Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial

Paul Little; Katherine Bradbury; Beth Stuart; Jane Barnett; Adele Krusche; Mary Steele; Elena Heber; Steph Easton; Kirsten A. Smith; Joanna Slodkowska-Barabasz; Liz Payne; Teresa Corbett; Laura Wilde; Guiqing Lily Yao; Sebastien Pollet; Jazzine Smith; Judith Joseph; Megan Lawrence; Dankmar Böhning; Tara Cheetham-Blake; Diana Eccles; Claire Foster; Adam W A Geraghty; Geraldine Leydon; Andre Matthias Müller; Richard D. Neal; Richard Osborne; Shanaya Rathod; Alison Richardson; Chloe Grimmett; Geoffrey Sharman; Roger Bacon; Lesley Turner; Richard Stephens; Kirsty Rogers; James Raftery; Shihua Zhu; Karmpaul Singh; Frances Webley; Gareth Griffiths; Jaqui Nutall; Trudie Chalder; Clare  Wilkinson; Eila Watson; Lucy Yardley

doi:10.3399/BJGP.2023.0262

Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial

Paul Little, Katherine Bradbury, Beth Stuart, Jane Barnett, Adele Krusche, Mary Steele, Elena Heber, Steph Easton, Kirsten A. Smith, Joanna Slodkowska-Barabasz, Liz Payne, Teresa Corbett, Laura Wilde, Guiqing Lily Yao, Sebastien Pollet, Jazzine Smith, Judith Joseph, Megan Lawrence, Dankmar Böhning, Tara Cheetham-BlakeDiana Eccles, Claire Foster, Adam W A Geraghty, Geraldine Leydon, Andre Matthias Müller, Richard D. Neal, Richard Osborne, Shanaya Rathod, Alison Richardson, Chloe Grimmett, Geoffrey Sharman, Roger Bacon, Lesley Turner, Richard Stephens, Kirsty Rogers, James Raftery, Shihua Zhu, Karmpaul Singh, Frances Webley, Gareth Griffiths, Jaqui Nutall, Trudie Chalder, Clare Wilkinson, Eila Watson, Lucy Yardley

Centre for Healthcare and Communities

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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 and setting: This was a pragmatic parallel open randomised trial in UK general practices (ISRCTN:96374224).

Method: People having finished primary treatment (≤10 years previously) for colorectal, breast, or prostate cancers, with European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC 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, and 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 all groups improved (primary time point: n for the generic, Renewed groups, and Renewed with support were 806, 749, and 705, respectively), with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both the Renewed groups. By 12 months there were small improvements in EORTC QLQ-C30 for Renewed with support (versus generic advice: 1.42, 95% confidence interval [CI] = 0.33 to 2.51); both Renewed groups improved global health (12 months: Renewed: 3.06, 95% CI = 1.39 to 4.74; Renewed with support: 2.78, 95% CI = 1.08 to 4.48), dyspnoea, constipation and enablement, and lower primary care NHS costs (in comparison with generic advice [£265]: Renewed was –£141 [95% CI = –£153 to–£128] and Renewed with Support was –£77 [95% CI = –£90 to –£65]); 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 language	English
Article number	BJGP.2023.0262
Pages (from-to)	(In-Press)
Number of pages	9
Journal	British Journal of General Practice
Volume	(In-Press)
Early online date	13 Jan 2025
DOIs	https://doi.org/10.3399/BJGP.2023.0262
Publication status	E-pub ahead of print - 13 Jan 2025

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/).

Funding

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).

Funders	Funder number
National Institute for Health and Care Research	RP-PG-0514-20001

Keywords

cancer survivors
health resources
primary health care
self-management

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

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Wilde2025VoRFinal published version, 576 KBLicence: CC BY

Cite this

Little, P., Bradbury, K., Stuart, B., Barnett, J., Krusche, A., Steele, M., Heber, E., Easton, S., Smith, K. A., Slodkowska-Barabasz, J., Payne, L., Corbett, T., Wilde, L., Yao, G. L., Pollet, S., Smith, J., Joseph, J., Lawrence, M., Böhning, D., ... Yardley, L. (2025). Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial. British Journal of General Practice, (In-Press), (In-Press). Article BJGP.2023.0262. Advance online publication. https://doi.org/10.3399/BJGP.2023.0262

Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial. / Little, Paul; Bradbury, Katherine; Stuart, Beth et al.
In: British Journal of General Practice, Vol. (In-Press), BJGP.2023.0262, 13.01.2025, p. (In-Press).

Research output: Contribution to journal › Article › peer-review

Little, P, Bradbury, K, Stuart, B, Barnett, J, Krusche, A, Steele, M, Heber, E, Easton, S, Smith, KA, Slodkowska-Barabasz, J, Payne, L, Corbett, T, Wilde, L, Yao, GL, Pollet, S, Smith, J, Joseph, J, Lawrence, M, Böhning, D, Cheetham-Blake, T, Eccles, D, Foster, C, Geraghty, AWA, Leydon, G, Müller, AM, Neal, RD, Osborne, R, Rathod, S, Richardson, A, Grimmett, C, Sharman, G, Bacon, R, Turner, L, Stephens, R, Rogers, K, Raftery, J, Zhu, S, Singh, K, Webley, F, Griffiths, G, Nutall, J, Chalder, T, Wilkinson, C, Watson, E & Yardley, L 2025, 'Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial', British Journal of General Practice, vol. (In-Press), BJGP.2023.0262, pp. (In-Press). https://doi.org/10.3399/BJGP.2023.0262

