CANcer BEhavioural nutrition and exercise feasibility trial (CanBenefit); phase I qualitative interview findings

Our plain-English summary of CANcer BEhavioural nutrition and exercise feasibility trial (CanBenefit); phase I qualitative interview findings, by F. Swan, H. Chen, C.C. Forbes, et al (Journal of Geriatric Oncology, 2021).

The study

• Authors: F. Swan, H. Chen, C.C. Forbes, M.J. Johnson, M. Lind
• Journal: Journal of Geriatric Oncology
• Published: 2021;12(4):641-648
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Older people with lung cancer are often frail and unfit due to their cancer and co-morbidities and may tolerate cancer treatments poorly. Physical activity (PA) and a healthy diet offer quality of life benefit to people with cancer before, during, and post treatment. However, older adults are poorly represented in the clinical trials on which recommendations were made.

Objective: To assess the acceptability, usefulness, and practicality of delivering a tailored wellbeing (PA and nutrition) intervention for older adults with lung cancer before, during, and after cancer treatments (chemotherapy and/or immunotherapy).

Methods: Semi-structured interviews conducted with nine patients with lung cancer and three patients with mesothelioma, ≥70 years and ten informal carers, and nine Multidisciplinary Team (MDT) members. A topic guide covered the acceptability, usefulness, and practicality of a wellbeing intervention as well as specific feedback on individual components. Data were subjected to thematic analysis.

Findings: Four themes were generated: current lack of wellbeing care in clinical work; preferred "can have" dietary and "can do" PA advice; peer support as facilitating factor; and barriers to compliance including patients' psychological and physical issues as well as current cancer pathway and staffing issues.

Conclusion: Older adults with lung cancer would welcome a proactive, clear and instructive, wellbeing intervention. Many barriers to compliance exist, particularly before and during cancer treatments due to the psycho-social impact of diagnosis, and the effects of cancer treatment. The intervention must be tailored to individual need and address physical limitations, psychological and social welfare in addition to PA and nutritional advice.

Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.

In plain English

This qualitative interview study took place at a single cancer centre in the UK between April and November 2019, as early work toward a physical activity and diet programme for older adults with lung cancer. The researchers interviewed twelve patients aged 70 to 81 (nine with lung cancer, three with mesothelioma), ten informal carers or family members, and nine hospital cancer-team staff. The article does not discuss asbestos and does not report the mesothelioma patients' views separately. Few participants had received formal diet or exercise advice, and most wanted clinicians to offer it without being asked. They preferred practical "can have" and "can do" advice and valued peer support. Reported barriers included the shock of diagnosis, treatment side effects, other illnesses, short timelines to treatment, and stretched staff. The authors concluded that older adults with lung cancer would welcome clear, proactive advice, but that any programme must be tailored to individual need. They noted that the small sample means the findings cannot be generalised.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Qualitative study using semi-structured, in-depth interviews with purposive sampling, analysed by thematic analysis. It was developmental work for a planned feasibility trial.
• Who was studied: 31 people in total. Twelve patients aged 70 or older (range 70 to 81; eight male): nine with lung cancer and three with mesothelioma. Also ten informal carers or family members, and nine members of the multidisciplinary cancer team, including a dietician, physiotherapist, nurses, a medical registrar and a therapy services manager. Patients were recruited at a single cancer centre in the UK between April and November 2019.
• Exposure: No asbestos or other exposure was studied. The interviews concerned views on a proposed tailored wellbeing (physical activity and diet) intervention to be given before, during and after chemotherapy and/or immunotherapy.
• Main results:
  • Few participants had received formal diet or physical activity guidance, with a particular lack of physical activity instructions.
  • Most participants felt clinicians should offer advice and information proactively rather than wait to be asked.
  • Patients and carers wanted to be told what to do, including information on the safety of physical activity.
  • Staff agreed that "can have" or "can do" lists would help people take part.
  • Patients and carers strongly wanted a support group, although some preferred little or no social contact at the time of diagnosis.
  • The psychological impact of the diagnosis was described as very high and was seen as a barrier, especially before treatment.
  • Treatment side effects were a physical barrier. The first week after chemotherapy was considered the most restrictive period for physical activity.
  • Other illnesses (co-morbidities) were also a barrier, mainly to physical activity rather than diet.
  • Health-service barriers included the short time between diagnosis and the start of treatment, and staff who were already stretched to capacity.
• The authors' conclusion: The authors concluded that older adults with lung cancer would welcome proactive, clear and instructive information for a wellbeing intervention. They found that barriers are high, particularly before and during treatment, and that any such intervention must be tailored to individual need, including physical limitations and psychological and social welfare.
• Limitations the authors state:
  • Carers being present in most interviews may have limited what patients said.
  • Only patients interested in physical activity and nutrition may have been recruited.
  • The small sample means the findings cannot be generalised to all older adults with lung cancer.
  • Social acceptability bias is possible in interviews.
  • The interviewer's own views as a physiotherapist committed to physical activity may have biased interpretation.
  • Not all minor findings could be presented in the paper.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Quality of Life, Clinical Trial, Chemotherapy, Immunotherapy, Mesothelioma, Multidisciplinary Team.

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