist. Interviews were conducted to explore participants' experiences of the intervention. The interview data were analysed systematically and thematically. Participants were also asked to complete patient diaries every week. RESULTS Twelve of the 13 participants who completed the intervention agreed to be interviewed. Following analysis, three main themes emerged including managing a hernia/bulge, benefits and barriers. Participants talked about the benefits of this programme including: reduction of the size of their hernia, increased abdominal control, body confidence and posture, as well as increased physical activity levels. The barriers described were generally overcome allowing participants to engage in what was perceived to be a positive and potentially life-changing experience. CONCLUSIONS A clinical pilates-based exercise programme for people with a parastomal hernia can bring both direct and indirect improvements to a patient's hernia management, sense of wellbeing and day-to-day life. Individuals with a hernia should be informed about the need for, and value of, exercise to strengthen core muscles, as part of their non-surgical options for self-management.
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Affiliation(s)
- Claire Taylor
- Macmillan Nurse Consultant in Colorectal Cancer, London North West University Healthcare NHS Trust and Visiting Lecturer, King's College, London
| | - Julie Munro
- Researcher, Department of Nursing & Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Inverness
| | - William Goodman
- Research Fellow, Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Sarah Russell
- Clinical Exercise Specialist, The Ostomy Studio, Wadhurst, East Sussex
| | - Raymond Oliphant
- Colorectal Consultant Surgeon, NHS Highland, Raigmore Hospital, Inverness
| | - Rebecca J Beeken
- Associate Professor of Behavioural Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Gill Hubbard
- Professor of Health Services Research, Department of Nursing & Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Inverness
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Lally P, Miller NE, Lawrence C, Beeken RJ, Fisher A. Associations of self-reported and device-assessed physical activity with fatigue, quality of life, and sleep quality in adults living with and beyond cancer. J Sport Health Sci 2023; 12:664-673. [PMID: 37172763 PMCID: PMC10658319 DOI: 10.1016/j.jshs.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/20/2023] [Accepted: 03/23/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Greater physical activity is associated with improved outcomes in people living with and beyond cancer. However, most studies in exercise oncology use self-reported measures of physical activity. Few have explored agreement between self-reported and device-based measures of physical activity in people living with and beyond cancer. This study aimed to describe physical activity in adults affected by cancer across self-reported and device-assessed activity, to explore levels of agreement between these measures in terms of their utility for categorizing participants as meeting/not meeting physical activity guidelines, and to explore whether meeting guidelines is associated with fatigue, quality of life, and sleep quality. METHODS A total of 1348 adults living with and beyond cancer from the Advancing Survivorship Cancer Outcomes Trial completed a survey assessing fatigue, quality of life, sleep quality, and physical activity. The Godin-Shephard Leisure-Time Physical Activity Questionnaire was used to calculate a Leisure Score Index (LSI) and an estimate of moderate-to-vigorous physical activity (MVPA). Average daily steps and weekly aerobic steps were derived from pedometers worn by participants. RESULTS The percentage of individuals meeting physical activity guidelines was 44.3% using LSI, 49.5% using MVPA, 10.8% using average daily steps, and 28.5% using weekly aerobic steps. Agreement (Cohen's κ) between self-reported and pedometer measures ranged from 0.13 (LSI vs. average daily steps) to 0.60 (LSI vs. MVPA). After adjusting for sociodemographic and health-related covariates, meeting activity guidelines using all measures was associated with not experiencing severe fatigue (odds ratios (ORs): 1.43-1.97). Meeting guidelines using MVPA was associated with no quality-of-life issues (OR = 1.53). Meeting guidelines using both self-reported measures were associated with good sleep quality (ORs: 1.33-1.40). CONCLUSION Less than half of all adults affected by cancer are meeting physical activity guidelines, regardless of measure. Meeting guidelines is associated with lower fatigue across all measures. Associations with quality of life and sleep differ depending on measure. Future research should consider the impact of physical activity measure on findings, and where possible, use multiple measures.
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Affiliation(s)
- Phillippa Lally
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Department of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Natalie Ella Miller
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Claire Lawrence
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Leeds Institute of Health Sciences, Leeds LS2 9NL, UK
| | - Abigail Fisher
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK.
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Buck C, Pini S, Lally P, Beeken RJ, Fisher A. The impact of the COVID-19 pandemic on the health behaviours of people living with and beyond breast, prostate, and colorectal cancer-a qualitative study. J Cancer Surviv 2023; 17:1488-1498. [PMID: 35854193 PMCID: PMC9296113 DOI: 10.1007/s11764-022-01234-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/07/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Positive health behaviours (sufficient exercise, healthy diet, limiting alcohol, and not smoking) can improve multiple outcomes after a cancer diagnosis. Observational studies suggest that health behaviours were negatively impacted for some but not all individuals living with and beyond cancer. The aim of this study was to qualitatively explore the impact of the pandemic on health behaviours of people in this population. METHODS Thirty participants were purposively sampled for characteristics including diagnostic group (breast, prostate, and colorectal cancers), gender, time since diagnosis, and age. Semi-structured interviews were conducted to discuss the impact of the pandemic on health behaviours. Thematic analysis and a secondary Ideal Types analysis were conducted. RESULTS Five themes covered changes in food, weight management, relationship to alcohol, and exercise. Five "types" were identified, representing orientations to health behaviours. The "gift of time" provided by the pandemic had an impact on health behaviours, with trends towards increases in drinking, eating unhealthy food, and exercising less. CONCLUSIONS The COVID-19 pandemic impacted engagement in positive health behaviours among participants in this study. Strict restrictions and changes in routines resulted in individuals adjusting how they managed their diet, alcohol intake, and exercise behaviours. The typology identified within this study helps to define how different orientation to health behaviours could underpin the responses of individual people LWBC. IMPLICATIONS FOR CANCER SURVIVORS Alongside providing an understanding of the experiences of people LWBC during the COVID-19 pandemic, the proposed typology suggests how, with further development, future health behaviour interventions in this group could be targeted based on individual orientations to health, rather than demographic or clinical variables.
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Affiliation(s)
- Caroline Buck
- UCL Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Simon Pini
- Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Phillippa Lally
- UCL Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Abigail Fisher
- UCL Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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Taylor KS, Beeken RJ, Fisher A, Lally P. Did the COVID-19 pandemic impact the dietary intake of individuals living with and beyond breast, prostate, and colorectal cancer and who were most likely to experience change? Support Care Cancer 2023; 31:585. [PMID: 37728860 PMCID: PMC10511549 DOI: 10.1007/s00520-023-08032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The present work investigated dietary changes amongst individuals living with and beyond cancer (LWBC) from before to during the pandemic. To identify those at greatest risk of unhealthy changes, it was further examined whether patterns varied by sociodemographic, health-related, and COVID-19-related characteristics. METHODS This longitudinal cohort study analysed data from 716 individuals LWBC participating in the Advancing Survivorship Cancer Outcomes Trial (ASCOT). Using data provided before and during the pandemic, changes in fruit and vegetable, snack, and alcohol intake were tested using mixed-effect regression models. RESULTS Fruit and vegetable (95%CI: - 0.30; - 0.04) and alcohol consumption (95%CI: - 1.25; - 0.31) decreased, whilst snacking increased (95%CI: 0.19; 0.53). Women and individuals with limited social contact were more likely to reduce fruit and vegetable intake during the pandemic. Women and individuals with poorer sleep quality, limited social contact, and shielding requirements and without higher education were more likely to increase snacking during the pandemic. Individuals with poorer sleep quality, poorer mental health, and regular social contact were more likely to decrease alcohol consumption during the pandemic. CONCLUSIONS Findings suggest decreased intake for fruit, vegetable, and alcohol consumption and increased snack intake in response to the pandemic amongst individuals LWBC. These changes appear to differ across various characteristics, suggesting the pandemic has not equally impacted everyone in this population. Findings highlight the need for targeted post-COVID strategies to support individuals LWBC most adversely affected by the pandemic, including women and socially isolated individuals. This encourages resources to be prioritised amongst these groups to prevent further negative impact of the pandemic. Whilst the findings are statistically significant, practically they appear less important. This is necessary to acknowledge when considering interventions and next steps.
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Affiliation(s)
- Katie S Taylor
- Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK
| | - Phillippa Lally
- Department of Psychology, University of Surrey, Guildford, GU2 7XH, UK
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Pini S, Goodman W, Raby E, McGinley C, Perez-Cornago A, Johnson F, Beeken RJ. Development and initial qualitative evaluation of a novel school-based nutrition intervention - COOKKIT (Cooking Kit for Kids). BMC Public Health 2023; 23:1742. [PMID: 37679667 PMCID: PMC10483801 DOI: 10.1186/s12889-023-16598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Excess weight and an unhealthy diet are risk factors for many cancers, and in high income countries, both are more prevalent among low income families. Dietary interventions targeting primary-school aged children (under 11) can improve healthy eating behaviours, but most are not designed to support the translation of skills learnt in the classroom to the home setting. This paper assessed attitudes and approaches to cooking and eating at home, and the potential to enhance engagement in healthy eating through the COOKKIT intervention. METHODS COOKKIT is an intervention to deliver weekly cooking classes and supportive materials for low-income families to maintain healthy eating at home. Preliminary qualitative interviews were conducted with teachers and parent-child dyads from a range of primary schools in the UK to explore attitudes, barriers and facilitators for healthy eating and inform the development of COOKKIT. Following implementation, ten children (8-9 y/o) participated in post-intervention focus groups, alongside interviews with teaching staff and parents. RESULTS Thematic analysis identified five themes under which to discuss the children's experience of food, cooking and the impact of COOKKIT: Involving children in planning and buying food for the family; Engaging children in preparing meals at home; Trying to eat healthy meals together in the midst of busy lives; Role-modelling; and Balancing practicalities, information and engagement when delivering cooking classes. CONCLUSIONS Results suggest COOKKIT provides engaging and easy to follow in-school resources for children and school staff with take-home kits facilitating continued engagement and reinforcing lessons learned in the home environment. Importantly, participants highlighted the combination of healthy eating information, applied practical skills and low costs could support families to continue following the COOKKIT advice beyond the intervention, suggesting further evaluation of COOKKIT is warranted.
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Affiliation(s)
- Simon Pini
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - William Goodman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elizabeth Raby
- Helen Hamlyn Centre for Design, Royal College of Art, London, UK
| | - Chris McGinley
- Helen Hamlyn Centre for Design, Royal College of Art, London, UK
| | - Aurora Perez-Cornago
- Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | | | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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10
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Munro J, Goodman W, Oliphant R, Russell S, Taylor C, Beeken RJ, Hubbard G. Hernia Active Living Trial (HALT): a feasibility study of a physical activity intervention for people with a bowel stoma who have a parastomal hernia/bulge. Pilot Feasibility Stud 2023; 9:111. [PMID: 37400863 DOI: 10.1186/s40814-023-01329-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/26/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Parastomal bulging/hernia is a common complication associated with a stoma. Strengthening of the abdominal muscles via exercise may be a useful self-management strategy. The aim of this feasibility work was to address uncertainties around testing a Pilates-based exercise intervention for people with parastomal bulging. METHODS An exercise intervention was developed and tested in a single-arm trial (n = 17 recruited via social media) followed by a feasibility randomised controlled trial RCT (n = 19 recruited from hospitals). Adults with an ileostomy or colostomy with a bulge or diagnosed hernia around their stoma were eligible. The intervention involved a booklet, videos, and up to 12 online sessions with an exercise specialist. Feasibility outcomes included intervention acceptability, fidelity, adherence, and retention. Acceptability of self-report measures for quality of life, self-efficacy, and physical activity were assessed based on missing data within surveys pre- and post-intervention. Interviews (n = 12) explored participants' qualitative experiences of the intervention. RESULTS Nineteen of 28 participants referred to the intervention completed the programme (67%) and received an average of 8 sessions, lasting a mean of 48 min. Sixteen participants completed follow-up measures (44% retention), with low levels of missing data across the different measures, apart from body image and work/social function quality of life subscales (50% and 56% missing, respectively). Themes from qualitative interviews related to the benefits of being involved, including behavioural and physical changes in addition to improved mental health. Identified barriers included time constraints and health issues. CONCLUSIONS The exercise intervention was feasible to deliver, acceptable to participants, and potentially helpful. Qualitative data suggests physical and psycholosical benefits. Strategies to improve retention need to be included in a future study. TRIAL REGISTRATION ISRCTN, ISRCTN15207595 . Registered on 11 July 2019.
