The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer

a pilot randomised controlled trial with embedded feasibility study

G Hubbard, J. Munro, R. O'Carroll, N. Mutrie, L. Kidd, S. Haw, R. Adams, A. J. M. Watson, S. J. Leslie, P Rauchaus, A. Campbell, H. Mason, S. Manoukian, G. Sweetman, S. Treweek

Research output: Contribution to journalArticle

25 Downloads (Pure)

Abstract

Background Colorectal cancer (CRC) survivors are not meeting the recommended physical activity levels associated with improving their chances of survival and quality of life. Rehabilitation could address this problem. Objectives The aims of the Cardiac Rehabilitation In Bowel cancer study were to assess whether or not cardiac rehabilitation is a feasible and acceptable model to aid the recovery of people with CRC and to test the feasibility and acceptability of the protocol design. Design Intervention testing and feasibility work (phase 1) and a pilot randomised controlled trial with embedded qualitative study (phase 2), supplemented with an economic evaluation. Randomisation was to cardiac rehabilitation or usual care. Outcomes were differences in objective measures of physical activity and sedentary behaviour, self-reported measures of quality of life, anxiety, depression and fatigue. Qualitative work involved patients and clinicians from both cancer and cardiac specialties. Setting Three colorectal cancer wards and three cardiac rehabilitation facilities. Participants Inclusion criteria were those who were aged > 18 years, had primary CRC and were post surgery. Results Phase 1 (single site) – of 34 patient admissions, 24 (70%) were eligible and 4 (17%) participated in cardiac rehabilitation. Sixteen clinicians participated in an interview/focus group. Modifications to trial procedures were made for further testing in phase 2. Additionally, 20 clinicians in all three sites were trained in cancer and exercise, rating it as excellent. Phase 2 (three sites) – screening, eligibility, consent and retention rates were 156 (79%), 133 (67%), 41 (31%) and 38 (93%), respectively. Questionnaire completion rates were 40 (97.5%), 31 (75%) and 25 (61%) at baseline, follow-up 1 and follow-up 2, respectively. Forty (69%) accelerometer data sets were analysed; 20 (31%) were removed owing to invalid data. Qualitative study CRC and cardiac patients and clinicians were interviewed. Key themes were benefits and barriers for people with CRC attending cardiac rehabilitation; generic versus disease-specific rehabilitation; key concerns of the intervention; and barriers to participation (CRC participants only). Economic evaluation The average out-of-pocket expenses of attending cardiac rehabilitation were £50. The costs of cardiac rehabilitation for people with cancer are highly dependent on whether it involves accommodating additional patients in an already existing service or setting up a completely new service. Limitations and conclusions The main limitation is that this is a small feasibility and pilot study. The main novel finding is that cardiac rehabilitation for cancer and cardiac patients together is feasible and acceptable, thereby challenging disease-specific rehabilitation models. Future work This study highlighted important challenges to doing a full-scale trial of cardiac rehabilitation but does not, we believe, provide sufficient evidence to reject the possibility of such a future trial. We recommend that any future trial must specifically address the challenges identified in this study, such as suboptimal consent, completion, missing data and intervention adherence rates and recruitment bias, and that an internal pilot trial be conducted. This should have clear ‘stop–proceed’ rules that are formally reviewed before proceeding to the full-scale trial. Trial registration Current Controlled Trials ISRCTN63510637.
Original languageEnglish
JournalHealth Services and Delivery Research
Volume4
Issue number24
DOIs
Publication statusPublished - Aug 2016

Fingerprint

Feasibility Studies
Colonic Neoplasms
Randomized Controlled Trials
Heart Neoplasms
Rehabilitation
Exercise
Quality of Life
Cardiac Rehabilitation
Neoplasms
Patient Admission
Random Allocation
Health Expenditures
Focus Groups
Cost-Benefit Analysis
Fatigue
Survivors
Colorectal Neoplasms
Anxiety
Economics
Interviews

Cite this

The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer : a pilot randomised controlled trial with embedded feasibility study. / Hubbard, G; Munro, J.; O'Carroll, R.; Mutrie, N.; Kidd, L.; Haw, S.; Adams, R.; Watson, A. J. M.; Leslie, S. J.; Rauchaus, P; Campbell, A.; Mason, H.; Manoukian, S.; Sweetman, G.; Treweek, S.

