Exercise and Nutrition for Head and Neck Cancer Patients (ENHANCE)
2016년 10월 24일 업데이트: Dr. Nicole Culos-Reed, University of Calgary
Exercise and Nutrition for Head and Neck Cancer Patients: A Patient Oriented, Clinic-Supported Randomized Controlled Trial
Research on physical activity and nutrition interventions aimed at positively impacting symptom management, treatment-related recovery and quality of life has largely excluded head and neck cancer populations.
This translates into a lack of clinical programming available for these patient populations.
Head and neck cancer patients deal with severe weight loss, with upwards of 70% attributed to lean muscle wasting, leading to extended recovery times, decreased quality of life (QoL), and impaired physical functioning.
To date, interventions to address body composition issues have focused solely on diet, despite findings that nutritional therapy alone is insufficient to mitigate changes.
A combined physical activity and nutrition intervention, that also incorporates important educational components known to positively impact behaviour change, is warranted for this population.
Pilot work suggests that there is large patient demand and clinic support from the health care professionals for a comprehensive program.
Therefore, the purpose of the present study is to examine the impact of timing of a 12-week PA and nutrition intervention (either during or following treatment) for HN cancer patients on body composition, recovery, serum inflammatory markers and quality of life.
In addition, the investigators will examine the impact of a 12-week maintenance program, delivered immediately following the intervention, on adherence, patient-reported outcomes (i.e., management of both physical and psychosocial treatment-related symptoms and side-effects), as well as return to work.
The investigators hypothesize that (1) patients who are randomized to the intervention at treatment start will experience improved symptom management and decreased lean body composition changes, directly improving recovery and QoL; (2) patients who receive a maintenance support program will have better long-term adherence and therefore superior treatment-related symptom management, physical and psychosocial functioning; and (3) return to work indices will improve and healthcare utilization costs will be lower in the participants who receive the immediate intervention (vs.
delayed) as well as in those who receive the maintenance program (vs.
no maintenance).
This research will facilitate advancements in patient wellness, survivorship, and autonomy, and carve the path for a physical activity and wellness education model that can be implemented in other cancer centers.
연구 개요
연구 유형
중재적
등록 (실제)
60
단계
- 해당 없음
연락처 및 위치
이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.
연구 장소
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Alberta
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Calgary, Alberta, 캐나다, T2N4N2
- Tom Baker Cancer Centre
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Calgary, Alberta, 캐나다, T2N1N4
- University of Calgary
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참여기준
연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.
자격 기준
공부할 수 있는 나이
18년 이상 (성인, 고령자)
건강한 자원 봉사자를 받아들입니다
아니
연구 대상 성별
모두
설명
Inclusion Criteria:
- Over 18 Years of Age
- Has received a diagnosis of nasopharyngeal, oropharyngeal or hypopharyngeal cancer
- Will receive radiation as part of treatment plan
- Able to walk without assistance
- Received clearance for exercise from treating oncologist
- Lives in Calgary, Alberta area
- Can speak and write English
- Is interested in participating in the study
공부 계획
이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 지지 요법
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 하나의
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
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실험적: Immediate Lifestyle Intervention - Maintenance Program
Patients will receive a 12-week lifestyle program during treatment.
Patients will also receive maintenance support following the 12-week program.
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Participants in the Lifestyle Intervention will receive a 12-week individualized exercise and dietary program based on their exercise assessment and dual energy x-ray absorptiometry (DXA) scan results, will attend twice weekly group exercise classes, and perform their individualized at-home program an additional two times per week.
In addition, participants will be required to attend six education sessions during the 12-week intervention.
Patients randomized to receive the Maintenance Program Intervention following treatment will receive a Survivorship Care Plan outlining their physical activity, dietary, and health behaviour progress throughout the program, future goals, individualized maintenance strategies, and optional drop-in exercise sessions.
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실험적: Immediate Lifestyle Intervention - No Maintenance Program
Patients will begin the 12-week lifestyle intervention during treatment.
Patients will not receive a maintenance support following the 12-week intervention.
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Participants in the Lifestyle Intervention will receive a 12-week individualized exercise and dietary program based on their exercise assessment and dual energy x-ray absorptiometry (DXA) scan results, will attend twice weekly group exercise classes, and perform their individualized at-home program an additional two times per week.
In addition, participants will be required to attend six education sessions during the 12-week intervention.