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Affiliation(s)
- Julie Munro
- Department of Nursing & Midwifery, Centre for Health Sciences, University of the Highlands and Islands, Inverness, UK.
| | - William Goodman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Claire Taylor
- London North West University Healthcare NHS Trust & Visiting Lecturer, Chief Nursing Officer Macmillan Cancer saupport King's College, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gill Hubbard
- Department of Nursing & Midwifery, Centre for Health Sciences, University of the Highlands and Islands, Inverness, UK.
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11
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Kennedy F, Lally P, Miller NE, Conway RE, Roberts A, Croker H, Fisher A, Beeken RJ. Fatigue, quality of life and associations with adherence to the World Cancer Research Fund guidelines for health behaviours in 5835 adults living with and beyond breast, prostate and colorectal cancer in England: A cross-sectional study. Cancer Med 2023; 12:12705-12716. [PMID: 37021752 PMCID: PMC10278485 DOI: 10.1002/cam4.5899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Many individuals living with and beyond cancer (LWBC) have ongoing quality of life (QoL) issues, including fatigue. The World Cancer Research Fund (WCRF) provides health behaviour recommendations for people LWBC, and there is some evidence linking adherence to these with improved QoL. METHODS Adults LWBC (specifically breast, colorectal or prostate cancer) completed a survey covering health behaviours (diet, physical activity, alcohol consumption and smoking), fatigue (FACIT-Fatigue Scale, version 4) and a broad measure of QoL (EQ-5D-5L descriptive scale). Participants were categorised as meeting/not meeting WCRF recommendations, using the following cut-offs classified as meeting the guidelines: ≥150 min physical activity/week, fruit and vegetables (≥5 portions/day), fibre (≥30 g fibre per day), free sugar (<5% of total calories from free sugar), fat (<33% total energy), red meat (<500 g/week), processed meat (none), alcohol consumption (<14 units/week) and not a current smoker. Logistic regression analyses explored associations between WCRF adherence and fatigue and QoL issues, controlling for demographic and clinical variables. RESULTS Among 5835 individuals LWBC (mean age: 67 years, 56% female, 90% white, breast 48%, prostate 32% and colorectal 21%), 22% had severe fatigue and 72% had 1+ issue/s on the EQ-5D-5L. Adhering to physical activity recommendations (odds ratio [OR] = 0.88, confidence interval [CI] = 0.77-0.99), meeting various dietary recommendations (fruit and vegetables OR = 0.79; CI = 0.68-0.91, free sugar OR = 0.85; CI = 0.76-0.96, fat OR = 0.71; CI = 0.62-0.82, red meat OR = 0.65; CI = 0.50-0.85) and not smoking (OR = 0.53, CI = 0.41-0.67) were associated with decreased odds of experiencing severe fatigue. Adhering to physical activity guidelines (OR = 0.71, CI = 0.62-0.82) was also associated with decreased odds of having 1+ QoL issue/s. CONCLUSIONS Adherence to various WCRF recommendations, particularly the recommendation for physical activity, was associated with less fatigue and better QoL in a large UK cohort of people living with and beyond breast, colorectal or prostate cancer. Multi-component interventions designed to support people LWBC to improve health behaviours, in line with the levels recommended by the WCRF, may also improve QoL.
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Affiliation(s)
- Fiona Kennedy
- Leeds Institute of Health Sciences, University of LeedsClarendon WayLeedsLS2 9NLUK
| | - Phillippa Lally
- Department of PsychologyUniversity of SurreyGuildfordSurreyGU2 7XHUK
| | - Natalie Ella Miller
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Rana E. Conway
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Anna Roberts
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Helen Croker
- World Cancer Research Fund International140 Pentonville RoadLondonN1 9FWUK
| | - Abigail Fisher
- Behavioural Science and HealthUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of LeedsClarendon WayLeedsLS2 9NLUK
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12
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Almatrafi A, Thomas O, Callister M, Gabe R, Beeken RJ, Neal R. The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis. J Med Screen 2023; 30:3-13. [PMID: 35942779 PMCID: PMC9925896 DOI: 10.1177/09691413221117685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comorbidity is associated with adverse outcomes for all lung cancer patients, but its burden is less understood in the context of screening. This review synthesises the prevalence of comorbidities among lung cancer screening (LCS) candidates and summarises the clinical recommendations for screening comorbid individuals. METHODS We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases from January 1990 to February 2021. We included LCS studies that reported a prevalence of comorbidity, as a prevalence of a particular condition, or as a summary score. We also summarised LCS clinical guidelines that addressed comorbidity or frailty for LCS as a secondary objective for this review. Meta-analysis was used with inverse-variance weights obtained from a random-effects model to estimate the prevalence of selected comorbidities. RESULTS We included 69 studies in the review; seven reported comorbidity summary scores, two reported performance status, 48 reported individual comorbidities, and 12 were clinical guideline papers. The meta-analysis of individual comorbidities resulted in an estimated prevalence of 35.2% for hypertension, 23.5% for history of chronic obstructive pulmonary disease (COPD) (10.7% for severe COPD), 16.6% for ischaemic heart disease (IHD), 13.1% for peripheral vascular disease (PVD), 12.9% for asthma, 12.5% for diabetes, 4.5% for bronchiectasis, 2.2% for stroke, and 0.5% for pulmonary fibrosis. CONCLUSIONS Comorbidities were highly prevalent in LCS populations and likely to be more prevalent than in other cancer screening programmes. Further research on the burden of comorbid disease and its impact on screening uptake and outcomes is needed. Identifying individuals with frailty and comorbidities who might not benefit from screening should become a priority in LCS research.
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Affiliation(s)
- Anas Almatrafi
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Epidemiology, Umm Al-Qura University, Makkah, Saudi Arabia,Anas Almatrafi, Leeds Institute of Health
Sciences, University of Leeds, Leeds LS2 9NL, UK.
| | - Owen Thomas
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK
| | - Matthew Callister
- Department of Respiratory Medicine, Leeds
Teaching Hospitals, St James's University Hospital, Leeds, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population
Health, Queen Mary University of
London, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Behavioural Science and
Health, University College London, London, UK
| | - Richard Neal
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,College of Medicine and Health, University of Exeter, Exeter, UK
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13
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Tew GA, Bailey L, Beeken RJ, Cooper C, Copeland R, Brady S, Heron P, Hill A, Lee E, Spanakis P, Stubbs B, Traviss-Turner G, Walker L, Walters S, Gilbody S, Peckham E. Physical Activity in Adults with Schizophrenia and Bipolar Disorder: A Large Cross-Sectional Survey Exploring Patterns, Preferences, Barriers, and Motivating Factors. Int J Environ Res Public Health 2023; 20:2548. [PMID: 36767931 PMCID: PMC9916302 DOI: 10.3390/ijerph20032548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Adults with severe mental ill health may have specific attitudes toward physical activity. To inform intervention development, we conducted a survey to assess the physical activity patterns, preferences, barriers, and motivations of adults with severe mental ill health living in the community. Data were summarised using descriptive statistics, and logistic regressions were used to explore relationships between physical activity status and participant characteristics. Five-hundred and twenty-nine participants (58% male, mean age 49.3 years) completed the survey. Large numbers were insufficiently active and excessively sedentary. Self-reported levels of physical activity below that recommended in national guidelines were associated with professional inactivity, consumption of fewer than five portions of fruit and vegetables per day, older age, and poor mental health. Participants indicated a preference for low-intensity activities and physical activity that they can do on their own, at their own time and pace, and close to home. The most commonly endorsed source of support was social support from family and friends. Common motivations included improving mental health, physical fitness, and energy levels. However, poor mental and physical health and being too tired were also common barriers. These findings can inform the development of physical activity interventions for this group of people.
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Affiliation(s)
- Garry A. Tew
- Institute for Health and Care Improvement, York St John University, York YO31 7EX, UK
| | - Laura Bailey
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | | | - Cindy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 3TU, UK
| | - Samantha Brady
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Paul Heron
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Andrew Hill
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Ellen Lee
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Panagiotis Spanakis
- Department of Health Sciences, University of York, York YO10 5DD, UK
- School of Psychology, Mediterranean College, 104 34 Athens, Greece
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
| | | | - Lauren Walker
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York YO10 5DD, UK
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14
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Heuchan GN, Lally PJ, Beeken RJ, Fisher A, Conway RE. Perception of a need to change weight in individuals living with and beyond breast, prostate and colorectal cancer: a cross-sectional survey. J Cancer Surviv 2023:10.1007/s11764-023-01333-0. [PMID: 36701100 DOI: 10.1007/s11764-023-01333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE People living with and beyond cancer (LWBC) are advised to achieve a body mass index (BMI) within the healthy range (≥ 18.5 and < 25). Not perceiving a need for weight change may be a barrier to achieving a healthy weight. This study aimed to explore factors associated with perceived need for weight change among people LWBC. METHODS Adults diagnosed with breast, prostate, or colorectal cancer were recruited through National Health Service sites in Essex and London. Participants (N = 5835) completed the 'Health and Lifestyle After Cancer' survey, which included a question on perceived need to change weight. Associations between perceived need for weight change and BMI, and perceived need for weight change and health and demographic variables, were analyzed using chi-square tests and logistic regression, respectively. RESULTS The proportion of participants perceiving a need to lose weight differed according to BMI category: healthy weight (23%), overweight (64%), obese (85%) (P < 0.001). Having overweight or obesity but not perceiving a need to lose weight was associated with being older, male, non-white, not married or cohabiting, and having cancer that had spread, no formal qualifications, no comorbidities, and having received chemotherapy. CONCLUSIONS Perceived need to lose weight is prevalent among people LWBC with obesity and overweight. This group may be interested in weight management support. Demographic and health factors were associated with having obesity or overweight but not perceiving a need to lose weight. IMPLICATIONS FOR CANCER SURVIVORS Weight loss interventions for people LWBC are needed. A subset of people LWBC with overweight and obesity may need additional information or motivators to engage with weight management.
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Affiliation(s)
- Gabriella N Heuchan
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa J Lally
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
- Department of Psychology, University of Surrey, Guildford, Surrey, GU2 7HX, UK
| | - Rebecca J Beeken
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rana E Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
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15
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Aronsen S, Conway R, Lally P, Roberts A, Croker H, Beeken RJ, Fisher A. Determinants of sleep quality in 5835 individuals living with and beyond breast, prostate, and colorectal cancer: a cross-sectional survey. J Cancer Surviv 2022; 16:1489-1501. [PMID: 34750779 DOI: 10.1007/s11764-021-01127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study aimed to quantify the level of sleep problems in 5835 breast, prostate, and colorectal cancer survivors, and explore a number of potential determinants of poor sleep quality in the present sample. BMI, diet, and physical activity were of particular interest as potential determinants. METHODS Participants who completed the 'Health and Lifestyle after Cancer' survey were adults who had been diagnosed with breast, prostate, or colorectal cancer (mean time since cancer diagnosis was 35.5 months, SD=13.56). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. BMI was calculated from self-reported height and weight. Participants were categorised as meeting/not meeting the World Cancer Research Fund (WCRF) recommendations for fibre, fruit and vegetables, added sugar, red meat, processed meat, fat, alcohol, and physical activity. Analyses accounted for demographic and clinical factors. RESULTS Fifty-seven percent of those with sleep data were classified as poor sleepers (response rate 79%). Being female, having a higher number of cancer treatments, more comorbid conditions, and being more anxious/depressed increased the odds of being a poor sleeper. After adjustment for these factors, there were no associations between diet/alcohol/physical activity and sleep. However, BMI was associated with sleep. Individuals in the overweight and obese categories had 22% and 79% higher odds of being poor sleepers than individuals in the underweight/healthy weight category, respectively. CONCLUSIONS The findings suggest that there may be a need to develop sleep quality interventions for cancer survivors with obesity. Even after adjustment for multiple clinical and demographic factors, BMI (particularly obesity) was associated with poor sleep. Thus, researchers and health professionals should find ways to support individuals with overweight and obesity to improve their sleep quality. IMPLICATIONS FOR CANCER SURVIVORS The present findings highlight that poor sleep is a common issue in cancer survivors. Interventions seeking to improve outcomes for cancer survivors over the longer term should consider sleep quality.
