A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors

Paul Little, Katherine Bradbury, Beth Stuart, Jane Barnett, Adele Krusche, Mary Steele, Elena Heber, Steph Easton, Kirsten Ailsa Smith, Joanna Slodkowska-Barabasz, Liz Payne, Teresa Corbett, Guiqing Yao, Sebastien Pollet, Jazzine Smith, Judith Joseph, Megan Lawrence, Dankmar Bohning, Tara Cheetham-Blake, Diana EcclesClaire Foster, Adam W A Geraghty, Geraldine Leydon, Andre Muller, Richard Neal, Richard Osborne, Shanaya Rathod, Alison Richardson, Chloe Grimmett, Geoff Sharman, Roger Bacon, Lesley Turner, Richard Stephens, Tamsin Burford, Laura Wilde, Karen Middleton, Megan Liddiard, Kirsty Rogers, James Raftery, Shihua Zhu, Fran Webley, Gareth Griffiths, Jaqui Nutall, Trudie Chalder, Clare E Wilkinson, Eila Watson, Lucy Yardley

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Abstract

Background: Many cancer survivors following primary treatment have prolonged poor quality of life.
Aim: To determine the effectiveness of a bespoke digital intervention to support cancer survivors.
Design: Pragmatic parallel open randomised trial.
Setting: UK general practices.
Methods: People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1) detailed ‘generic’ digital NHS support (‘LiveWell’;n=906), 2) a bespoke complex digital intervention (‘Renewed’;n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) ‘Renewed-with-support’ (n=903): ‘Renewed’ with additional brief email and telephone support.
Results: Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n’s respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified.
Conclusion: Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health
enablement and symptom management, with substantially lower NHS costs.
Original languageEnglish
Article numberBJGP.2023.0262
Pages (from-to)(In-Press)
Number of pages22
JournalBritish Journal of General Practice
Volume(In-Press)
Early online date20 Dec 2023
DOIs
Publication statusE-pub ahead of print - 20 Dec 2023

Bibliographical note

This is an Open Access article distributed under the terms of the Creative
Commons Attribution 4.0 License (http://creativecommons.org/licenses/by/4.0/).

Funder

This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant ref No RP-PG-0514-20001). LY is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West and NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation. The Renewed intervention was developed using LifeGuide software, which is partly supported by the NIHR Southampton Biomedical Research Centre (BRC).

Keywords

  • cancer survivors
  • global health
  • resource use

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