In: Health Services and Delivery Research, Vol. 4, No. 24, 08.2016.

Research output: Contribution to journalArticle

Hubbard, G, Munro, J, O'Carroll, R, Mutrie, N, Kidd, L, Haw, S, Adams, R, Watson, AJM, Leslie, SJ, Rauchaus, P, Campbell, A, Mason, H, Manoukian, S, Sweetman, G & Treweek, S 2016, 'The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial with embedded feasibility study', Health Services and Delivery Research, vol. 4, no. 24. https://doi.org/10.3310/hsdr04240
Hubbard, G ; Munro, J. ; O'Carroll, R. ; Mutrie, N. ; Kidd, L. ; Haw, S. ; Adams, R. ; Watson, A. J. M. ; Leslie, S. J. ; Rauchaus, P ; Campbell, A. ; Mason, H. ; Manoukian, S. ; Sweetman, G. ; Treweek, S. / The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer : a pilot randomised controlled trial with embedded feasibility study. In: Health Services and Delivery Research. 2016 ; Vol. 4, No. 24.
@article{73987bfcf1354d3abe7d9d33e19d2c96,
title = "The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial with embedded feasibility study",
abstract = "Background Colorectal cancer (CRC) survivors are not meeting the recommended physical activity levels associated with improving their chances of survival and quality of life. Rehabilitation could address this problem. Objectives The aims of the Cardiac Rehabilitation In Bowel cancer study were to assess whether or not cardiac rehabilitation is a feasible and acceptable model to aid the recovery of people with CRC and to test the feasibility and acceptability of the protocol design. Design Intervention testing and feasibility work (phase 1) and a pilot randomised controlled trial with embedded qualitative study (phase 2), supplemented with an economic evaluation. Randomisation was to cardiac rehabilitation or usual care. Outcomes were differences in objective measures of physical activity and sedentary behaviour, self-reported measures of quality of life, anxiety, depression and fatigue. Qualitative work involved patients and clinicians from both cancer and cardiac specialties. Setting Three colorectal cancer wards and three cardiac rehabilitation facilities. Participants Inclusion criteria were those who were aged > 18 years, had primary CRC and were post surgery. Results Phase 1 (single site) – of 34 patient admissions, 24 (70{\%}) were eligible and 4 (17{\%}) participated in cardiac rehabilitation. Sixteen clinicians participated in an interview/focus group. Modifications to trial procedures were made for further testing in phase 2. Additionally, 20 clinicians in all three sites were trained in cancer and exercise, rating it as excellent. Phase 2 (three sites) – screening, eligibility, consent and retention rates were 156 (79{\%}), 133 (67{\%}), 41 (31{\%}) and 38 (93{\%}), respectively. Questionnaire completion rates were 40 (97.5{\%}), 31 (75{\%}) and 25 (61{\%}) at baseline, follow-up 1 and follow-up 2, respectively. Forty (69{\%}) accelerometer data sets were analysed; 20 (31{\%}) were removed owing to invalid data. Qualitative study CRC and cardiac patients and clinicians were interviewed. Key themes were benefits and barriers for people with CRC attending cardiac rehabilitation; generic versus disease-specific rehabilitation; key concerns of the intervention; and barriers to participation (CRC participants only). Economic evaluation The average out-of-pocket expenses of attending cardiac rehabilitation were £50. The costs of cardiac rehabilitation for people with cancer are highly dependent on whether it involves accommodating additional patients in an already existing service or setting up a completely new service. Limitations and conclusions The main limitation is that this is a small feasibility and pilot study. The main novel finding is that cardiac rehabilitation for cancer and cardiac patients together is feasible and acceptable, thereby challenging disease-specific rehabilitation models. Future work This study highlighted important challenges to doing a full-scale trial of cardiac rehabilitation but does not, we believe, provide sufficient evidence to reject the possibility of such a future trial. We recommend that any future trial must specifically address the challenges identified in this study, such as suboptimal consent, completion, missing data and intervention adherence rates and recruitment bias, and that an internal pilot trial be conducted. This should have clear ‘stop–proceed’ rules that are formally reviewed before proceeding to the full-scale trial. Trial registration Current Controlled Trials ISRCTN63510637.",
author = "G Hubbard and J. Munro and R. O'Carroll and N. Mutrie and L. Kidd and S. Haw and R. Adams and Watson, {A. J. M.} and Leslie, {S. J.} and P Rauchaus and A. Campbell and H. Mason and S. Manoukian and G. Sweetman and S. Treweek",
note = "This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 4, No. 24. See the NIHR Journals Library website for further project information.",
year = "2016",
month = "8",
doi = "10.3310/hsdr04240",
language = "English",
volume = "4",
journal = "Health Services and Delivery Research",
issn = "2050-4349",
number = "24",