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Affiliation(s)
- Silje Aronsen
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Rana Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Anna Roberts
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Helen Croker
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
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16
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Gil N, Fisher A, Beeken RJ, Pini S, Miller N, Buck C, Lally P, Conway R. The role of partner support for health behaviours in people living with and beyond cancer: A qualitative study. Psychooncology 2022; 31:1997-2006. [PMID: 36097392 PMCID: PMC9828063 DOI: 10.1002/pon.6032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to qualitatively explore how partner support for health behaviours is perceived, received, and utilised in people living with and beyond cancer (LWBC). METHODS Semi-structured audio interviews were conducted with 24 participants, 15 men and nine women, living with and beyond breast, prostate, and colorectal cancer. Inductive and deductive Thematic Analysis was used to analyse the data. RESULTS Three key themes with six subthemes were identified relating to partner support for health behaviours: (1) Interdependence (Reciprocity, Overt Control, Influence & Motivation) (2) Concordance (Shared Attitudes & Health Beliefs, Shared Health Behaviour) and (3) Communal Coping (Communal Orientation towards Health and Decision Making, Co-operative Action in Health Behaviour). CONCLUSIONS Partner support plays a unique and significant role in the health behaviours of people LWBC. Partners play a collaborative role in managing health and facilitating health behaviours, while the high level of concordance in couples may represent a potential barrier to change via the reinforcement of maladaptive health beliefs and behaviours. IMPLICATIONS FOR CANCER SURVIVORS Overall, findings demonstrate that partners should be considered and included where possible when designing future behaviour change interventions for people LWBC.
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Affiliation(s)
- Natalie Gil
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Abigail Fisher
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Rebecca J. Beeken
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Simon Pini
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Natalie Miller
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Caroline Buck
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Phillippa Lally
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Rana Conway
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
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17
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Miller N, Conway R, Pini S, Buck C, Gil N, Lally P, Beeken RJ, Fisher A. Exploring the perceived impact of social support on the health behaviours of people living with and beyond cancer during the COVID-19 pandemic: a qualitative study. Support Care Cancer 2022; 30:8357-8366. [PMID: 35879472 PMCID: PMC9311339 DOI: 10.1007/s00520-022-07291-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Social support facilitated healthy behaviours in people living with and beyond cancer (LWBC) before the COVID-19 pandemic. Little is known about how social support impacted their health behaviours during the pandemic when social restrictions were imposed. The aim of this study was to qualitatively explore how social support was perceived to impact the health behaviours of people LWBC during the COVID-19 pandemic. METHODS Semi-structured interviews were conducted via telephone with 24 adults living with and beyond breast, prostate and colorectal cancer. Inductive and deductive framework analysis was used to analyse the data. RESULTS Five themes developed. These were (1) Companionship and accountability as motivators for physical activity, (2) Social influences on alcohol consumption, (3) Instrumental support in food practices, (4) Informational support as important for behaviour change and (5) Validation of health behaviours from immediate social networks. CONCLUSION This study described how companionship, social influence, instrumental support, informational support and validation were perceived to impact the health behaviours of people LWBC during the COVID-19 pandemic. Interventions for people LWBC could recommend co-participation in exercise with friends and family; promote the formation of collaborative implementation intentions with family to reduce alcohol consumption; and encourage supportive communication between partners about health behaviours. These interventions would be useful during pandemics and at other times. Government policies to help support clinically extremely vulnerable groups of people LWBC during pandemics should focus on providing access to healthier foods.
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Affiliation(s)
- Natalie Miller
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, Gower Street, London, UK.
| | - Rana Conway
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, Gower Street, London, UK
| | - Simon Pini
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Caroline Buck
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, Gower Street, London, UK
| | - Natalie Gil
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, Gower Street, London, UK
| | - Phillippa Lally
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, Gower Street, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, Gower Street, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Abigail Fisher
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, Gower Street, London, UK
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18
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Pallin ND, Beeken RJ, Jones KP, Woznitza N, Fisher A. A Survey of Therapeutic Radiographers' Knowledge, Practices, and Barriers in Delivering Health Behaviour Advice to Cancer Patients. J Cancer Educ 2022; 37:890-897. [PMID: 33063254 PMCID: PMC9399055 DOI: 10.1007/s13187-020-01896-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
Therapeutic radiographers (TRs) are well-placed to deliver advice to cancer patients; however, limited research exists on their practices in providing advice on healthy lifestyle behaviours. Through an online survey, this study aimed to explore TRs' current practices, barriers, and facilitators around delivering healthy behaviour advice to cancer patients. An online survey was sent to 72 radiotherapy departments in the UK and 583 TRs responded to the survey. Findings showed that levels of enquiry and provision of advice on healthy behaviours were low, with less than 25% advising patients on physical activity, healthy eating, weight management, smoking cessation, and reducing alcohol intake as standard practice. Lack of knowledge, resources, and training were identified as barriers, in addition to perceived lack of patient interest and lack of time. TRs reported a strong desire to undergo training to enable them to deliver health behaviour advice to patients, with an identified preference for online training. Cancer patients look to healthcare professionals for advice on health behaviours, and TRs are well-placed to deliver this advice. The findings of this study provide insight into the areas that need addressing to enable TRs to support positive health behaviours among cancer patients.
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Affiliation(s)
- Nickola D. Pallin
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Allied Health Sciences, School of Health and Social Care, London South Bank University, London, UK
| | - Rebecca J. Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Nick Woznitza
- Radiology Department, Homerton University Hospital, London, UK
| | - Abigail Fisher
- Department of Behavioural Science and Health, University College London, London, UK
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Land J, Hackett J, Sidhu G, Heinrich M, McCourt O, Yong KL, Fisher A, Beeken RJ. Myeloma patients’ experiences of a supervised physical activity programme: a qualitative study. Support Care Cancer 2022; 30:6273-6286. [PMID: 35467117 PMCID: PMC9035778 DOI: 10.1007/s00520-022-07062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/11/2022] [Indexed: 10/31/2022]
Abstract
Abstract
Purpose
The Myeloma: Advancing Survival Cancer Outcomes Trial (MASCOT) tested the impact of a supervised exercise programme on fatigue, clinical, and patient-reported outcomes in multiple myeloma [MM] patients. The current study explored MM patients’ experiences of the programme to guide future interventions.
Methods
Purposive sampling was used to recruit stable MM patients participating in MASCOT. Semi-structured, face-to-face interviews were conducted, transcribed verbatim, and analysed using thematic analysis.
Results
Six themes were identified. Key drivers for participation in MASCOT were “Altruism and extended cancer care”; participants wanted to give something back and assist in improving post-treatment care for MM patients, especially as after treatment “Barriers to being physically active” were a fear of damage and lack of health professional guidance. “Influences fostering change within the intervention” included physiotherapy supervision and tailored exercises, which gave participants confidence to push themselves in a safe environment and broke down misconceptions about their body. “Social support”, from both family and peers in the programme, promoted motivation and adherence. Participants expressed concerns about “Maintaining things going forward” but had identified mechanisms to aid continuation. “Physical and mental benefits” of the programme were highlighted; participants were able to do things they couldn’t before and described feeling free from the constraints of MM.
Conclusions
A post-treatment exercise intervention for MM patients was a positive experience, which enhanced participants’ physical and psychological wellbeing. Tailored gym and home-based exercises, a specialist cancer physiotherapist, and sustained support were perceived to be important for success.
Implications for cancer survivors
Exercise support for MM patients, ideally with physiotherapist supervision, should be incorporated into survivorship care to qualitatively improve patients’ quality of life, self-efficacy, and mental wellbeing.
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Jacob R, Tremblay A, Fildes A, Llewellyn C, Beeken RJ, Panahi S, Provencher V, Drapeau V. Validation of the Adult Eating Behaviour Questionnaire adapted for the French-speaking Canadian population. Eat Weight Disord 2022; 27:1163-1179. [PMID: 34185309 DOI: 10.1007/s40519-021-01229-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The Adult Eating Behaviour Questionnaire (AEBQ) is a newly developed questionnaire adapted from the widely used Child Eating Behaviour Questionnaire. This questionnaire assesses four food approach scales, namely hunger, food responsiveness, emotional overeating (EOE) and enjoyment of food, and four food avoidance scales, namely satiety responsiveness (SR), emotional undereating (EUE), food fussiness and slowness in eating (SE). This study aimed to validate a French version of the AEBQ in controlled conditions among French-speaking adults from Quebec, Canada. METHODS The AEBQ was pre-tested through structured interviews with 30 individuals. Participants of the validation study (n = 197, aged 19-65 years) had their height and weight measured and completed the AEBQ, Three-Factor Eating Questionnaire (TFEQ) and Intuitive Eating Scale-2 to assess factorial structure, internal consistency and construct validity. Test-retest reliability over 2 weeks was assessed among 144 participants. RESULTS Confirmatory factor analysis indicated an excellent model fit (NNFI = 0.98, CFI = 0.98, RMSEA = 0.03, χ2/df = 1.17) and provided support for the use of the original 8-factor questionnaire. Internal consistency was adequate for most scales (Cronbach's alpha = 0.66-0.94) and moderate to excellent test-retest reliability was observed for all scales (ICC = 0.70-90). Women showed higher levels of EOE and SR, and individuals with overweight and obesity showed higher levels of EOE and lower levels of EUE and SE. Construct validity was also supported by expected correlations with disinhibition and susceptibility to hunger from the TFEQ and intuitive eating. CONCLUSION This study indicates that the French AEBQ is a valid and reliable tool to measure eating behaviours in the adult population of Quebec. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies. The data are cross-sectional, but all measurement were undertaken in controlled laboratory conditions and the study provided new information.
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Affiliation(s)
- Raphaëlle Jacob
- School of Nutrition, Laval University, Quebec, G1V 0A6, Canada.,Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, G1V 0A6, Quebec, Canada.,Quebec Heart and Lung Institute Research Center, Laval University, Quebec, G1V 4G5, Canada
| | - Angelo Tremblay
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, G1V 0A6, Quebec, Canada.,Quebec Heart and Lung Institute Research Center, Laval University, Quebec, G1V 4G5, Canada.,Department of Kinesiology, Faculty of Medicine, Laval University, Quebec, G1V 0A6, Canada
| | - Alison Fildes
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Clare Llewellyn
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Shirin Panahi
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, G1V 0A6, Quebec, Canada.,Quebec Heart and Lung Institute Research Center, Laval University, Quebec, G1V 4G5, Canada.,Department of Kinesiology, Faculty of Medicine, Laval University, Quebec, G1V 0A6, Canada.,Department of Physical Education, Faculty of Education, Laval University, QC, G1V 0A6, Québec, Canada
| | - Véronique Provencher
- School of Nutrition, Laval University, Quebec, G1V 0A6, Canada.,Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, G1V 0A6, Quebec, Canada
| | - Vicky Drapeau
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, G1V 0A6, Quebec, Canada. .,Quebec Heart and Lung Institute Research Center, Laval University, Quebec, G1V 4G5, Canada. .,Department of Physical Education, Faculty of Education, Laval University, QC, G1V 0A6, Québec, Canada.
