Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

Manuel Ester, S Nicole Culos-Reed, Amane Abdul-Razzak, Julia T Daun, Delaney Duchek, George Francis, Gwyn Bebb, Jennifer Black, Audra Arlain, Chelsia Gillis, Lyle Galloway, Lauren C Capozzi, Manuel Ester, S Nicole Culos-Reed, Amane Abdul-Razzak, Julia T Daun, Delaney Duchek, George Francis, Gwyn Bebb, Jennifer Black, Audra Arlain, Chelsia Gillis, Lyle Galloway, Lauren C Capozzi

Abstract

Background: Advanced lung cancer patients face significant physical and psychological burden leading to reduced physical function and quality of life. Separately, physical activity, nutrition, and palliative symptom management interventions have been shown to improve functioning in this population, however no study has combined all three in a multimodal intervention. Therefore, we assessed the feasibility of a multimodal physical activity, nutrition, and palliative symptom management intervention in advanced lung cancer.

Methods: Participants received an individually tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, behaviour change education, and nutrition and palliative care consultations. Patients reported symptom burden, energy, and fatigue before and after each class. At baseline and post-intervention, symptom burden, quality of life, fatigue, physical activity, dietary intake, and physical function were assessed. Post-intervention interviews examined participant perspectives.

Results: The multimodal program was feasible, with 44% (10/23) recruitment, 75% (75/100) class attendance, 89% (8/9) nutrition and palliative consult attendance, and 85% (17/20) assessment completion. Of ten participants, 70% (7/10) completed the post-intervention follow-up. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being.

Conclusion: A multimodal physical activity, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation in a larger cohort trial.

Trial registration: NCT04575831 , Registered 05 October 2020 - Retrospectively registered.

Keywords: Advanced lung cancer; Exercise oncology; Nutrition; Quality of life; Supportive cancer care; Symptom management.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Modified CONSORT flow diagram for the single-arm ENPAL study. legend: Recruitment began in October 2019 and the post-assessments concluded in March 2020. NSCLC = non-small-cell lung cancer. NMS = neuromusculoskeletal

