Award Title: Exercise as medicine in oncology: a feasibility study investigating a patient-centred approach to exercise for head and neck cancer survivors
Funder: Department of Health and Social Care

Abstract: Research question What is the feasibility of implementing personalised, flexible, and collaborative exercise programmes for head and neck cancer (HaNC) survivors?  Background  Rates of HaNC have almost doubled in the last decade. Treatment is aggressive and often multi-modal, resulting in fundamental changes to physical fitness, musculoskeletal function, breathing, speech, swallowing and appearance. Survival rates have improved, with increasing numbers of survivors, living longer with chronic side-effects.   Physical exercise has proven benefits in several cancer groups; reducing fatigue, low mood, treatment toxicities and mortality rates, although few studies include HaNC survivors.  This group has multiple challenges, often being less physically active pre-diagnosis with high alcohol and tobacco consumption, many patients have considerable co-morbidities, low socio-economic status and poor health literacy. HaNC services are centralised, with many living long distances from treatment centres. Recent evidence demonstrated that personalised exercise programmes tailored to circumstances and preferences improved outcomes and adherence. Further work is indicated to increase engagement, improve delivery and implementation of physical exercise in HaNC survivors.   Aim: To investigate delivery of personalised, flexible, and collaborative exercise programmes in HaNC.  Objectives  To investigate:    HaNC survivors  eligibility, recruitment, adherence, and retention rates.  Feasibility of delivery, integration into pathways, intervention components, and fidelity.  Frequency, intensity, time, and type of exercise prescribed based on needs and preferences.  HaNC survivors  and professionals  views on acceptability, processes and integration to care.  Suitable outcome measures and determine sample size for a definitive study   Methods   This single armed study will assess feasibility of personalised exercise programme for 70 patients diagnosed with HaNC, across two centres. Patients referred for curative treatment can enrol at any time between diagnosis and up to 8-weeks post-treatment.  Those intended for palliative care or classified as high-risk on an exercise risk stratification tool will be excluded.  Intervention  An 8-week exercise programme which has been successfully piloted with seven HaNC survivors.  It includes  i) needs analysis with personalised goals and exercise preferences  ii) programme prescribed, guided and supported by a Cancer Exercise Specialist  iii) flexibility to accommodate changes in symptom-burden, preferred exercise type and location  iv) content adhering to physical exercise cancer guidelines  v) personalised exit plan to promote maintenance.  Adherence will be facilitated by bespoke support tools, co-created by our PPI group.  Outcomes  Primary outcomes are uptake, adherence and compliance. Secondary outcomes are safety, cardiorespiratory fitness, strength, endurance, agility and balance. Patient-reported outcomes include a fatigue scale, activity levels and QoL.  Patients and staff interviews will explore the intervention s acceptability and its integration into clinical care.  PPI: PPI will be integral throughout the project  Impact and dissemination: Findings will be shared on a website and Twitter-feed. Outcomes will be presented in journals and at conferences. Briefings will be sent to patient groups and charities. This study will provide a roadmap for exercise integration into the care pathway. Ultimately it aims to improve the physical and mental health of HaNC survivors, thereby improving survival and reducing NHS costs  Timelines  0-4m     Ethics, resource development  5-17m   Recruitment  7-19m   Intervention delivery   20m      Data collection complete  20-24m Analysis, dissemination

Lay Abstract: Background  We aim to increase head and neck cancer (HaNC) patients  engagement in physical exercise. There are many proven benefits of exercise following cancer treatment, aiding recovery, reducing risk of cancer returning, improving physical and psychological well-being and quality of life (QOL). However, the vast majority of HaNC patients have low levels of physical activity both pre- and post-treatment. There are multiple reasons for this; HaNC treatment is often aggressive with severe side-effects e.g. profoundly dry mouth, breathing through a hole in the neck, shoulder dysfunction, poor swallowing making it difficult to exercise; apprehension about participating in groups due to altered facial appearance; many are from low socio-economic areas, with high risk smoking and alcohol behaviours and other health problems; HaNC services are regional, requiring long journeys to access specialist support. Our survey of 400 HaNC patients found a desire to participate in an exercise programme, if tailored to individual needs and preferences. We will develop a collaborative, flexible, patient-centred personalised programme, with tools to support HaNC-specific barriers to exercise, and test whether this is feasible and acceptable.  Design  We will recruit 70 HaNC patients, pre-treatment and up to 2 months post-treatment, across two large HaNC units in NW and NE England. In consultation with a HaNC Physiotherapist, patients will work with a local Cancer Exercise Specialist to devise a personalised exercise programme (including options for time, frequency, intensity, type, location, remote delivery), using support tools to overcome HaNC-specific barriers, with weekly virtual support, delivered over 8-weeks.  We will assess; rates of uptake, retention and exercise completion; patient reported symptoms and QOL; physical fitness. We will interview patients and healthcare professionals to understand how acceptable they found the programme and explore any issues with integrating it into HaNC care.  Our study will determine whether further research into personalised exercise programmes is feasible and worthwhile for HaNC patients.  PPI  Our PPI group helped identify this as an important research area, recognising the benefits of exercise, but that HaNC patients find it difficult to participate. They have since met regularly to develop the study design, advising on assessments, timing and delivery of the programme. Our experienced patient co-applicant has assisted in project development and will chair regular PPI meetings throughout the study. They will help develop information resources, support tools and top-tips guidance, comment on findings and help disseminate outputs to reach a broad audience.  Dissemination  We will present results at conferences and in scientific articles. We will: inform publishers of the UK HaNC clinical guidelines of our findings; advise local health service managers; and distribute accessible information to charities and patient groups regularly. The public will be able to access updates and results via our website, Twitter feed and press releases.

Research Activity Codes: 5.7 PHYSICAL;6.7 PHYSICAL
Health Categories: CANCER AND NEOPLASMS