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Conway RE, Rigler FV, Croker HA, Lally PJ, Beeken RJ, Fisher A. Dietary supplement use by individuals living with and beyond breast, prostate, and colorectal cancer: A cross-sectional survey. Cancer 2022; 128:1331-1338. [PMID: 34927236 DOI: 10.1002/cncr.34055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Dietary supplements (DSs) are not recommended for the prevention of cancer recurrence. Although DS use is common in individuals living with and beyond cancer, its associations with beliefs about reduced cancer recurrence risk and demographic and health behaviors are unclear. METHODS Adults (18 years old or older) who had been diagnosed with breast, prostate, or colorectal cancer were recruited through National Health Service sites in Essex and London. Participants completed a mailed survey and telephone or online 24-hour dietary recalls (MyFood24). Supplement use was collected during the dietary recalls. Associations between DS use and demographics, health behaviors, and beliefs about DSs and cancer were explored. RESULTS Nineteen percent of 1049 individuals believed that DSs were important for the reduction of cancer recurrence risk, and 40% of individuals reported DS use. DS use was positively associated with being female (odds ratio [OR], 2.48; confidence interval [CI], 1.72-3.56), meeting 5-a-day fruit and vegetable recommendations (OR, 1.36; CI, 1.02-1.82), and believing that DSs were important for reducing cancer recurrence risk (OR, 3.13; CI, 2.35-4.18). DS use was negatively associated with having obesity (OR, 0.58; CI, 0.38-0.87). The most commonly taken DSs overall were fish oils (taken by 13%). Calcium with or without vitamin D was the most common DS taken by individuals with breast cancer (15%). CONCLUSIONS DS use by individuals living with and beyond cancer is associated with demographic factors and health behaviors. A belief that DSs reduce the risk of cancer recurrence is common and positively associated with DS use. There is a need for health care professionals to provide advice about DS use and cancer recurrence risk.
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Affiliation(s)
- Rana E Conway
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Freyja V Rigler
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Helen A Croker
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Phillippa J Lally
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | | | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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23
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Hall LH, Thorneloe R, Rodriguez-Lopez R, Grice A, Thorat MA, Bradbury K, Kamble MW, Okoli GN, Powell D, Beeken RJ. Delivering brief physical activity interventions in primary care: a systematic review. Br J Gen Pract 2022; 72:e209-e216. [PMID: 34782318 PMCID: PMC8597771 DOI: 10.3399/bjgp.2021.0312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Physical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown. AIM To examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity. DESIGN AND SETTING A mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results. METHOD CINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model. RESULTS After screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%-100% and 0.6%-100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers - including a lack of time and training/guidelines - remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients' receptivity to advice. CONCLUSION PA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals' confidence in their delivery.
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Affiliation(s)
- Louise H Hall
- National Institute for Health Research (NIHR) in-practice fellow
| | - Rachael Thorneloe
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield
| | | | - Adam Grice
- National Institute for Health Research (NIHR) in-practice fellow
| | - Mangesh A Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Katherine Bradbury
- NIHR Southampton Biomedical Research Centre, NIHR Applied Research Collaboration Wessex, Southampton
| | | | - Grace N Okoli
- Institute of Population Health Sciences, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Daniel Powell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen
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24
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Hunot-Alexander C, Arellano-Gómez LP, Smith AD, Kaufer-Horwitz M, Vásquez-Garibay EM, Romero-Velarde E, Fildes A, Croker H, Llewellyn CH, Beeken RJ. Examining the validity and consistency of the Adult Eating Behaviour Questionnaire-Español (AEBQ-Esp) and its relationship to BMI in a Mexican population. Eat Weight Disord 2022; 27:651-663. [PMID: 33966254 PMCID: PMC8933343 DOI: 10.1007/s40519-021-01201-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Appetitive traits in adults and their associations with weight can be measured using the Adult Eating Behaviour Questionnaire (AEBQ). The aim of this study was to confirm the factor structure of the Spanish AEBQ (AEBQ-Esp) in a Mexican sample and explore associations between the eight traits with body mass index (BMI). METHOD A sample of 1023 adults, mean age of 36.8 ± 12.8 years, was recruited from Guadalajara, Mexico. Researchers weighed and measured participants, and they completed the AEBQ-Esp either online or in paper format and reported sociodemographic data. To test two alternative factor structures (eight factors including Hunger; seven factors excluding Hunger), confirmatory factor analysis (CFA) was used. Internal reliability was assessed using Cronbach's alpha; test-retest reliability was assessed using intra-class correlation coefficients. Multivariate linear regressions were used to test for associations between the AEBQ subscales and BMI, adjusted for age, sex, format of AEBQ responses, education, marital and employment status. RESULTS A seven-factor structure was the best model fit using CFA, excluding the Hunger subscale but similar to the original AEBQ. Internal reliability was good for all subscales (Cronbach's α = 0.70-0.86), and the intra-class correlation coefficient (0.70-0.91) reflected good test-retest reliability. In the fully adjusted models, Satiety Responsiveness [β = - 0.61; (- 1.01, - 0.21)] and Slowness in Eating [β = - 0.70; (- 1.01, - 0.39)] were negatively associated with BMI, and Emotional Over-Eating [β = 0.94; (0.62, 1.27)] was positively associated with BMI. CONCLUSIONS The AEBQ-Esp (excluding Hunger) appears to be a valid and reliable psychometric questionnaire for measuring appetitive traits in a Mexican Spanish-speaking population. Some traits appear to be associated with BMI in adulthood and warrant further exploration. LEVEL OF EVIDENCE Level III evidence obtained from well-designed cohort or case-control analytic studies. Although this was just an observational study, it was well designed and provided new evidence.
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Affiliation(s)
- Claudia Hunot-Alexander
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Edificio anexo al Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", 3ª piso ala norte. Salvador Quevedo y Zubieta No. 750, C.P. 44340, Guadalajara, Jalisco, Mexico
| | - Laura Patricia Arellano-Gómez
- Licenciatura en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud (DPES), Instituto Tecnológico de Estudios Superiores de Occidente (ITESO), Periférico Sur Manuel Gómez Morín #8585, C.P. 45604, Tlaquepaque, Jalisco, Mexico
| | - Andrea D Smith
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Martha Kaufer-Horwitz
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, C.P.14080, Ciudad de México, Mexico
| | - Edgar M Vásquez-Garibay
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Edificio anexo al Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", 3ª piso ala norte. Salvador Quevedo y Zubieta No. 750, C.P. 44340, Guadalajara, Jalisco, Mexico
| | - Enrique Romero-Velarde
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Edificio anexo al Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", 3ª piso ala norte. Salvador Quevedo y Zubieta No. 750, C.P. 44340, Guadalajara, Jalisco, Mexico
| | - Alison Fildes
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Clare H Llewellyn
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK.
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Goodman W, Downing A, Allsop M, Munro J, Taylor C, Hubbard G, Beeken RJ. Quality of life profiles and their association with clinical and demographic characteristics and physical activity in people with a stoma: a latent profile analysis. Qual Life Res 2022; 31:2435-2444. [PMID: 35217962 PMCID: PMC9250477 DOI: 10.1007/s11136-022-03102-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/03/2022]
Abstract
Purpose Quality of life can be negatively impacted by the formation of a stoma and is influenced by a number of factors. Research to date treats people with a stoma as a homogenous group based on their quality of life. We attempted to identify subgroups based upon self-reported quality of life and explored variables associated with group membership. Methods The present study is a secondary analysis of a cross-sectional sample of 1419 people with a stoma. Participants completed validated questionnaires for quality of life, physical activity and clinical and demographic characteristics. Latent profile analysis was used to identify the optimal number of subgroups (profiles) and multinomial regression modelling was conducted to identify variables associated with profile membership. Results The analysis revealed 4 distinct profiles of people with a stoma: ‘consistently good quality of life’ [N = 891 (62.8%)], ‘some quality of life concerns’ [N = 184 (13.0%)], ‘low quality of life’ [N = 181 (12.8%)] and ‘financial concerns’ [N = 163 (11.5%)]. Modelling revealed that people with a recent stoma (formed < 2 years previously), who have a hernia and are less physically active were more likely to belong to the ‘low quality of life’ profile. Furthermore, those aged 16–55 were more likely to have financial concerns. Conclusion This study was the first to identify latent profiles within this population and assess whether certain variables are associated with membership. Future research should build upon this to identify additional variables associated with these profiles, which can help to provide the basis for targeting and tailoring future interventions to specific subgroups of people with a stoma. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03102-5.
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Affiliation(s)
- William Goodman
- School of Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
| | - Amy Downing
- School of Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
| | - Matthew Allsop
- School of Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
| | - Julie Munro
- Department of Nursing, University of the Highlands and Islands, 12b Ness Walk, Inverness, IV3 5SQ, UK
| | - Claire Taylor
- London North West Healthcare NHS Trust, Watford Road, Harrow, HA1 3UJ, UK
| | - Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, 12b Ness Walk, Inverness, IV3 5SQ, UK
| | - Rebecca J Beeken
- School of Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK.
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
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Derbyshire AE, MacKintosh ML, Pritchard CM, Pontula A, Ammori BJ, Syed AA, Beeken RJ, Crosbie EJ. Women's Risk Perceptions and Willingness to Engage in Risk-Reducing Interventions for the Prevention of Obesity-Related Endometrial Cancer. Int J Womens Health 2022; 14:57-66. [PMID: 35115844 PMCID: PMC8806047 DOI: 10.2147/ijwh.s326417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/19/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Endometrial cancer rates are rising in parallel with the global obesity epidemic. Our aim was to assess the willingness of women at greatest risk of obesity-related endometrial cancer to engage with risk-reducing strategies and establish perceived barriers that may preclude their participation in a randomized controlled trial of primary endometrial cancer prevention. Materials and Methods Women attending gynecology, obesity and sleep apnea clinics in Manchester Academic Health Sciences Centre-affiliated hospitals with obesity classes II (BMI 35–39.9kg/m2) and III (BMI ≥40kg/m2) were invited to participate in a cross-sectional survey. We asked women about their perceived risk, knowledge of risk factors and willingness to engage with endometrial cancer risk-reducing interventions. Results Seventy-four women with a median age of 51 years (range 22–73) and BMI of 47kg/m2 (range 34–81) took part in the study. Two-thirds (65.6%) knew that obesity was a risk factor for endometrial cancer but few were able to recall other major risk factors. Just over half (53.5%) perceived their risk of developing endometrial cancer to be higher than average. Women were prepared to lose weight (94%), eat healthily (91%), exercise more (87%), take a pill every day (74%) or receive an intra-uterine device (49%) for primary endometrial cancer prevention. Perceived barriers included cost, forgetting, willpower, finding time, physical fitness, social anxiety, possible side effects and previous bad experiences. Conclusion Women at highest risk of obesity-related endometrial cancer may not always appreciate their susceptibility. However, willingness to engage in risk-reducing strategies suggests recruitment to a randomized controlled trial for primary endometrial cancer prevention could be feasible.