References

    1. Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics 2019. 2019. . Accessed 28 May 2020.
    1. Lehto RH. Psychosocial challenges for patients with advanced lung cancer: interventions to improve well-being. Lung Cancer. 2017;8:79–90. doi: 10.2147/LCTT.S120215.
    1. Peddle-McIntyre CJ, Singh F, Thomas R, Newton RU, Galvão DA, Cavalheri V. Exercise training for advanced lung cancer. Cochrane Database Syst Rev. 2019;2(2):CD012685. doi: 10.1002/14651858.CD012685.pub2.
    1. John LD. Self-care strategies used by patients with lung cancer to promote quality of life. InOncology Nursing Forum 2010 May 1 (Vol. 37, No. 3). doi:10.1188/10.onf.339-347.
    1. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA. Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med. 2010;363(8):733–742. doi: 10.1056/nejmoa1000678.
    1. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, Moore M, Rydall A, Rodin G, Tannock I, Donner A. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–1730. doi: 10.1016/s0140-6736(13)62416-2.
    1. Albrecht TA, Taylor AG. Physical activity in patients with advanced-stage cancer: a systematic review of the literature. Clin J Oncol Nurs. 2012;16(3):293. doi: 10.1188/12.cjon.293-300.
    1. Hall CC, Cook J, Maddocks M, Skipworth RJ, Fallon M, Laird BJ. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Support Care Cancer. 2019;3:1–4. doi: 10.1007/s00520-019-04749-6.
    1. Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer–a systematic review of the epidemiological literature. Nutr J. 2012;11(1):27. doi: 10.1186/1475-2891-11-27.
    1. Kvale PA, Selecky PA, Prakash UB. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines. Chest. 2007;132(3):368S–403S. doi: 10.1378/chest.07-1391.
    1. Uster A, Ruehlin M, Mey S, Gisi D, Knols R, Imoberdorf R, Pless M, Ballmer PE. Effects of nutrition and physical exercise intervention in palliative cancer patients: a randomized controlled trial. Clin Nutr. 2018;37(4):1202–1209. doi: 10.1016/j.clnu.2017.05.027.
    1. McNeely ML, Sellar C, Williamson T, Shea-Budgell M, Joy AA, Lau HY, Easaw JC, Murtha AD, Vallance J, Courneya K, Mackey JR, Parliament M, Culos-Reed N. Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study. BMJ Open. 2019;9(9):e029975. doi: 10.1136/bmjopen-2019-029975.
    1. Albinati NKR. The feasibility of a physical activity intervention for advanced multiple myeloma patients: a mixed methods study [master’s thesis] Calgary, AB: University of Calgary; 2019.
    1. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH, Morris GS. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390. doi: 10.1249/MSS.0000000000002116.
    1. Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011;26(11):1479–1498. doi: 10.1080/08870446.2010.540664.
    1. Amireault S, Godin G, Lacombe J, Sabiston CM. The use of the Godin-Shephard leisure-time physical activity questionnaire in oncology research: a systematic review. BMC Med Res Methodol. 2015;15(1):60. doi: 10.1186/s12874-015-0045-7.
    1. Cella DF, Bonomi AE, Lloyd SR, Tulsky DS, Kaplan E, Bonomi P. Reliability and validity of the functional assessment of Cancer therapy—lung (FACT-L) quality of life instrument. Lung Cancer. 1995;12(3):199–220. doi: 10.1016/0169-5002(95)00450-f.
    1. Chang VT, Hwang SS, Feuerman M. Validation of the Edmonton symptom assessment scale. Cancer. 2000;88(9):2164–2171. doi: 10.1002/(sici)1097-0142(20000501)88:9<2164::aid-cncr24>;2-5.
    1. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E. Measuring fatigue and other anemia-related symptoms with the functional assessment of Cancer therapy (FACT) measurement system. J Pain Symptom Manag. 1997;13(2):63–74. doi: 10.1016/s0885-3924(96)00274-6.
    1. Subar AF, Kirkpatrick SI, Mittl B, Zimmerman TP, Thompson FE, Bingley C, Willis G, Islam NG, Baranowski T, McNutt S, Potischman N. The automated self-administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute. J Acad Nutr Diet. 2012;112(8):1134–1137. doi: 10.1016/j.jand.2012.04.016.
    1. Lau DC. Synopsis of the 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. Cmaj. 2007;176(8):1103–1106. doi: 10.1503/cmaj.070306.
    1. Canadian Society for Exercise Physiology . The Canadian physical activity, Fitness & Lifestyle Approach: CSEP–Health-Related Appraisal & Counseling Strategy. Ottawa-ON: Health Canada; 2003.
    1. Rikli RE, Jones CJ. Senior fitness test manual. Champaign, IL: Human kinetics; 2013.
    1. Fleishman E. The structure and measurement of physical fitness. Oxford: Prentice-Hall; 1964.
    1. Thorne S. Interpretive description: qualitative research for applied practice: Routledge; 2016 Mar 21.
    1. Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches: Sage publications; 2016 Dec 19.
    1. Paterson C, Primeau C, Pullar I, Nabi G. Development of a Prehabilitation Multimodal Supportive Care Interventions for Men and Their Partners Before Radical Prostatectomy for Localized Prostate Cancer. Cancer Nurs. 2019;42(4):E47–E53. doi: 10.1097/NCC.0000000000000618.
    1. Sheill G, Guinan E, Brady L, Hevey D, Hussey J. Exercise interventions for patients with advanced cancer: a systematic review of recruitment, attrition, and exercise adherence rates. Palliative & Supportive Care. 2019;17(6):686–696. doi: 10.1017/s1478951519000312.
    1. Mikkelsen MK, Nielsen DL, Vinther A, Lund CM, Jarden M. Attitudes towards physical activity and exercise in older patients with advanced cancer during oncological treatment–a qualitative interview study. Eur J Oncol Nurs. 2019;41:16–23. doi: 10.1016/j.ejon.2019.04.00547.
