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Early Rehabilitation of Cancer Patients

ABSTRACT: A life threatening disease such as cancer may lead to post traumatic stress disorder, and even when reporting low levels of side-effects from cancer disease and treatment, 80% report high levels of stress symptoms. The purpose of the present randomised controlled trial is to examine the psychosocial effects of a stress management intervention based on cognitive behaviour therapy and with focus on increased physical activity in patients with various cancer diagnoses using a stepped-care approach. When using a stepped-care approach it is possible to study the level and intensity of stress management intervention required to achieve increased well-being. A cost-utility analysis will also be performed. 300 adult patients with a recent diagnosis of breast-, colorectal- prostate, testicular cancer or lymphoma and scheduled for adjuvant and/or curative oncologic treatment at Haukeland University Hospital, will be consecutively included in the prospective intervention study. The patients will be randomized to intervention or control. In step 1, all patients in the intervention group (I-a) will receive 2 counselling sessions. Patients who report clinically significant levels of stress, such as intrusive thoughts/avoidance behaviour (measured by Impact of Event Scale) and/or worry and depressions (measured by Hospital and Depression Scale) will be included in Step 2 (I-b) and include another 4-7 counselling sessions. There will also be a focus on motivating to increase physical activity level. Both the intervention (I) and control group (C) are allowed to take part in the common rehabilitation program with patient education and physical training. Data will be collected with self-reported standardized questionnaires. Objectively measures of physical activity level, sleep and daily energy expenditure are recorded with SenseWear Pro3 Armband. Measure point is at inclusion and than after 6 week, 4, 8, 12 and 24 month.

DISEASE(S): Testicle Cancer,Colorectal Cancer,Prostate Cancer,Breast Cancer,Lymphoma,Testicular Neoplasms

PROVIDER: 2124564 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:This model is from the article: A model of flux regulation in the cholesterol biosynthesis pathway: Immune mediated graduated flux reduction versus statin-like led stepped flux reduction. Watterson S, Guerriero ML, Blanc M, Mazein A, Loewe L, Robertson KA, Gibbs H, Shui G, Wenk MR, Hillston J, Ghazal P. Biochimie. 2012 Jun 1. 22664637 , Abstract: The cholesterol biosynthesis pathway has recently been shown to play an important role in the innate immune response to viral infection with host protection occurring through a coordinate down regulation of the enzymes catalysing each metabolic step. In contrast, statin based drugs, which form the principle pharmaceutical agents for decreasing the activity of this pathway, target a single enzyme. Here, we build an ordinary differential equation model of the cholesterol biosynthesis pathway in order to investigate how the two regulatory strategies impact upon the behaviour of the pathway. We employ a modest set of assumptions: that the pathway operates away from saturation, that each metabolite is involved in multiple cellular interactions and that mRNA levels reflect enzyme concentrations. Using data taken from primary bone marrow derived macrophage cells infected with murine cytomegalovirus or treated with IFNγ, we show that, under these assumptions, coordinate down-regulation of enzyme activity imparts a graduated reduction in flux along the pathway. In contrast, modelling a statin-like treatment that achieves the same degree of down-regulation in cholesterol production, we show that this delivers a step change in flux along the pathway. The graduated reduction mediated by physiological coordinate regulation of multiple enzymes supports a mechanism that allows a greater level of specificity, altering cholesterol levels with less impact upon interactions branching from the pathway, than pharmacological step reductions. We argue that coordinate regulation is likely to show a long-term evolutionary advantage over single enzyme regulation. Finally, the results from our models have implications for future pharmaceutical therapies intended to target cholesterol production with greater specificity and fewer off target effects, suggesting that this can be achieved by mimicking the coordinated down-regulation observed in immunological responses.

Project description:Interventions: The intervention will include (I) providing a wearable tracker; (ii) up to six individual telephone or social media based sessions of health coaching. and (iii) a booklet with physical activity information and motivational tools to support behaviour change. The wearable tracker will be a wrist worn Fitbit Charge 2. Participants will be encouraged to wear the Fitbit during all waking hours, except for showering or swimming. However, it is not mandatory to wear the Fitbit during all waking hours. Participants will choose mode of delivery according to their preferences from a choice of telephone, Skype, zoom, or messenger etc. This is a distance-based intervention. Therefore the wearable tracker will be mailed to participants. Four sessions of health coaching are fixed (at wk 1, 2, 4 and 8) for all participants and will last up to 45 minutes each. However, the intervention includes a patient-centred and stepped-care approach by providing additional health coaching sessions (i.e., at wk 6, and 10) to those who may need them in order to achieve meaningful sustained physical activity change. A Health coach will be employed to deliver the intervention and will be required to have a background in Psychology or allied health discipline (at least to degree level), and previous experience of interviewing or working with patients. There is no specific exercise prescription but participants will be encouraged to meet the physical activity guidelines for cancer survivors, which is at least 150 minutes of moderate-intensity physical activity per week. They will also be informed that 3-5 hours of moderate-intensity physical activity will bring maximum benefits and will be encouraged to reach this goal once achieve the minimum guidelines of 150-minutes per week. The purpose of the health coaching is to motivate and support increased physical activity through supporting self-efficacy, action planning, and coping planning. The first session will cover technical issues and featu Primary outcome(s): The primary outcome is Minutes of Moderate to vigorous physical activity per week assessed using an accelerometer (the Actigraph GT9 X). At each assessment point, participants will be mailed the Actigraph and asked to wear the device on their hip or waist for a period of 7 consecutive days during all waking hours.[week 12 post baseline assessment];Change in minutes of sedentary behaviour per week, also assessed using the Actigraph GT9X . Sedentary behaviour will be defined by accelerometer activity counts of <100 counts per minute, for 20 consecutive minutes or more.[week24 post baseline assessment] Study Design: Purpose: Prevention; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