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Affiliation(s)
- Abigail E Derbyshire
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle L MacKintosh
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christina M Pritchard
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Arya Pontula
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Basil J Ammori
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Akheel A Syed
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.,Department of Obesity Medicine, Diabetes & Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Emma J Crosbie
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
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Pallin ND, Webb J, Brown L, Woznitza N, Stewart-Lord A, Charlesworth L, Beeken RJ, Fisher A. Online training resources to aid therapeutic radiographers in engaging in conversations about physical activity and diet: A mixed methods study. Radiography (Lond) 2022; 28:124-132. [PMID: 34583887 DOI: 10.1016/j.radi.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This study explored changes in therapeutic radiographers' (TRs) self-reported knowledge and skills to engage in conversations about physical activity and diet with people living with and beyond cancer following completion of publicly available online courses. METHODS Participants were randomly assigned to two of five online courses that aim to support health professionals to engage in conversations about physical activity and diet in the oncology setting. Participants rated their agreement with 18 statements related to the COM-B (capability, opportunity and motivation-behaviour) model components following completion of an online course on healthy diet (n = 16) and physical activity (n = 21). Semi-structured telephone interviews (n = 21) were also conducted. Analysis of the interviews was guided by the Theoretical Domains Framework. RESULTS Overall, the online courses were acceptable and the TRs in this study self-reported improved COM to deliver advice on physical activity and diet. The inclusion of the evidence and scientific rationale on the benefits of diet and physical activity, and also guidance on how to start conversations with patients were highlighted as important features of the courses. Suggestions for adaptations to the nutrition courses included the need for content that accounts for the side effects cancer patients experience while undergoing treatment. To support the implementation of training and the delivery of advice on these topics, multi-disciplinary working, organisational support and guidance around professional role boundaries were highlighted as important. CONCLUSION Current publicly available online courses on physical activity and diet for oncology health professionals can reduce some barriers among TRs to providing advice to those living with and beyond cancer. IMPLICATIONS FOR PRACTICE Existing online training courses could be used to support TRs to deliver physical activity and dietary advice in practice. Findings show that these courses can be disseminated within radiotherapy departments. The results also highlight a number of important considerations for the implementation of brief health behaviour advice and online training interventions on physical activity and diet within cancer care.
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Affiliation(s)
- N D Pallin
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland; School of Health and Social Care, London South Bank University, London, UK.
| | - J Webb
- Centre for Primary Health and Social Care, School of Social Professions, London Metropolitan University, London, UK.
| | - L Brown
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - N Woznitza
- Radiology, Homerton University Hospital NHS Foundation Trust, London, UK.
| | - A Stewart-Lord
- School of Health and Social Care, London South Bank University, London, UK.
| | - L Charlesworth
- School of Health and Social Care, University of Lincoln, Lincoln, UK.
| | - R J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Behavioural Science & Health, University College London, London, UK.
| | - A Fisher
- Department of Behavioural Science & Health, University College London, London, UK.
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28
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Cohen TR, Kakinami L, Plourde H, Hunot-Alexander C, Beeken RJ. Concurrent Validity of the Adult Eating Behavior Questionnaire in a Canadian Sample. Front Psychol 2021; 12:779041. [PMID: 34925181 PMCID: PMC8675385 DOI: 10.3389/fpsyg.2021.779041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
The current study aimed to test the factor structure of the Adult Eating Behavior Questionnaire (AEBQ), its construct validity against the Three-Factor Eating Questionnaire (TFEQ-R18) and its associations with body mass index (BMI) in Canadian adults (n = 534, 76% female). Confirmatory factor analysis (CFA) revealed that a seven-factor AEBQ model, with the Hunger subscale removed, had better fit statistics than the original eight-factor structure. Cronbach's alpha was used to assess the internal reliability of each subscale and resulted with α > 0.70 for all subscales except for Hunger (α = 0.68). Pearson's correlations were used to inform the convergent and discriminant validation of AEBQ against the TFEQ-R18 and to examine the relationship between AEBQ and BMI. All AEBQ Food Approach subscales positively correlated with that of the TFEQ-R18 Emotional Eating and Uncontrolled Eating subscales. Similarly, BMI correlated positively with Food Approach subscales (except Hunger) and negatively with Food Avoidance subscales (except Food Fussiness). These results support the use of a seven-factor AEBQ for adults self-reporting eating behaviors, construct validity of the AEBQ against TFEB-R18, and provide further evidence for the association of these traits with BMI.
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Affiliation(s)
- Tamara R. Cohen
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Lisa Kakinami
- PERFORM Centre, Concordia University, Montreal, QC, Canada
- Department of Mathematics and Statistics, Concordia University, Montreal, QC, Canada
| | - Hugues Plourde
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Claudia Hunot-Alexander
- Instituto de Nutrición Humana, Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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29
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Goodman W, Allsop M, Downing A, Munro J, Taylor C, Hubbard G, Beeken RJ. A systematic review and meta-analysis of the effectiveness of self-management interventions in people with a stoma. J Adv Nurs 2021; 78:722-738. [PMID: 34708416 DOI: 10.1111/jan.15085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/20/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022]
Abstract
AIMS Explore the evidence from randomized controlled trials for the effect of self-management interventions on quality of life, self-management skills and self-efficacy, and to explore which intervention characteristics are associated with effectiveness. DESIGN Systematic review. DATA SOURCES A search of the literature was conducted in these databases: MEDLINE (OVID), EMBASE (OVID) and PsychINFO (OVID) from January 2000 to February 2020. REVIEW METHODS Studies were included if participants had a bowel stoma, were over the age of 18 and the design was a randomized controlled trial of a self-management programme. The outcome measures for this review were quality of life, self-management skills and self-efficacy. The Behaviour Change Technique Taxonomy was used to code interventions for underlying components and alongside other intervention characteristics, associations with improvements in outcomes were explored. RESULTS The search identified 3141 articles, 16 of which were eligible. A meta-analysis of self-efficacy scores from five studies (N = 536) found an improvement in those that received the self-management intervention at follow-up with a 12-point mean difference compared with the usual care group. Effects on quality of life and self-management skills were mixed, and meta-analyses of these data were not possible. Across 13 studies an average of 10 behaviour change techniques were used with, credible source (e.g. nurse, doctor, therapist) (n = 13), instruction on how to perform the behaviour (n = 13), demonstration of the behaviour (n = 12) used most often. The behaviour change technique of self-monitoring was associated with an improvement in quality of life. The involvement of a nurse was associated with higher self-efficacy and self-management skills. CONCLUSION This review suggests that self-management interventions can increase peoples' self-efficacy for managing their stoma. IMPACT A standardized approach to the reporting of interventions and the measures used is needed in future studies to better understand the effect on quality of life and self-management skills.
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Affiliation(s)
| | | | - Amy Downing
- School of Medicine, University of Leeds, Leeds, UK
| | - Julie Munro
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | | | - Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Rebecca J Beeken
- School of Medicine, University of Leeds, Leeds, UK.,Research Department of Behavioural Science and Health, University College London, London, UK
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30
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Beeken RJ, Leurent B, Vickerstaff V, Wilson R, Croker H, Morris S, Omar RZ, Nazareth I, Wardle J. Correction to: A brief intervention for weight control based on habit-formation theory delivered through primary care: results from a randomised controlled trial. Int J Obes (Lond) 2021; 45:2137-2138. [PMID: 34099843 PMCID: PMC8380537 DOI: 10.1038/s41366-021-00862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R J Beeken
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - B Leurent
- Department of Primary Care and Population Health, University College London, London, UK
| | - V Vickerstaff
- Department of Primary Care and Population Health, University College London, London, UK
| | - R Wilson
- Department of Epidemiology and Public Health, University College London, London, UK
| | - H Croker
- Department of Epidemiology and Public Health, University College London, London, UK
| | - S Morris
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R Z Omar
- Department of Statistical Science, University College London, London, UK
| | - I Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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31
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Soni A, Beeken RJ, McGowan L, Lawson V, Chadwick P, Croker H. 'Shape-Up', a Modified Cognitive-Behavioural Community Programme for Weight Management: Real-World Evaluation as an Approach for Delivering Public Health Goals. Nutrients 2021; 13:2807. [PMID: 34444967 PMCID: PMC8402118 DOI: 10.3390/nu13082807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
Abstract
Obesity is widespread, with serious health consequences; addressing it requires considerable effort at a public health level, incorporating prevention and management along with policies to support implementation. Behavioural weight-management programmes are widely used by public health bodies to address overweight and obesity. Shape-Up is an evidence-based programme combining a structured behavioural intervention (targeting nutrition and physical activity behaviours) within a peer-learning framework. This study was a service-evaluation of Shape-Up, as delivered in Rotherham by a local leisure provider, and included a secondary analysis of data collected in the community by service providers. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to explore programme effectiveness, implementation, and whom it reached. A total of 141 participants were included. Compared to local demographics, participants were older, at 48.9 (SD 14.47) years, with a lower employment rate (41% employed) and greater proportion female (67% female). Mean BMI was 38.0 (SD 7.54) kg/m2. Mean weight-change between baseline and endpoint (12 weeks, 10 group sessions) was -4.4 (SD 3.38) kg, and degree of weight change was associated with session attendance (F (9, 131) = 6.356, p < 0.0005). There were positive effects on participants' weight, health-related behaviours, and quality of life. The intervention content (including the focus of nutritional recommendations) and structure were adapted during implementation to better suit national guidelines and local population needs. RE-AIM was found to be a useful framework for evaluating and adapting an existing evidence-based weight management programme in line with local population needs. This could be a more cost-effective approach, compared to developing new programmes, for delivering public health goals relating to obesity, nutrition, and physical activity.
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Affiliation(s)
- Amber Soni
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK;
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK;
| | - Laura McGowan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast BT9 7BL, UK;
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT9 5DL, UK
| | - Victoria Lawson
- Talking Therapies Southwark, Maudsley Hospital, London SE5 8AZ, UK;
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London WC1E 6BT, UK;
| | - Helen Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
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32
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Lally P, Beeken RJ, Wilson R, Omar R, Hunter R, Fovargue S, Anderson D, King M, Hassiotis A, Croker H. A manualised weight management programme for adults with mild-moderate intellectual disabilities affected by excess weight: A randomised controlled feasibility trial (Shape Up-LD). J Appl Res Intellect Disabil 2021; 35:112-122. [PMID: 34297441 DOI: 10.1111/jar.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim was to pilot an adapted manualised weight management programme for persons with mild-moderate intellectual disabilities affected by overweight or obesity ('Shape Up-LD'). METHOD Adults with intellectual disabilities were enrolled in a 6-month trial (3-month active intervention and 3-month follow-up) and were individually randomised to Shape Up-LD or a usual care control. Feasibility outcomes included recruitment, retention, initial effectiveness and cost. RESULTS Fifty people were enrolled. Follow-up rates were 78% at 3 months and 74% at 6 months. At 3 and 6 months, controlling for baseline weight, no difference was observed between groups (3 months: β: -0.34, 95% confidence interval [CI]: -2.38, 1.69, 6 months: β: -0.55, 95%CI -4.34, 3.24). CONCLUSION It may be possible to carry out a trial of Shape Up-LD, although barriers to recruitment, carer engagement and questionnaire completion need to be addressed, alongside refinements to the intervention.
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Affiliation(s)
- Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK.,Leeds Institute of Health Sciences, London, UK
| | - Rose Wilson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care & Population Health, University College London, London, UK.,Priment Clinical Trials Unit, London, UK
| | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, UK
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33
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Gardner B, Richards R, Lally P, Rebar A, Thwaite T, Beeken RJ. Breaking habits or breaking habitual behaviours? Old habits as a neglected factor in weight loss maintenance. Appetite 2021; 162:105183. [PMID: 33651994 DOI: 10.1016/j.appet.2021.105183] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Maintaining weight loss requires long-term behaviour change. Theory and evidence around habitual behaviour - i.e., action triggered by impulses that are automatically activated upon exposure to cues, due to learned cue-action associations - can aid development of interventions to support weight loss maintenance. Specifically, weight loss is more likely to be sustained where people develop new habits that support weight management, and break old habits that may undermine such efforts. Interventions seeking to break 'bad' weight-related habits have focused on inhibiting unwanted impulses or avoiding cues. This paper draws attention to the possibility that while such approaches may discontinue habitual behaviour, underlying habit associations may remain. We use evidence from existing qualitative studies to demonstrate that, left unchecked, unwanted habit associations can render people prone to lapsing into old patterns of unhealthy behaviours when motivation or willpower is momentarily weakened, or when returning to familiar settings following temporarily discontinued exposure. We highlight six behaviour change techniques especially suited to disrupting habit associations, but show that these techniques have been underused in weight loss maintenance interventions to date. We call for intervention developers and practitioners to adopt techniques conducive to forming new habit associations to directly override old habits, and to use the persistence of unwanted habit associations as a potential indicator of long-term weight loss intervention effectiveness.