}

TY - JOUR

T1 - The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer

T2 - a pilot randomised controlled trial with embedded feasibility study

AU - Hubbard, G

AU - Munro, J.

AU - O'Carroll, R.

AU - Mutrie, N.

AU - Kidd, L.

AU - Haw, S.

AU - Adams, R.

AU - Watson, A. J. M.

AU - Leslie, S. J.

AU - Rauchaus, P

AU - Campbell, A.

AU - Mason, H.

AU - Manoukian, S.

AU - Sweetman, G.

AU - Treweek, S.

N1 - This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 4, No. 24. See the NIHR Journals Library website for further project information.

PY - 2016/8

Y1 - 2016/8

N2 - Background Colorectal cancer (CRC) survivors are not meeting the recommended physical activity levels associated with improving their chances of survival and quality of life. Rehabilitation could address this problem. Objectives The aims of the Cardiac Rehabilitation In Bowel cancer study were to assess whether or not cardiac rehabilitation is a feasible and acceptable model to aid the recovery of people with CRC and to test the feasibility and acceptability of the protocol design. Design Intervention testing and feasibility work (phase 1) and a pilot randomised controlled trial with embedded qualitative study (phase 2), supplemented with an economic evaluation. Randomisation was to cardiac rehabilitation or usual care. Outcomes were differences in objective measures of physical activity and sedentary behaviour, self-reported measures of quality of life, anxiety, depression and fatigue. Qualitative work involved patients and clinicians from both cancer and cardiac specialties. Setting Three colorectal cancer wards and three cardiac rehabilitation facilities. Participants Inclusion criteria were those who were aged > 18 years, had primary CRC and were post surgery. Results Phase 1 (single site) – of 34 patient admissions, 24 (70%) were eligible and 4 (17%) participated in cardiac rehabilitation. Sixteen clinicians participated in an interview/focus group. Modifications to trial procedures were made for further testing in phase 2. Additionally, 20 clinicians in all three sites were trained in cancer and exercise, rating it as excellent. Phase 2 (three sites) – screening, eligibility, consent and retention rates were 156 (79%), 133 (67%), 41 (31%) and 38 (93%), respectively. Questionnaire completion rates were 40 (97.5%), 31 (75%) and 25 (61%) at baseline, follow-up 1 and follow-up 2, respectively. Forty (69%) accelerometer data sets were analysed; 20 (31%) were removed owing to invalid data. Qualitative study CRC and cardiac patients and clinicians were interviewed. Key themes were benefits and barriers for people with CRC attending cardiac rehabilitation; generic versus disease-specific rehabilitation; key concerns of the intervention; and barriers to participation (CRC participants only). Economic evaluation The average out-of-pocket expenses of attending cardiac rehabilitation were £50. The costs of cardiac rehabilitation for people with cancer are highly dependent on whether it involves accommodating additional patients in an already existing service or setting up a completely new service. Limitations and conclusions The main limitation is that this is a small feasibility and pilot study. The main novel finding is that cardiac rehabilitation for cancer and cardiac patients together is feasible and acceptable, thereby challenging disease-specific rehabilitation models. Future work This study highlighted important challenges to doing a full-scale trial of cardiac rehabilitation but does not, we believe, provide sufficient evidence to reject the possibility of such a future trial. We recommend that any future trial must specifically address the challenges identified in this study, such as suboptimal consent, completion, missing data and intervention adherence rates and recruitment bias, and that an internal pilot trial be conducted. This should have clear ‘stop–proceed’ rules that are formally reviewed before proceeding to the full-scale trial. Trial registration Current Controlled Trials ISRCTN63510637.

