Physical Activity in Lung Cancer Patients Receiving Immunotherapy
Research type
Research Study
Full title
Fatigue and Physical Activity in Lung Cancer Patients Treated with Immunotherapy: a mixed methods study.
IRAS ID
256556
Contact name
Lynn Calman
Contact email
Sponsor organisation
University of Southampton
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 9 months, 30 days
Research summary
Due to improvements in survival there is an increased number of people experiencing cancer as a life changing condition instead of a life-limiting, incurable disease. This has resulted in the research having a great focus on cancer patient’s quality of life both during and post treatment. Although there has been a dramatic increase in survival rates, there are still a number of cancer groups where survival is poor. In recent years’ immunotherapy has improved survival rates for some cancer patients, notably, lung cancer. Research and clinical reports have identified that cancer related fatigue has the biggest impact on patients during immunotherapy. Physical activity has been shown to be a successful intervention in addressing fatigue in advanced stage cancer patients receiving conventional therapy, however, due to the increased availability of immunotherapy the context of care has changed radically. Therefore, research is required to examine if existing interventions are appropriate for patients whilst meeting their needs living with a challenging treatment regime. We hope that gaining insight into the impact of cancer related fatigue on lung cancer patients undergoing immunotherapy treatment will allow us to establish the potential value and role of physical activity interventions. To answer the study’s research question, a mixed methods approach will be used. A survey using validated questionnaires will be used to gain quantitative data, whilst semi-structured interviews will be employed to understand the experiences of immunotherapy specifically focusing on the impacts of cancer related fatigue and the potential of using physical activity as an intervention. The study’s sample will consist of advanced stage non-small cell lung cancer patients recruited from a local immunotherapy clinic who are receiving immunotherapy. Data collection for the study will be undertaken between February 2019 – June 2019.
Lay summary of study results: We have limited understanding of how immunotherapy (IO) impacts on the lives of people living with advanced lung cancer. Treatment can convey survival advantage but toxicity is common, trial data suggests around 30% of patients’ experience cancer- related fatigue (CRF). Physical activity (PA) interventions are established as effective in reducing CRF in other cancer populations.
This study was conducted by two MSc physiotherapy students in fulfilment of their MSc dissertation.
The aim of the study was to understand the impact of cancer- related fatigue and the potential value and role of physical activity interventions to support this population living with incurable disease, challenging treatment regime and significant uncertainty.
Methods
Undertaken as two linked MSc projects in a single cancer centre a survey utilised validated questionnaires to establish levels of cancer- related fatigue, physical activity, self-efficacy (confidence to manage) and quality of life (QoL). Descriptive statistical analysis explored associations between variables. Semi-structured interviews and framework analysis explored the impact of cancer related fatigue and acceptability of physical activity.
Data were collected in one specialist cancer clinical centre in the south east of England. Participants were recruited from outpatient clinics.
Results
Forty-two patients were eligible for the study and 28 participated in the survey (70% of eligible) and six patients were interviewed.
Health and wellbeing
Fatigue and dyspnoea produced the highest symptom scores, both above thresholds of clinical significance (Giesinger et al 2016). Over half of the participants experienced at least moderate fatigue. Ninety-six percent experienced some form of fatigue.
Higher QoL scores were significantly associated with lower fatigue scores and higher self-efficacy for management of fatigue scores. More active participants reported lower fatigue levels (p=0.044) Only 24% achieved the NHS activity guidelines of 150 minutes of moderate aerobic activity and 3.7% undertook any strength exercises each week (NHS 2018). Strength training can improve muscle mass, thus indirectly improving fatigue, function, QoL and survival (Bye et al., 2017; Versteeg et al 2017).
One third of the sample had ‘moderate-low’ confidence to self-manage their disease and around half of participants had ‘moderate-low’ confidence to self-manage their fatigue levels Interviews revealed the impact of immunotherapy treatment (positive and negative), barriers and facilitators to taking part in physical activity, including lack of information, how and why to engage in physical activity. Four themes were identified.
• Incapacitation for some inconvenience for others – highly individual experiences of treatment
• Balancing living with side effects of immunotherapy versus not living at all
• Comorbidities and understanding – as barriers to physical activities
• The importance of who delivered information and and whenConclusions
Despite this being a small sample in a single center, to our knowledge this is the first study to explore cancer related fatigue, physical activity and self efficacy in this population and has revealed sub-optimal quality of life, physical activity, high levels of fatigue and lack confidence in managing symptoms. Insights from interviews can support the development of interventions for this population. Although all participants reported cancer related fatigue whilst receiving immunotherapy, the severity experienced differed tremendously. Participants reported improved quality of life and thus a return to normality since starting immunotherapy and a willingness to engage in in physical activity. Comorbidities and a lack of understanding in how to engage in physical activity were the two primary reasons for not undertaking physical activity. Getting advice from a health professional, thus having confidence in the information provided was highlighted as a potential facilitator to engaging with physical activity.REC name
South Central - Hampshire A Research Ethics Committee
REC reference
19/SC/0109
Date of REC Opinion
29 Apr 2019
REC opinion
Further Information Favourable Opinion