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Affiliation(s)
| | | | - Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Amanda Rebar
- School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Tanya Thwaite
- School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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34
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Beeken RJ, Scott AM, Sims R, Cleo G, Clifford H, Glasziou P, Thomas R. A Community Jury on initiating weight management conversations in primary care. Health Expect 2021; 24:1450-1458. [PMID: 34153150 PMCID: PMC8369079 DOI: 10.1111/hex.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/27/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Current guidelines recommend that patients attending general practice should be screened for excess weight, and provided with weight management advice. Objective This study sought to elicit the views of people with overweight and obesity about the role of GPs in initiating conversations about weight management. Methods Participants with a body mass index ≥25 were recruited from a region in Australia to take part in a Community Jury. Over 2 days, participants (n = 11) deliberated on two interconnected questions: ‘Should GPs initiate discussions about weight management?’ And ‘if so, when: (a) opportunistically, (b) in the context of disease prevention, (c) in the context of disease management or (d) other?’ The jury deliberations were analysed qualitatively to elicit their views and recommendations. Results The jury concluded GPs should be discussing weight management, but within the broader context of general health. The jury were divided about the utility of screening. Jurors felt GPs should initiate the conversation if directly relevant for disease prevention or management, otherwise GPs should provide opportunities for patients to consent to the issue being raised. Conclusion The jury's verdict suggests informed people affected by overweight and obesity believe GPs should discuss weight management with their patients. GPs should feel reassured that discussions are likely to be welcomed by patients, particularly if embedded within a more holistic focus on person‐centred care. Public contribution Members of the public took part in the conduct of this study as jurors, but were not involved in the design, analysis or write‐up.
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Affiliation(s)
- Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anna M Scott
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Gina Cleo
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Helen Clifford
- Gold Coast Hospital and Health Service, Public Health Unit, Gold Coast, Qld, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
| | - Rae Thomas
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia
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35
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Kliemann N, Viallon V, Murphy N, Beeken RJ, Rothwell JA, Rinaldi S, Assi N, van Roekel EH, Schmidt JA, Borch KB, Agnoli C, Rosendahl AH, Sartor H, Huerta JM, Tjønneland A, Halkjær J, Bueno-de-Mesquita B, Gicquiau A, Achaintre D, Aleksandrova K, Schulze MB, Heath AK, Tsilidis KK, Masala G, Panico S, Kaaks R, Fortner RT, Van Guelpen B, Dossus L, Scalbert A, Keun HC, Travis RC, Jenab M, Johansson M, Ferrari P, Gunter MJ. Metabolic signatures of greater body size and their associations with risk of colorectal and endometrial cancers in the European Prospective Investigation into Cancer and Nutrition. BMC Med 2021; 19:101. [PMID: 33926456 PMCID: PMC8086283 DOI: 10.1186/s12916-021-01970-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/22/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The mechanisms underlying the obesity-cancer relationship are incompletely understood. This study aimed to characterise metabolic signatures of greater body size and to investigate their association with two obesity-related malignancies, endometrial and colorectal cancers, and with weight loss within the context of an intervention study. METHODS Targeted mass spectrometry metabolomics data from 4326 participants enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort and 17 individuals from a single-arm pilot weight loss intervention (Intercept) were used in this analysis. Metabolic signatures of body size were first determined in discovery (N = 3029) and replication (N = 1297) sets among EPIC participants by testing the associations between 129 metabolites and body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) using linear regression models followed by partial least squares analyses. Conditional logistic regression models assessed the associations between the metabolic signatures with endometrial (N = 635 cases and 648 controls) and colorectal (N = 423 cases and 423 controls) cancer risk using nested case-control studies in EPIC. Pearson correlation between changes in the metabolic signatures and weight loss was tested among Intercept participants. RESULTS After adjustment for multiple comparisons, greater BMI, WC, and WHR were associated with higher levels of valine, isoleucine, glutamate, PC aa C38:3, and PC aa C38:4 and with lower levels of asparagine, glutamine, glycine, serine, lysoPC C17:0, lysoPC C18:1, lysoPC C18:2, PC aa C42:0, PC ae C34:3, PC ae C40:5, and PC ae C42:5. The metabolic signature of BMI (OR1-sd 1.50, 95% CI 1.30-1.74), WC (OR1-sd 1.46, 95% CI 1.27-1.69), and WHR (OR1-sd 1.54, 95% CI 1.33-1.79) were each associated with endometrial cancer risk. Risk of colorectal cancer was positively associated with the metabolic signature of WHR (OR1-sd: 1.26, 95% CI 1.07-1.49). In the Intercept study, a positive correlation was observed between weight loss and changes in the metabolic signatures of BMI (r = 0.5, 95% CI 0.06-0.94, p = 0.03), WC (r = 0.5, 95% CI 0.05-0.94, p = 0.03), and WHR (r = 0.6, 95% CI 0.32-0.87, p = 0.01). CONCLUSIONS Obesity is associated with a distinct metabolic signature comprising changes in levels of specific amino acids and lipids which is positively associated with both colorectal and endometrial cancer and is potentially reversible following weight loss.
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Affiliation(s)
- Nathalie Kliemann
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Vivian Viallon
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Neil Murphy
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Joseph A Rothwell
- Health Across Generations team, Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Nada Assi
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kristin Benjaminsen Borch
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Claudia Agnoli
- Epidemiology and Prevention Unit. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ann H Rosendahl
- Clinical Sciences Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Hanna Sartor
- Diagnostic Radiology, Lund University, Lund, Sweden
| | - José María Huerta
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | | | - Jytte Halkjær
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Audrey Gicquiau
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - David Achaintre
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Krasimira Aleksandrova
- Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Matthias B Schulze
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Salvatore Panico
- Dipartimento di Medicin Clinica e Chirurgia, Frederico II Univeristy, Naples, Italy
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology, Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Laure Dossus
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Augustin Scalbert
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hector C Keun
- Cancer Metabolism and Systems Toxicology Group, Division of Cancer, Department of Surgery and Cancer, Imperial College, London, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mazda Jenab
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mattias Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Pietro Ferrari
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Marc J Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France.
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Grimmett C, Beeken RJ, Fisher A. Physical Activity and Exercise Interventions in Cancer Survivors. Psychooncology 2021. [DOI: 10.1093/med/9780190097653.003.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The field of exercise oncology has developed such that it is clear that people affected by cancer should be encouraged to be physically active from the point of diagnosis; indeed, this is now a key component of the survivorship care package in many countries. However, there are still gaps in the evidence. The majority of evidence for the benefits of exercise after cancer comes from breast, prostate, and colorectal cancer patients, usually without metastatic disease. Trials have usually been rated as low to moderate in quality, and although double-blinding will always be an issue in behavioral trials, there is a need to approach exercise studies with the rigor applied to drug trials if it is to be considered an adjuvant cancer therapy. Additionally, there are still gaps around the most appropriate types of exercise for specific cancer sites and how best to implement exercise as part of cancer care, balancing interventions that are likely to reach a large number of patients (e.g., remote, digital) versus those that may have greater benefit (e.g., supervised, face to face). Finally, while observational data are strongly supportive of higher self-reported postdiagnosis physical activity being associated with lower all-cause and cancer-specific mortality, and possibly recurrence, definitive trial data does not yet exist (although a number of trials are underway). Until survival data are generated, caution should be used in how the benefits of exercise are presented to cancer patients, with a focus on the large number of outcomes that have been robustly demonstrated to improve in response to intervention.
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Goodman W, Beeken RJ. Aggression as a Mediating Behavior in the Association Between Video Game Use and Body Mass Index-Reply. JAMA Pediatr 2020; 174:1219-1220. [PMID: 33136120 DOI: 10.1001/jamapediatrics.2020.2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Quaife SL, Ruparel M, Dickson JL, Beeken RJ, McEwen A, Baldwin DR, Bhowmik A, Navani N, Sennett K, Duffy SW, Waller J, Janes SM. Reply to Wilson: Improving Lung Cancer Screening Uptake. Am J Respir Crit Care Med 2020; 202:1193-1194. [PMID: 32525401 PMCID: PMC7560797 DOI: 10.1164/rccm.202005-1699le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samantha L. Quaife
- University College LondonLondon, United Kingdom
- Corresponding author (e-mail: )
| | | | | | - Rebecca J. Beeken
- University College LondonLondon, United Kingdom
- University of LeedsLeeds, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and TrainingDorchester, United Kingdom
| | | | | | - Neal Navani
- University College London HospitalLondon, United Kingdom
| | | | | | - Jo Waller
- University College LondonLondon, United Kingdom
- King’s College LondonLondon, United Kingdom
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Hubbard G, Beeken RJ, Taylor C, Oliphant R, Watson AJM, Munro J, Russell S, Goodman W. HALT (Hernia Active Living Trial): protocol for a feasibility study of a randomised controlled trial of a physical activity intervention to improve quality of life in people with bowel stoma with a bulge/parastomal hernia. Pilot Feasibility Stud 2020; 6:142. [PMID: 32983558 PMCID: PMC7517671 DOI: 10.1186/s40814-020-00674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Parastomal hernia (PSH) can be repaired surgically, but results to date have been disappointing, with reported recurrence rates of 30 to 76%. Other types of intervention are therefore needed to improve the quality of life of people with PSH. One potential intervention is physical activity. We hypothesise that the intervention will increase core activation and control across the abdominal wall at a site of potential weakness and thus reduce the risk of PSH progression. Increases in physical activity will improve body image and quality of life (QoL). METHODS Subjects and sampleThere were approximately 20 adults with a bowel stoma and PSH. People with previous PSH repair will be excluded as well as people who already do core training.Study designThis is a feasibility study of a randomised controlled trial with 2 months follow-up, in 2 sites using mixed methods. Stage 1 involves intervention development and in stage 2, intervention and trial parameters will be assessed.InterventionA theoretically informed physical activity intervention was done, targeting people with PSH.Main outcome of feasibility studyThe main outcome is the decision by an independent Study Steering Committee whether to proceed to a full randomised controlled trial of the intervention.Other outcomesWe will evaluate 4 intervention parameters-fidelity, adherence, acceptability and safety and 3 trial parameters (eligible patients' consent rate, acceptability of study design and data availability rates for following endpoints): I.Diagnosis and classification of PSHII.Muscle activationIII.Body composition (BMI, waist circumference)IV.Patient reported outcomes: QoL, body image and physical functioningV.Physical activity;VI.Psychological determinants of physical activityOther dataIncluded are other data such as interviews with all participants about the intervention and trial procedures.Data analysis and statistical powerAs this is a feasibility study, the quantitative data will be analysed using descriptive statistics. Audio-recorded qualitative data from interviews will be transcribed verbatim and analysed thematically. DISCUSSION The feasibility and acceptability of key intervention and trial parameters will be used to decide whether to proceed to a full trial of the intervention, which aims to improve body image, quality of life and PSH progression. TRIAL REGISTRATION ISRCTN15207595.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH UK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Claire Taylor
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, Middlesex, HA1 3UJ UK
| | - Raymond Oliphant
- Department of Surgery, Raigmore Hospital, NHS Highland, Old Perth Rd, Inverness, IV2 3UJ UK
| | - Angus J. M. Watson
- Department of Surgery, Raigmore Hospital, NHS Highland, Old Perth Rd, Inverness, IV2 3UJ UK
| | - Julie Munro
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH UK
| | | | - William Goodman
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
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Land J, McCourt O, Heinrich M, Beeken RJ, Koutoukidis DA, Paton B, Yong K, Hackshaw A, Fisher A. The adapted Zelen was a feasible design to trial exercise in myeloma survivors. J Clin Epidemiol 2020; 125:76-83. [PMID: 32289352 PMCID: PMC7482584 DOI: 10.1016/j.jclinepi.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 03/04/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We used a method rarely seen in cancer behavioral trials to explore methods of overcoming difficulties often seen in randomized controlled trials. We report our experiences of the adapted Zelen design, so that other researchers can consider this approach for behavioral trials. STUDY DESIGN AND SETTING The adapted Zelen design was used to explore the effects of exercise on multiple myeloma patients fatigue, quality of life, and physical outcomes. All participants consented to an observational cohort study of lifestyle factors but were unaware of subsequent randomization to remain in cohort only group or be offered an exercise intervention requiring second consent. RESULTS There was lower than expected uptake to the exercise offered group (57%), so the length of recruitment increased from 24 to 29 months to ensure power was reached. At enrollment, patients were unaware of the potential increased commitment, and as a result, 62% of participants allocated to the intervention declined because of the extra time/travel commitment required. This emulates clinical settings and suggests improvements in intervention delivery are required. Our findings suggest that the adapted Zelen design may be useful in limiting dropout of controls due to dissatisfaction from group allocation, or contamination of control arm. CONCLUSION Future use of this design warrants careful consideration of the study resources and recruitment time frames required but holds potential value in reducing contamination, control group dissatisfaction, and resulting dropout. Adapted Zelen design reduces selection bias and therefore gives clinicians a better understanding of acceptability in clinical settings. Future studies should evaluate control group experiences of the design and formally record contamination throughout the study to confirm its acceptability.