AB - Background Colorectal cancer (CRC) survivors are not meeting the recommended physical activity levels associated with improving their chances of survival and quality of life. Rehabilitation could address this problem. Objectives The aims of the Cardiac Rehabilitation In Bowel cancer study were to assess whether or not cardiac rehabilitation is a feasible and acceptable model to aid the recovery of people with CRC and to test the feasibility and acceptability of the protocol design. Design Intervention testing and feasibility work (phase 1) and a pilot randomised controlled trial with embedded qualitative study (phase 2), supplemented with an economic evaluation. Randomisation was to cardiac rehabilitation or usual care. Outcomes were differences in objective measures of physical activity and sedentary behaviour, self-reported measures of quality of life, anxiety, depression and fatigue. Qualitative work involved patients and clinicians from both cancer and cardiac specialties. Setting Three colorectal cancer wards and three cardiac rehabilitation facilities. Participants Inclusion criteria were those who were aged > 18 years, had primary CRC and were post surgery. Results Phase 1 (single site) – of 34 patient admissions, 24 (70%) were eligible and 4 (17%) participated in cardiac rehabilitation. Sixteen clinicians participated in an interview/focus group. Modifications to trial procedures were made for further testing in phase 2. Additionally, 20 clinicians in all three sites were trained in cancer and exercise, rating it as excellent. Phase 2 (three sites) – screening, eligibility, consent and retention rates were 156 (79%), 133 (67%), 41 (31%) and 38 (93%), respectively. Questionnaire completion rates were 40 (97.5%), 31 (75%) and 25 (61%) at baseline, follow-up 1 and follow-up 2, respectively. Forty (69%) accelerometer data sets were analysed; 20 (31%) were removed owing to invalid data. Qualitative study CRC and cardiac patients and clinicians were interviewed. Key themes were benefits and barriers for people with CRC attending cardiac rehabilitation; generic versus disease-specific rehabilitation; key concerns of the intervention; and barriers to participation (CRC participants only). Economic evaluation The average out-of-pocket expenses of attending cardiac rehabilitation were £50. The costs of cardiac rehabilitation for people with cancer are highly dependent on whether it involves accommodating additional patients in an already existing service or setting up a completely new service. Limitations and conclusions The main limitation is that this is a small feasibility and pilot study. The main novel finding is that cardiac rehabilitation for cancer and cardiac patients together is feasible and acceptable, thereby challenging disease-specific rehabilitation models. Future work This study highlighted important challenges to doing a full-scale trial of cardiac rehabilitation but does not, we believe, provide sufficient evidence to reject the possibility of such a future trial. We recommend that any future trial must specifically address the challenges identified in this study, such as suboptimal consent, completion, missing data and intervention adherence rates and recruitment bias, and that an internal pilot trial be conducted. This should have clear ‘stop–proceed’ rules that are formally reviewed before proceeding to the full-scale trial. Trial registration Current Controlled Trials ISRCTN63510637.

U2 - 10.3310/hsdr04240

DO - 10.3310/hsdr04240

M3 - Article

VL - 4

JO - Health Services and Delivery Research

JF - Health Services and Delivery Research

SN - 2050-4349

IS - 24

ER -