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실험적: Delayed Lifestyle Intervention - Maintenance Program
Patients will receive a 12-week lifestyle intervention program following treatment (12 weeks after diagnosis).
Patients will then receive maintenance support following the 12-week program.
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Participants in the Lifestyle Intervention will receive a 12-week individualized exercise and dietary program based on their exercise assessment and dual energy x-ray absorptiometry (DXA) scan results, will attend twice weekly group exercise classes, and perform their individualized at-home program an additional two times per week.
In addition, participants will be required to attend six education sessions during the 12-week intervention.
Patients randomized to receive the Maintenance Program Intervention following treatment will receive a Survivorship Care Plan outlining their physical activity, dietary, and health behaviour progress throughout the program, future goals, individualized maintenance strategies, and optional drop-in exercise sessions.
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실험적: Delayed Lifestyle Intervention - No Maintenance Program
Patients will receive a 12-week lifestyle intervention program following treatment completion (12 weeks following diagnosis).
Patients will not receive maintenance support following the 12-week program.
|
Participants in the Lifestyle Intervention will receive a 12-week individualized exercise and dietary program based on their exercise assessment and dual energy x-ray absorptiometry (DXA) scan results, will attend twice weekly group exercise classes, and perform their individualized at-home program an additional two times per week.
In addition, participants will be required to attend six education sessions during the 12-week intervention.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Change from Baseline in Body Composition
기간: At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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DXA Scan will be used to assess body composition
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At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Quality of Life
기간: At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Quality of Life will be assessed using the Functional Assessment of Cancer Therapy- Anemia module (FACT-AN), and the NCCN-FACT Fact Head/Neck Symptom Index-22 (FHNSI-22).
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At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Physical Activity Behaviour
기간: At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Physical activity will be assessed using Godin's (Godin, 1985) leisure score index (LSI) of the GLTEQ (Godin Leisure Time Exercise Questionnaire).
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At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Smoking History
기간: At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Smoking history will be assessed by a self report questionnaire which will classify patients as non-smokers, former smokers and current smokers.
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At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Depression
기간: At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Depression will be assessed using the Center for Epidemiological Studies on Depression Scale (CES-D).
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At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Karnofsky Performance Score (KPS)
기간: At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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The Karnofsky Performance Score (KSP) will be used to measure the participant's general ability to accomplish tasks of daily-living and overall well-being.
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At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Inflammatory Markers
기간: At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Inflammatory factors will be evaluated as they are associated with cancer cachexia and muscle wasting and may be modified by exercise (Seruga et al., 2008; Baldwin, 2011).
An overnight fasted blood draw will be collected at baseline, 3 months post diagnosis, 6 months post diagnosis, 9 months post diagnosis, and 12 months post diagnosis.
Serum inflammatory cytokine concentrations will be assessed in-house (Dr.
Raylene Reimer's laboratory) according to our established protocols.
TNF, IL-6, IL-1, IL-8 and C-reactive protein will be quantified using Milliplex Human Cytokine kits (Millipore, Billerica, MA).
Plate reading will be provided as a fee-for service through Eve Technologies Inc. (Calgary, AB).
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At baseline (diagnosis), and then at 3, 6, 9 and 12 months post diagnosis
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Cancer related Symptom Management
기간: At baseline (diagnosis) and then 3, 6, 9, 12 months post diagnosis & every week before and after class during the 12 week intervention
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Participants will complete the ESAS bi-weekly, before and after class.
The ESAS is a valid and reliable assessment tool to evaluate the nine more common symptoms experienced by cancer patients (Chang et al., 2000).
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At baseline (diagnosis) and then 3, 6, 9, 12 months post diagnosis & every week before and after class during the 12 week intervention
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Diet Behaviour - 3 Day food record
기간: At baseline (diagnosis) and 4 & 8 weeks, 3, 6, 9, 12 months post diagnosis.
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The 3-Day Diet Record is said to be the most accurate for mean macronutrient content and appropriate for use in studies where subjects may consume a wide variety of foods (American Dietetics Association / Dietitians Canada, 2000).
Participants are instructed to record their daily consumption over a period of three days, one of which must be a weekend day.
Written instructions and a sample entry are provided to increase accuracy of the daily record.
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At baseline (diagnosis) and 4 & 8 weeks, 3, 6, 9, 12 months post diagnosis.