    1. Chen HM, Tsai CM, Wu YC, Lin KC, Lin CC. Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer. Br J Cancer. 2015;112(3):438–445. doi: 10.1038/bjc.2014.612.
    1. Temel JS, Greer JA, Goldberg S, Vogel PD, Sullivan M, Pirl WF, Lynch TJ, Christiani DC, Smith MR. A structured exercise program for patients with advanced non-small cell lung cancer. J Thorac Oncol. 2009;4(5):595–601. doi: 10.1097/jto.0b013e31819d18e5.
    1. Miller W, Brown PR. Motivators, facilitators, and barriers to physical activity in older adults: a qualitative study. Holist Nurs Pract. 2017;31(4):216–224. doi: 10.1097/HNP.0000000000000218.
    1. Rodrigues F, Teixeira DS, Neiva HP, Cid L, Monteiro D. The bright and dark sides of motivation as predictors of enjoyment, intention, and exercise persistence. Scand J Med Sci Sports. 2020;30(4):787–800. doi: 10.1111/sms.13617.
    1. Cheville AL, Girardi J, Clark MM, Rummans TA, Pittelkow T, Brown P, Hanson J, Atherton P, Johnson ME, Sloan JA, Gamble G. Therapeutic exercise during outpatient radiation therapy for advanced cancer: feasibility and impact on physical well-being. American journal of physical medicine & rehabilitation. 2010;89(8):611–619. doi: 10.1097/phm.0b013e3181d3e782.
    1. Adamsen L, Stage M, Laursen J, Rørth M, Quist M. Exercise and relaxation intervention for patients with advanced lung cancer: a qualitative feasibility study. Scand J Med Sci Sports. 2012;22(6):804–815. doi: 10.1111/j.1600-0838.2011.01323.x.
    1. Ferrell B, Sun V, Hurria A, Cristea M, Raz DJ, Kim JY, Reckamp K, Williams AC, Borneman T, Uman G, Koczywas M. Interdisciplinary palliative care for patients with lung cancer. J Pain Symptom Manag. 2015;50(6):758–767. doi: 10.1016/j.jpainsymman.2015.07.005.
    1. Ringash J, O'Sullivan B, Bezjak A, Redelmeier DA. Interpreting clinically significant changes in patient-reported outcomes. Cancer. 2007;110(1):196–202. doi: 10.1002/cncr.22799.
    1. Payne C, Larkin PJ, McIlfatrick S, Dunwoody L, Gracey JH. Exercise and nutrition interventions in advanced lung cancer: a systematic review. Curr Oncol. 2013;20(4):e321. doi: 10.3747/co.20.1431.
    1. Kiss N, Isenring E, Gough K, Wheeler G, Wirth A, Campbell BA, Krishnasamy M. Early and intensive dietary counseling in lung Cancer patients receiving (chemo) radiotherapy—a pilot randomized controlled trial. Nutr Cancer. 2016;68(6):958–967. doi: 10.1080/01635581.2016.1188972.
    1. Kiss N. Nutrition support and dietary interventions for patients with lung cancer: current insights. Lung Cancer: Targets and Therapy. 2016;7:1. doi: 10.2147/LCTT.S85347.
    1. Kisner DL. Malnutrition in lung cancer: incidence, prognostic implications, and pathogenesis. In adjuvant therapies of Cancer 1982 (pp. 240-245). Springer, Berlin. Heidelberg. . 10.1007/978-3-642-81685-7_38.
    1. Lin YY, Liu MF, Tzeng JI, Lin CC. Effects of walking on quality of life among lung cancer patients: a longitudinal study. Cancer Nurs. 2015;38(4):253–259. doi: 10.1097/ncc.0000000000000176.
    1. Douglas E. Exercise in cancer patients. Phys Ther Rev. 2005;10(2):71–88. doi: 10.1179/108331905x43490.
    1. Mouri T, Naito T, Morikawa A, Tatematsu N, Miura S, Okayama T, Omae K, Takayama K. Promotion of behavioral change and the impact on quality of life in elderly patients with advanced cancer: a physical activity intervention of the multimodal nutrition and exercise treatment for advanced cancer program. Asia Pac J Oncol Nurs. 2018;5(4):383. doi: 10.4103/apjon.apjon_21_18.
    1. Bade BC, Hyer JM, Bevill BT, Pastis A, Rojewski AM, Toll BA, Silvestri GA. A patient-centered activity regimen improves participation in physical activity interventions in advanced-stage lung cancer. Integrative Cancer Therapies. 2018;17(3):921–927. doi: 10.1177/1534735418781739.
    1. Polanski J, Jankowska-Polanska B, Rosinczuk J, Chabowski M, Szymanska-Chabowska A. Quality of life of patients with lung cancer. OncoTargets and therapy. 2016;9:1023. doi: 10.2147/OTT.S100685.
    1. Quist M, Rørth M, Langer S, Jones LW, Laursen JH, Pappot H, Christensen KB, Adamsen L. Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study. Lung Cancer. 2012;75(2):203–208. doi: 10.1016/j.lungcan.2011.07.006.
    1. McNeely ML, Parliament MB, Seikaly H, Jha N, Magee DJ, Haykowsky MJ, Courneya KS. Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial. Cancer. 2008;113(1):214–222. doi: 10.1002/cncr.23536.
    1. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005;23(7):1431–1438. doi: 10.1200/jco.2005.02.054.
    1. Capozzi LC, Boldt KR, Lau H, Shirt L, Bultz B, Culos-Reed SN. A clinic-supported group exercise program for head and neck cancer survivors: managing cancer and treatment side effects to improve quality of life. Support Care Cancer. 2015;23(4):1001–1007. doi: 10.1007/s00520-014-2436-4.
    1. Midtgaard J, Røssell K, Christensen JF, Uth J, Adamsen L, Rørth M. Demonstration and manifestation of self-determination and illness resistance—a qualitative study of long-term maintenance of physical activity in posttreatment cancer survivors. Support Care Cancer. 2012;20(9):1999–2008. doi: 10.1007/s00520-011-1304-8.
    1. Kuehr L, Wiskemann J, Abel U, Ulrich CM, Hummler S, Thomas M. Exercise in patients with non-small cell lung cancer. Med Sci Sports Exerc. 2014;46(4):656–663. doi: 10.1249/MSS.0000000000000158.

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