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Affiliation(s)
- Joanne Land
- Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK
| | - Orla McCourt
- Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK; Research Department of Haematology, Cancer Institute, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Malgorzata Heinrich
- Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Dimitrios A Koutoukidis
- Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bruce Paton
- Institute of Sport Exercise & Health, London, UK
| | - Kwee Yong
- Research Department of Haematology, Cancer Institute, University College London, London, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Abigail Fisher
- Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK.
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Pallin ND, Beeken RJ, Pritchard-Jones K, Charlesworth L, Woznitza N, Fisher A. Therapeutic radiographers' delivery of health behaviour change advice to those living with and beyond cancer: a qualitative study. BMJ Open 2020; 10:e039909. [PMID: 32788193 PMCID: PMC7422652 DOI: 10.1136/bmjopen-2020-039909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Therapeutic radiographers (TRs) are well placed to deliver health behaviour change advice to those living with and beyond cancer (LWBC). However, there is limited research on the opinions of TRs around delivering such advice to those LWBC. This study aimed to explore TRs' practices and facilitators in delivering advice on physical activity, healthy eating, alcohol intake, smoking and weight management. SETTING AND PARTICIPANTS Fifteen UK-based TRs took part in a telephone interview using a semi-structured interview guide. Data was analysed using the framework analysis method. RESULTS Emergent themes highlighted that TRs are mainly aware of the benefits of healthy behaviours in managing radiotherapy treatment related side effects, with advice provision lowest for healthy eating and physical activity. Participants identified themselves as well placed to deliver advice on improving behaviours to those LWBC, however reported a lack of knowledge as a limiting factor to doing so. The TRs reported training and knowledge as key facilitators to the delivery of advice, with a preference for online training. CONCLUSIONS There is a need for education resources, clear referral pathways and in particular training for TRs on delivering physical activity and healthy eating advice to those LWBC.
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Affiliation(s)
- Nickola D Pallin
- Behavioural Science and Health, University College London, London, UK
- Department of Allied Health Sciences, London South Bank University, London, UK
| | - Rebecca J Beeken
- Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Nick Woznitza
- Radiology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Abigail Fisher
- Behavioural Science and Health, University College London, London, UK
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Goodman W, Jackson SE, McFerran E, Purves R, Redpath I, Beeken RJ. Association of Video Game Use With Body Mass Index and Other Energy-Balance Behaviors in Children. JAMA Pediatr 2020; 174:563-572. [PMID: 32250384 PMCID: PMC7136857 DOI: 10.1001/jamapediatrics.2020.0202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/31/2019] [Indexed: 12/27/2022]
Abstract
Importance Childhood obesity is one of the biggest public health threats facing the UK, and video game use is considered a risk behavior for obesity among children. However, few studies have explored the prospective association between video game use and body mass index (BMI) or the potential mediators of this association. Objectives To investigate whether a longer-term association exists between video game use at a young age and BMI SD score in later years, independent of television use, and to ascertain whether this association is mediated by other energy-balance behaviors. Design, Setting, and Participants This cohort study is a secondary analysis of data from the Millennium Cohort Study, a nationally representative sample of children who were born in the UK between September 1, 2000, and January 31, 2002, that focused on data collected when the children were aged 5, 7, 11, and 14 years. Data for all variables, except BMI, were provided by parental or caregiver reporting if the children were younger than 14 years of age. At age 14 years, the children self-reported their own behavior. Initial data analysis was conducted between September 18, 2018, and September 28, 2018, with supplementary analyses conducted from October 7, 2019, to November 22, 2019. Main Outcomes and Measures The main outcome variable was BMI SD scores, with video game use as the exposure variable of interest. Physical activity, bedtime regularity, sugar-sweetened beverage consumption, and high-calorie food consumption were included as potential mediating behaviors. Results The full sample comprised 16 376 children and had a nearly equal number of boys (8393 [51.3%]) and girls (7983 [48.7%]). Every 1 SD increase in the number of hours of video game use at age 5 years was associated with a β = 0.018 higher BMI SD score at age 14 years (95% CI, 0.004-0.032). A small partial mediation of this association was found (direct association: β = 0.017 [95% CI, 0.003-0.031]; indirect association: β = 0.0011 [95% CI, 0.0003-0.0019]), suggesting that irregular bedtimes and higher consumption of sugar-sweetened beverages were mediators. The mediation model accounted for 36.7% (95% CI, 35.5-37.8) of the variance of the BMI SD score at age 14 years. Conclusions and Relevance Results of this study suggest a small (and not clinically meaningful) association between video game use in early childhood and higher BMI in later years, which may be mediated by irregular bedtimes and higher consumption of sugar-sweetened beverages. Future interventions to prevent childhood obesity should incorporate health promotion in mainstream video games to target children most at risk because of their high level of video game use.
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Affiliation(s)
- William Goodman
- Research Department of Behavioural Science and Health, University College London, London, England
| | - Sarah E. Jackson
- Research Department of Behavioural Science and Health, University College London, London, England
| | - Ethna McFerran
- School of Medicine Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Richard Purves
- Institute for Social Marketing, University of Stirling, Stirling, United Kingdom
| | | | - Rebecca J. Beeken
- Research Department of Behavioural Science and Health, University College London, London, England
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England
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Quaife SL, Ruparel M, Dickson JL, Beeken RJ, McEwen A, Baldwin DR, Bhowmik A, Navani N, Sennett K, Duffy SW, Wardle J, Waller J, Janes SM. Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials. Am J Respir Crit Care Med 2020; 201:965-975. [PMID: 31825647 PMCID: PMC7159423 DOI: 10.1164/rccm.201905-0946oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
Rationale: Low uptake of low-dose computed tomography (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity.Objectives: To compare the effect of a targeted, low-burden, and stepped invitation strategy versus control on uptake of hospital-based Lung Health Check appointments offering LDCT screening.Methods: In a two-arm, blinded, between-subjects, randomized controlled trial, 2,012 participants were selected from 16 primary care practices using these criteria: 1) aged 60 to 75 years, 2) recorded as a current smoker within the last 7 years, and 3) no prespecified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of preinvitation, invitation, and reminder letters from their primary care practitioner offering prescheduled appointments. The key manipulation was the accompanying leaflet. The intervention group's leaflet targeted psychological barriers and provided low-burden information, mimicking the concept of the U.K. Ministry of Transport's annual vehicle test ("M.O.T. For Your Lungs").Measurements and Main Results: Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.82-1.16) or adjusted (OR, 0.98; 95% CI, 0.82-1.17) analyses. Current smokers were less likely to attend (adjusted OR, 0.70; 95% CI, 0.56-0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (P < 0.01).Conclusions: The intervention did not improve uptake. Regardless of trial arm, uptake was considerably higher than previous clinical and real-world studies, particularly given that the samples were predominantly lower socioeconomic position smokers. Strategies common to both groups, including a Lung Health Check approach, could represent a minimum standard.Clinical trial registered with www.clinicaltrials.gov (NCT02558101) and registered prospectively with the International Standard Registered Clinical/Social Study (N21774741).
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Affiliation(s)
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Rebecca J. Beeken
- Research Department of Behavioural Science and Health and
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, United Kingdom
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, United Kingdom
| | - Neal Navani
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom
| | - Karen Sennett
- Killick Street Health Centre, London, United Kingdom
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; and
| | - Jane Wardle
- Research Department of Behavioural Science and Health and
| | - Jo Waller
- Research Department of Behavioural Science and Health and
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
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von Wagner C, Cadar D, Hackett RA, Demakakos P, Beeken RJ, Cooper Bailey S, Wolf M, Steptoe A, Renzi C, Stoffel ST. Type 2 diabetes and colorectal cancer screening: Findings from the English Longitudinal Study of Ageing. J Med Screen 2020; 27:25-30. [PMID: 31547753 DOI: 10.1177/0969141319874834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Type 2 diabetes has been identified as a risk factor for colorectal cancer, but little is known about whether it influences participation in colorectal cancer screening programmes. This study tested the extent to which Type 2 diabetes is negatively associated with colorectal cancer screening uptake. Methods We analysed individual data of screening eligible men and women aged 60–75 without cancer diagnosis from wave 6 of the English Longitudinal Study of Ageing (collected 2012–2013), to investigate whether Type 2 Diabetes influences colorectal cancer screening behaviour independently of demographic characteristics, body mass index, socio-economic status and other chronic diseases. Results Individuals who reported to have Type 2 diabetes or had glycated haemoglobin (HbA1c) levels of 48 mmol/mol or higher were less likely to have ever completed a screening test (faecal occult blood test; 62.8% vs. 75.8%, p < 0.01) or to be up-to-date with their biennial screening invitation (60.2% vs. 72.0%, p < 0.05). The negative associations of Type 2 diabetes on colorectal cancer screening were found both in unadjusted and adjusted regression models. Conclusions Future qualitative and quantitative research should identify reasons for this discrepancy, to inform interventions to increase screening uptake in this high-risk population.