Project description:Study hypothesis: Evidence suggests that increased physical activity following diagnosis and treatment for colorectal cancer may reduce the risk of disease recurrence after 2.7 years and improve survival by up to 50%. Studies have also shown an association between increased physical activity and other health outcomes for people living with colorectal cancer, for example improved quality of life and improved mental well-being. Partners may play a role in affecting physical activity behaviour change. The family can be a significant determinant of individual health behaviours. Shared familial environmental factors have been shown to partly account for similarities in physical activity levels amongst family members. Research has also shown that spousal support is an important factor in smoking cessation, use of health services and weight reduction. Partners may be also a receptive target for physical activity behaviour change. Physical activity consultations may help to increase the physical activity levels and improve the health outcomes of the partners of people living with colorectal cancer as well as the patient. Primary aim: To evaluate the feasibility of conducting a randomised controlled trial of physical activity consultations with people living with colorectal cancer and their partners. Research questions: 1. Is it possible to recruit patients who have completed all surgery and treatment for colorectal cancer in the last 24 months? 2. What would a likely response rate be for a future randomised controlled trial? 3. What are the demographic characteristics of those who are recruited to the study? 4. Can participants be retained in the study for the full 6 months? 5. Is it possible to conduct joint physical activity consultations with people living with colorectal cancer and their partners? 6. Are the outcome measures able to be used and acceptable for use with people living with colorectal cancer and their partners? 7. What would the effect size be for a future power calculation? Secondary aim: To evaluate the effects of physical activity consultations on physical activity levels, mental health, quality of life and body composition. Research questions: 1. What is the effect of physical activity consultations on the physical activity levels of people living with colorectal cancer and their partners? 2. What is the effect of physical activity consultations on depression and anxiety? 3. What is the effect of physical activity consultations on quality of life? 4. What is the effect of physical activity consultations on body composition? 5. Do cancer and other health risk perceptions, intra-couple support and self-efficacy predict any changes in physical activity levels? Primary outcome(s): Feasibility will be measured by calculating the following rates: 1. Recruitment rate (number of participants randomised/number of eligible participants) 2. Completion rate (number of participants completing baseline and 6 month intervention assessments/number of participants randomised) 3. Adherence rate (number of physical activity consultations and telephone calls conducted/number of physical activity consultations and telephone calls scheduled)

Project description:Interventions: The intervention arm is named HoPS, an acronym of Home-based Physical Activity for Survivors. HoPS intervention programme aims to improve physical activity level among cancer survivors, in particular breast and colorectal cancer by employing Social Cognitive Theory (SCT) in the development of the programme. It combines of psychoeducation and social media approach to behavioural intervention. Participants of the HoPS will be provided with a non-tailored printed material and gradual tapering down of face-to-face group meetings to improve knowledge and skills of physical activity. While WhatsApp is used as a structured direct remote feedback strategy to allow for supervised home-based physical activity. 1. Face-to-face group meetings There will be 2 meet up sessions for all participants in the HoPS group. The sessions provide a standardized lectures deliver by the researcher using power point slides. The first session of lecture (1-hour duration) will cover the areas of a brief introduction of HoPS programme, physical activity knowledge and goal setting. The second session of lecture (15-minutes duration) will cover for barriers to physical activity and following that a sharing session (15-minutes duration) by a role model (a cancer survivor) to share her experience in engaging in physical activity. In each of the sessions, after the lectures, an exercise session will be conducted by a certified exercise instructor with at least 3 years experienced in coaching for exercise. The duration of this exercise session will be 2 hours and the focus is train the participants on how to perform a proper and correct exercise for cancer survivors. This will involved aerobic exercises and resistance exercis Primary outcome(s): Total MET-minutes/week using validated IPAQ [Baseline, at 8-week (immediately after intervention) and at 16-week post intervention] Study Design: Purpose: Educational / counselling / training; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

Project description:The intervention will be a physical exercise program for colorectal cancer patients during the adjuvant chemotherapy. The exercise program aims on reducing the side effects of the treatment and improving patients’ quality of life. In addition, the investigators try to improve endurance and resistance training level, in order to achieve greater physical functionality, survival and general well-being. For this, the investigators will carry out an exercise program based mainly on muscular strength and cardiorespiratory condition. It will last 6 months, with a frequency of 3 days per week, including sessions of 60 minutes. Sessions will consist of three parts: warm-up, main part (endurance and resistance training), and cool down. An individualized and supervised progression of training will take place. The intensity levels will always be adjusted to the initial levels of the participants, always considering their preferences and comfort. Participants’ preferences and exercise history will be considered through an initial interview. Motivational strategies based on self-determination theory will be applied, since it is one of the most used theories in the field of physical exercise. This theory proposes that all people need to feel competent, autonomous and socially related. If these three needs are satisfied, participants will develop more positive (autonomous) forms of motivation, which are related to better consequences such as vitality, enjoyment, quality of life and adherence to physical activity. In addition, motivational strategies will be applied for families and healthcare professionals. Before starting the program and at the end of it, each eligible patient will be evaluated through: * Physical activity: strength test of lower and upper limbs, agility test, stress test for cardiorespiratory fitness, physical activity levels, physical condition and body composition. * Psychological factors: autonomy support, basic psychological need satisfaction, motivation, quality of life, perceived barriers, depression, anxiety, hope, quality of life. * Clinical parameters: survival rate, side effects, biological factors, treatment delays and planned treatment completion.

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Early Rehabilitation of Cancer Patients

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