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Diet Behaviour: PG-SGA
기간: At baseline (diagnosis), each week during radiation treatment (6.5 weeks in duration), and 3, 6, 9, 12 months post diagnosis
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The PG-SGA assessment tool has been show to improve treatment outcomes, decrease side-effects, and improve weight-management in cancer patients, and therefore will be used weekly to assess and identify malnutrition among patients (McMahon et al., 2000; Doyle et al., 2006).
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At baseline (diagnosis), each week during radiation treatment (6.5 weeks in duration), and 3, 6, 9, 12 months post diagnosis
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Health related Fitness Measures - Resting Heart Rate
기간: At baseline (diagnosis), and 3, 6, 9, 12 months post diagnosis.
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Resting heart rate will be measured by palpating the radial artery and taking a 15 second count as per the CPAFLA protocol (CPAFLA, 2003).
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At baseline (diagnosis), and 3, 6, 9, 12 months post diagnosis.
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Health Related Fitness Outcome - Blood Pressure
기간: At baseline (diagnosis), and 3, 6, 9, 12 months post diagnosis.
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A resting blood pressure (mmHg) will be measured in duplicate on the left arm using a sphygmomanometer and stethoscope using standardized procedures (CPAFLA, 2003).
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At baseline (diagnosis), and 3, 6, 9, 12 months post diagnosis.
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Health Related Fitness Outcome - 6 minute walk test
기간: At baseline (diagnosis), and 3, 6, 9, 12 months post diagnosis.
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The six-minute walk test (6MWT) will be used to assess changes in functional aerobic capacity.
Using the standardized protocol, participants will be asked to walk as far as they can around a 400-meter track for six minutes [43].
The point reached at 6 minutes will be marked and measured to the nearest 0.5 meter.
Rating of perceived exertion (Borg scale) will be completed immediately after completion of the functional aerobic capacity test.
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At baseline (diagnosis), and 3, 6, 9, 12 months post diagnosis.
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Health Related Fitness Outcome - Grip Strength
기간: At baseline (diagnosis) and 3, 6, 9, and 12 months post diagnosis.
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Muscular strength will be assessed using a combined grip strength of the right and left hands will also be assessed using a hand dynamometer.
A sum will be determined in kilograms from the best score of 2 trials recorded for each hand according to the CPAFLA protocol.
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At baseline (diagnosis) and 3, 6, 9, and 12 months post diagnosis.
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Health Related Fitness Outcome - Lower Body Strength
기간: At baseline (diagnosis), and 3, 6, 9, and 12 months post diagnosis
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Lower body strength will be assessed using a 30-second sit to stand test.
The number of times participants can stand from a seated position in 30-second will be examined.
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At baseline (diagnosis), and 3, 6, 9, and 12 months post diagnosis
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Health Related Fitness Outcome - Flexibility
기간: At baseline (diagnosis) and 3, 6, 9, and 12 months post diagnosis
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Flexibility will be assessed by a trunk forward flexion sit-and-reach test using a Wells-Dillon flexometer.
The test will follow a standard protocol, with two trials allowed and the highest score to the nearest 0.5 cm recorded.
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At baseline (diagnosis) and 3, 6, 9, and 12 months post diagnosis
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Health Related Fitness Outcome - Balance
기간: At baseline (diagnosis), and 3, 6, 9, and 12 months post diagnosis.
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Balance will be assessed using a static balance test.
The test requires the participant to balance on one foot and then the other as long as they can (length of time to a maximum of 45 seconds) while standing on a 2.54 by 2.54 by 30.5 cm base using a standardized protocol, reported by Fleishman.
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At baseline (diagnosis), and 3, 6, 9, and 12 months post diagnosis.
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공동 작업자 및 조사자
여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.
수사관
- 연구 책임자: Lauren C Capozzi, PhD Student, University of Calgary
- 수석 연구원: Harold Lau, MD, Tom Baker Cancer Centre, University of Calgary
- 수석 연구원: Raylene Reimer, PhD, University of Calgary
간행물 및 유용한 링크
연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.
연구 기록 날짜
이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.
연구 주요 날짜
연구 시작
2012년 6월 1일
기본 완료 (실제)
2014년 8월 1일
연구 완료 (실제)
2014년 12월 1일
연구 등록 날짜
최초 제출
2012년 8월 31일
QC 기준을 충족하는 최초 제출
2012년 9월 5일
처음 게시됨 (추정)
2012년 9월 10일
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
2016년 10월 26일
QC 기준을 충족하는 마지막 업데이트 제출
2016년 10월 24일
마지막으로 확인됨
2016년 10월 1일
추가 정보
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .