Title: Effects of a physiotherapist-led exercise intervention delivered prior to and during stem cell transplant in patients with Myeloma
Funder: Health Education England

Abstract: Myeloma, a form of haematological cancer accounts for 10% of all haematological cancers and 5,500 new cases are diagnosed across the UK per year. Improved understanding of the disease and advances in treatment mean that survival rates in myeloma are increasing at the fastest rate among all cancer types in the UK. Median estimated survival time for patients with myeloma has increased six-fold over the last four decades and most recent statistics indicate that 5-year survival is now around 47%. The condition is associated with bone disease and pain, which can severely restrict physical functioning and have devastating consequences on quality of life (QOL). Myeloma is also the most common indication for autologous stem cell transplant (SCT) in the UK. The debilitating nature of this cancer, coupled with the considerable procedure-related morbidity of undergoing a SCT, puts myeloma patients at high-risk for loss of functionality and wellbeing long after their cancer treatment is completed. Today, with longer phases of disease free and overall survival, these patients face prolonged periods of disability with effects on QOL.Research investigating the introduction of physical activity (PA) interventions during cancer treatment for solid tumours have shown positive effects on QOL, fatigue and physical fitness, as well as reducing sedentary behaviour during and after cancer treatment. However, less evidence exists for PA interventions in the haematological cancer population, especially among patients having transplants, but small studies have found introducing exercise during hospital admission in this group to be safe and have indicated favourable effects. Anecdotally, myeloma survivors enrolled in recent post-treatment research being undertaken at the applicant's centre have expressed a need for earlier support and guidance regarding PA during treatment, explicitly prior to transplant. If found to be effective, this intervention could be embedded straight into the existing treatment pathway. The applicant's centre has the UK's largest myeloma clinic, conducting over 100 myeloma SCTs every year. Higher levels of fitness after cancer treatment have been associated with greater QOL among myeloma patients. An intervention that introduces exercise earlier in the cancer pathway, that could increase PA and reduce sedentary time may improve QOL for myeloma patients. Aims: The aim of this pilot study is to assess the feasibility of the delivery and data collection of a randomised controlled trial (RCT) investigating a physiotherapist-led intervention to myeloma patients prior to and during SCT treatment. The data collected will also allow an estimate of the intervention effect size with respect to fatigue, overall QOL and PA. To investigate the experiences and views of healthcare professionals (HPCs), who are regularly involved in the care and preparation of patients undergoing transplants. The study will gather data that will contribute to the practical planning and implementation of exercise into the treatment pathway. Plan of Investigation: Conduct a pilot RCT of a partly supervised exercise intervention delivered by a physiotherapist during the usual clinical pathway to patients with myeloma, both prior to and during SCT. Undertake structured qualitative interviews of UK HPCs involved in the care and management of myeloma patients. It is known that as little as 7% of myeloma patients reach recommended levels of PA during treatment and only 20% post-treatment. Previous research conducted at the applicant's centre indicated that a physiotherapist-led exercise intervention delivered after cancer treatment to myeloma patients in plateau phase was associated with improvements in QOL, fatigue and muscle strength. Further to those outcomes, it was extremely well received by patients. Although there is growing indication that patients seek lifestyle advice prior to and during treatment, the effects of a physiotherapist-led exercise intervention prior to and during SCT have not yet been investigated.

Lay abstract: People with the blood cancer myeloma, who undergo chemotherapy, are not routinely given exercise or physical activity advice as part of their treatment and many are even told to rest or not to exercise because of pain and bone disease related to their cancer. Yet research studies tell us that exercising before, during and after cancer treatment is beneficial and that excessive rest or being inactive can have detrimental effects on wellbeing. As the medical treatment for cancer gets better and more people are surviving, it is important that people have other therapies' to help them prepare for and potentially combat the side effects of their cancer treatment. This maybe especially important for myeloma patients who are receiving an intensive treatment called stem cell transplant. Studies are currently underway to assess the impacts of exercise after treatment, with promising results. This research will discover if it is feasible to run a large-scale trial into the effects of exercise before and during stem cell transplant treatment. This will help to plan future research to tell us if exercise improves people's physical and psychological wellbeing before stem cell transplant treatment, and helps their recovery after.This research will include a pilot trial comparing a group of patients who receive exercise and a group that has the current usual hospital care among people with myeloma before their stem cell transplant. The exercise group will receive aerobic and resistance exercises during 3 phases of their treatment: In phase 1, for 4-6 weeks before they come into hospital for their transplant they will be asked to exercise three times per week. They will have one session a week with a physiotherapist in a gym and do two other sessions at home. In phase 2, during their hospital stay, immediately after their stem cell transplant, the exercise participants will be supervised doing their exercises by a physiotherapist three times per week. In phase 3, for 3 months after they leave hospital the participants will be asked to continue exercising at home three times per week. They will also receive one phone or skype call per week from a physiotherapist for support and guidance. People with myeloma who are having stem cell transplant treatment at University College Hospital will be invited to take part in this research. Participants will be asked to complete questionnaires about their energy levels, quality of life and their use of healthcare. They will also have their fitness and strength tested and will be asked to wear a device that tracks their physical activity. These measures will be taken four times: when they start the study 4-6 weeks before their transplant, the day of their transplant, the day they leave hospital and 3 months after their transplant.The information gathered from this pilot research study will be written up for a doctoral thesis, for publication in scientific journals and presented widely at conferences. If it is seen to be successful, it could lead to further large-scale research that may change the usual care for people with myeloma having transplants and exercise could become an important part of the treatment pathway.This fellowship will also involve a second study in which healthcare professionals who are involved in the delivery of stem cell transplant treatment will be interviewed to gather information on their views and experiences on introducing exercise during the treatment pathway. The research findings will also allow planning for a bigger study, across different hospitals in the UK and other types of blood cancer.

Research activity codes: 6.7 PHYSICAL
Health categories: CANCER AND NEOPLASMS