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Affiliation(s)
- Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Dorina Cadar
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Ruth A Hackett
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
- Epidemiology and Public Health, University College London, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stacy Cooper Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrew Steptoe
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Cristina Renzi
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sandro T Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK
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Hubbard G, Taylor C, Watson AJM, Munro J, Goodman W, Beeken RJ. A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study. Pilot Feasibility Stud 2020; 6:12. [PMID: 32042438 PMCID: PMC7001297 DOI: 10.1186/s40814-020-0560-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We hypothesise that a physical activity (PA) intervention will improve the quality of life (QoL) of people with a stoma. A feasibility study of the intervention and trial parameters is necessary to inform a future main trial. METHODS Participants received a weekly PA consultation by telephone, video conferencing, or face-to-face for 12 weeks with a PA instructor who prescribed physical activities and supported participants by addressing stoma-related concerns and using behaviour change techniques. A feasibility study of the intervention and trial parameters was conducted in three UK sites using mixed methods. RESULTS The number of eligible patients consenting to the study was 30 out of 174 (17%). Most participants were female (73%); 73% had an ileostomy and 27% a colostomy; mean time since diagnosis was 6 months. A total of 18 (64%) participants completed pre- (baseline) and post-intervention (follow-up) measures. Results show an improvement on all scales measuring QoL and disease-specific fatigue. The median PA consultation rate per participant was eight sessions. Participants reported completing 75% or more of the prescribed PA each week. Eight stoma-related themes were identified from qualitative interviews: fear of hernia, bending down, fatigue, pain, prolapse, surgical wounds, stoma appliance, and stigma. The intervention appeared to address these issues. CONCLUSION This feasibility study demonstrated that a novel manualised PA intervention for people with a stoma is safe, feasible, and acceptable, and shows promise for improving outcomes. However, difficulties with recruitment will need to be carefully considered to ensure the success of future studies in this area. TRIAL REGISTRATION ISCTN, ISRCTN58613962; Registered 14/9/2017.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing and Midwifery, Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | - Claire Taylor
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, Middlesex HA1 3UJ UK
| | - Angus J. M. Watson
- Department of Surgery, Raigmore Hospital, NHS Highland, Old Perth Rd, Inverness, IV2 3UJ UK
| | - Julie Munro
- Department of Nursing and Midwifery, Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | - William Goodman
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
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Taylor C, Munro J, Goodman W, Beeken RJ, Dames N, Oliphant R, Watson AJ, Hubbard G. Experiences of wearing support garments by people living with a urostomy. ACTA ACUST UNITED AC 2019; 28:S26-S33. [PMID: 31835944 DOI: 10.12968/bjon.2019.28.22.s26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND support garments are commonly worn by people with a urostomy but there are no published data about their experiences of doing so. AIMS to identify the views of people living with a urostomy on the role of support garments. METHODS a cross-sectional survey of the stoma population's experiences of support garments was conducted in 2018. Recruitment was by social media. The free-text responses provided by a sub-sample of 58 people out of 103 respondents with a urostomy, were analysed. FINDINGS thematic analysis revealed four themes: physical self-management; psychosocial self-management; lifestyle; and healthcare advice and support. There were mixed feelings about the value of support garments. Many cited a sense of reassurance and confidence and being able to be more sociable and active; others reported discomfort and uncertainty about their value. CONCLUSION these findings add new understanding of experiences of support garments and provide novel theoretical insights about life with a urostomy.
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Affiliation(s)
- Claire Taylor
- Macmillan Nurse Consultant in Colorectal Cancer, London North West Healthcare NHS Trust
| | - Julie Munro
- Macmillan Nurse Consultant in Colorectal Cancer, London North West Healthcare NHS Trust
| | | | | | | | - Raymond Oliphant
- Department of Surgery, Raigmore Hospital, NHS Highland, Inverness
| | - Angus Jm Watson
- Department of Surgery, Raigmore Hospital, NHS Highland, Inverness
| | - Gill Hubbard
- Department of Nursing and Midwifery, Centre for Health Science, University of the Highlands and Islands, Inverness
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Hunot-Alexander C, Beeken RJ, Goodman W, Fildes A, Croker H, Llewellyn C, Steinsbekk S. Confirmation of the Factor Structure and Reliability of the 'Adult Eating Behavior Questionnaire' in an Adolescent Sample. Front Psychol 2019; 10:1991. [PMID: 31636576 PMCID: PMC6788325 DOI: 10.3389/fpsyg.2019.01991] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/14/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Appetitive traits, including Food Responsiveness, Enjoyment of Food, Satiety Responsiveness, Emotional Over- and Under-Eating, Food Fussiness and Slowness in Eating, have been captured across childhood using the Children’s Eating Behavior Questionnaire (CEBQ). The Adult Eating Behavior Questionnaire (AEBQ) has explored these traits in adults, but not adolescents. This study aimed to test the factor structure and reliability of the AEBQ in a sample of UK adolescents, and explore demographic differences. Materials and Methods Confirmatory factor analysis (CFA) tested an 8-factor and a 7-factor AEBQ, based on valid, completed AEBQ responses (n = 913) from adolescents aged 11–18 recruited from four London secondary schools. Test–retest reliability was analyzed in a subsample (n = 106) 2-weeks later, and 492 participants completed the Dutch Eating Behavior Questionnaire (DEBQ) to assess convergent validity. Demographic differences were explored using a multiple indicator multiple cause (MIMIC) model. Results The CFA revealed an adequate model fit for a 7-factor structure without Hunger [RMSEA = 0.038 (90% CI:0.035,0.041); CFI = 0.926, TLI = 0.916; and χ2(df = 595) = 8502.69, p < 0.001]. These seven subscales showed acceptable internal consistency (Cronbach’s α > 0.70). The ICC for the test–retest was above 0.70. Comparisons with the DEBQ supported the convergent validity of the AEBQ. Older age was associated with greater Food Responsiveness and Enjoyment of Food (all p-values < 0.005). Females reported higher levels of Emotional Over-Eating, Satiety Responsiveness, and Slowness in Eating than males (all p-values ≤ 0.003). Conclusion This study supports the use of the 7-factor AEBQ as a reliable measure of appetitive traits in adolescents.
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Affiliation(s)
- Claudia Hunot-Alexander
- Centro Universitario de Ciencias de la Salud, Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Instituto de Nutrición Humana, Universidad de Guadalajara, Guadalajara, Mexico
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, Yorkshire Cancer Research University Academic Fellow, Leeds, United Kingdom.,Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - William Goodman
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Alison Fildes
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Clare Llewellyn
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Silje Steinsbekk
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Hubbard G, Beeken RJ, Taylor C, Watson AJM, Munro J, Goodman W. A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study protocol. Pilot Feasibility Stud 2019; 5:78. [PMID: 31236285 PMCID: PMC6580610 DOI: 10.1186/s40814-019-0461-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/04/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Physical activity (PA) is positively associated with quality of life. People with a stoma are less likely to engage in PA than those without a stoma. METHODS In this feasibility intervention study, we will perform the following: (1) Develop a PA intervention for people with a stoma. An Expert Working Group of behavioural scientists, exercise scientists, clinicians and a Patient Advisory Group of people with a bowel stoma will meet with the research team to inform the development of a PA intervention for people with a stoma. A manual of the intervention will be the main output. (2) Explore PA instructors' experiences of delivering the PA intervention. PA instructors will record on paper the number of PA consultations with each patient and a researcher will interview the PA instructors about their experiences of delivering the intervention. (3) Assess the level of patient (bowel cancer or inflammatory bowel disease (IBD) patients with a stoma between 6 weeks and 24 months post-surgery) engagement with the PA intervention and their views on intervention acceptability and usefulness. Patients will keep a PA diary to record daily pedometer recorded step count and type and duration of activities. A researcher will interview patients about their experiences of the PA intervention. (4) Assess screening, eligibility, consent, data completion, loss to follow up, and missing data rates, representativeness of participants and potential treatment effects. A researcher will record on paper all study procedure parameters. Quality of life (stoma-quality of life; Functional Assessment of Cancer Therapy, Short IBD questionnaire), fatigue (FACIT fatigue scale) and PA (accelerometer) will be measured pre- and post-intervention in patients. For IBD patients only, blood will be taken to measure systemic inflammation. DISCUSSION We hypothesise that a PA intervention will be an effective means of improving the quality of life of people with a stoma. Before embarking on a full randomised controlled trial to test this hypothesis, a PA intervention needs to be developed and a feasibility study of the proposed PA intervention conducted. TRIAL REGISTRATION ISRCTN58613962, Protocol version: 0.1. 14 September 2017.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH Scotland, UK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL England, UK
| | - Claire Taylor
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, Middlesex, HA1 3UJ England, UK
| | - Angus J. M. Watson
- Department of Surgery, Raigmore Hospital, NHS Highland, Old Perth Rd, Inverness, IV2 3UJ England, UK
| | - Julie Munro
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH Scotland, UK
| | - William Goodman
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT England, UK
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Stevens C, Smith SG, Vrinten C, Waller J, Beeken RJ. Lifestyle changes associated with participation in colorectal cancer screening: Prospective data from the English Longitudinal Study of Ageing. J Med Screen 2019; 26:84-91. [PMID: 30336731 PMCID: PMC6484824 DOI: 10.1177/0969141318803973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/10/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Population-based cancer screening has been described as a teachable moment for behaviour change. This research examined the effect of faecal occult blood testing (FOBT) participation on smoking, alcohol consumption, fruit and vegetable consumption and physical activity. SETTING Data were from screening-naïve men within the English Longitudinal Study of Ageing, receiving their first FOBT invitation (n = 774). Four waves of data were included in analyses (wave 4, 2008/2009 - wave 7, 2014/2015). Baseline data were from the wave prior to FOBT invitation, and follow-up data were from the next consecutive wave (two years later). METHODS The effects of FOBT participation, time and group-by-time interactions on health behaviours were investigated using generalised estimating equations. Almost two-thirds of the sample (62.5%; n = 484) had participated in FOBT. RESULTS Screening participants were less likely to smoke (odds ratio (OR): 0.45, 95% confidence interval (CI): 0.29-0.68) and more likely to meet fruit and vegetable consumption guidelines (OR: 1.70, 95% CI: 1.14-2.55). Smoking decreased over time (OR: 0.74, 95% CI: 0.62-0.89), but adherence to alcohol guidelines also decreased (OR: 0.71, 95% CI: 0.53-0.91). A group-by-time interaction was found for vigorous physical activity; the odds of taking part in vigorous physical activity increased for FOBT participants, but decreased for non-participants (OR: 1.40, 95% CI: 1.01-1.95). CONCLUSIONS This research provides tentative support for FOBT as a teachable moment for increasing vigorous physical activity. However, overall, there was limited evidence for spontaneous improvement in multiple health behaviours following participation.
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Affiliation(s)
- Claire Stevens
- Department of Behavioural Science and Health, University College London, London, UK
| | - Samuel G Smith
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Beeken RJ, Haviland JS, Taylor C, Campbell A, Fisher A, Grimmett C, Ozakinci G, Slater S, Wilson I, Hubbard G. Smoking, alcohol consumption, diet and physical activity following stoma formation surgery, stoma-related concerns, and desire for lifestyle advice: a United Kingdom survey. BMC Public Health 2019; 19:574. [PMID: 31092219 PMCID: PMC6518630 DOI: 10.1186/s12889-019-6913-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 04/29/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adherence to smoking, alcohol consumption, diet and physical activity (PA) guidelines may improve outcomes for people with a stoma. A better understanding of these behaviours following stoma formation surgery and their experiences and attitudes towards receiving lifestyle advice, could help identify specific gaps and inform interventions going forward. The aim of this study was to describe changes in current lifestyle following stoma formation and to explore concerns, desire for lifestyle information, advice and support among people who have or have had a stoma. METHODS A sample of adults who currently had or in the past had a stoma for treatment for any medical condition was recruited online through relevant charities and companies, and invited to complete a cross-sectional, online survey. Consenting participants (n = 425) provided demographic information and completed brief, validated questionnaires about their lifestyle, alongside questions around their concerns regarding permanent stoma and experiences of lifestyle information and advice. Responses were summarised using descriptive statistics, and associations between reported concerns about stoma and changes in health behaviours were explored. RESULTS Most respondents (93%) still had a stoma at the time of completing the survey. The majority (80%) had not consumed at least 5 portions of fruit and vegetables on the previous day and 20% reported they had not participated in at least 30 min of physical activity on any day in the previous week. Most respondents were non-smokers (84%) and did not exceed recommendations for alcohol intake (60%). Most (56%) felt their PA had decreased following stoma formation. Frequencies of concerns about a permanent stoma were high, and appeared to be associated with reported decreases in PA. Of those reporting nausea, 40% felt their diet had worsened since having their stoma. A large proportion of respondents had not received PA (42%) or dietary (30%) advice, and of these > 90% would have liked guidance. CONCLUSIONS Few respondents to this survey were eating the recommended amount of fruit and vegetables, and most reported a decrease in their PA following stoma surgery. Lifestyle advice would be welcomed by this population, which professionals should take into account when addressing stoma- related concerns.
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Affiliation(s)
| | - Joanne S. Haviland
- Institute of Cancer Research Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Claire Taylor
- St Mark’s Hospital, London North West NHS Healthcare, Harrow, UK
| | | | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, London, UK
| | | | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Sarah Slater
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
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