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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 and setting: This was a pragmatic parallel open randomised trial in UK general practices (ISRCTN:96374224).Method: People having finished primary treatment (≤10 years previously) for colorectal, breast, or prostate cancers, with European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) score ≤85, were randomised by online software to: 1) detailed {\textquoteleft}generic{\textquoteright} digital NHS support ({\textquoteleft}LiveWell{\textquoteright}; n = 906); 2) a bespoke complex digital intervention ({\textquoteleft}Renewed{\textquoteright}; n = 903) addressing symptom management, physical activity, diet, weight loss, and distress; or 3) {\textquoteleft}Renewed with support{\textquoteright} (n = 903): {\textquoteleft}Renewed{\textquoteright} 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 all groups improved (primary time point: n for the generic, Renewed groups, and Renewed with support were 806, 749, and 705, respectively), with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both the Renewed groups. By 12 months there were small improvements in EORTC QLQ-C30 for Renewed with support (versus generic advice: 1.42, 95% confidence interval [CI] = 0.33 to 2.51); both Renewed groups improved global health (12 months: Renewed: 3.06, 95% CI = 1.39 to 4.74; Renewed with support: 2.78, 95% CI = 1.08 to 4.48), dyspnoea, constipation and enablement, and lower primary care NHS costs (in comparison with generic advice [£265]: Renewed was –£141 [95% CI = –£153 to–£128] and Renewed with Support was –£77 [95% CI = –£90 to –£65]); and for Renewed with support improvement in several other symptom subscales. No harms were identified.Conclusion: Cancer survivors{\textquoteright} 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.",

keywords = "cancer survivors, health resources, primary health care, self-management",

author = "Paul Little and Katherine Bradbury and Beth Stuart and Jane Barnett and Adele Krusche and Mary Steele and Elena Heber and Steph Easton and Smith, {Kirsten A.} and Joanna Slodkowska-Barabasz and Liz Payne and Teresa Corbett and Laura Wilde and Yao, {Guiqing Lily} and Sebastien Pollet and Jazzine Smith and Judith Joseph and Megan Lawrence and Dankmar B{\"o}hning and Tara Cheetham-Blake and Diana Eccles and Claire Foster and Geraghty, {Adam W A} and Geraldine Leydon and M{\"u}ller, {Andre Matthias} and Neal, {Richard D.} and Richard Osborne and Shanaya Rathod and Alison Richardson and Chloe Grimmett and Geoffrey Sharman and Roger Bacon and Lesley Turner and Richard Stephens and Kirsty Rogers and James Raftery and Shihua Zhu and Karmpaul Singh and Frances Webley and Gareth Griffiths and Jaqui Nutall and Trudie Chalder and Clare Wilkinson and Eila Watson and Lucy Yardley",

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/).",

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doi = "10.3399/BJGP.2023.0262",

language = "English",

volume = "(In-Press)",

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TY - JOUR

T1 - Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care

T2 - a randomised controlled trial

AU - Little, Paul

AU - Bradbury, Katherine

AU - Stuart, Beth

AU - Barnett, Jane

AU - Krusche, Adele

AU - Steele, Mary

AU - Heber, Elena

AU - Easton, Steph

AU - Smith, Kirsten A.

AU - Slodkowska-Barabasz, Joanna

AU - Payne, Liz

AU - Corbett, Teresa

AU - Wilde, Laura

AU - Yao, Guiqing Lily

AU - Pollet, Sebastien

AU - Smith, Jazzine

AU - Joseph, Judith

AU - Lawrence, Megan

AU - Böhning, Dankmar

AU - Cheetham-Blake, Tara

AU - Eccles, Diana

AU - Foster, Claire

AU - Geraghty, Adam W A

AU - Leydon, Geraldine

AU - Müller, Andre Matthias

AU - Neal, Richard D.

AU - Osborne, Richard

AU - Rathod, Shanaya

AU - Richardson, Alison

AU - Grimmett, Chloe

AU - Sharman, Geoffrey

AU - Bacon, Roger

AU - Turner, Lesley

AU - Stephens, Richard

AU - Rogers, Kirsty

AU - Raftery, James

AU - Zhu, Shihua

AU - Singh, Karmpaul

AU - Webley, Frances

AU - Griffiths, Gareth

AU - Nutall, Jaqui

AU - Chalder, Trudie

AU - Wilkinson, Clare

AU - Watson, Eila

AU - Yardley, Lucy

N1 - 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/).

PY - 2025/1/13

Y1 - 2025/1/13

N2 - 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 and setting: This was a pragmatic parallel open randomised trial in UK general practices (ISRCTN:96374224).Method: People having finished primary treatment (≤10 years previously) for colorectal, breast, or prostate cancers, with European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC 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, and 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 all groups improved (primary time point: n for the generic, Renewed groups, and Renewed with support were 806, 749, and 705, respectively), with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both the Renewed groups. By 12 months there were small improvements in EORTC QLQ-C30 for Renewed with support (versus generic advice: 1.42, 95% confidence interval [CI] = 0.33 to 2.51); both Renewed groups improved global health (12 months: Renewed: 3.06, 95% CI = 1.39 to 4.74; Renewed with support: 2.78, 95% CI = 1.08 to 4.48), dyspnoea, constipation and enablement, and lower primary care NHS costs (in comparison with generic advice [£265]: Renewed was –£141 [95% CI = –£153 to–£128] and Renewed with Support was –£77 [95% CI = –£90 to –£65]); 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.

AB - 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 and setting: This was a pragmatic parallel open randomised trial in UK general practices (ISRCTN:96374224).Method: People having finished primary treatment (≤10 years previously) for colorectal, breast, or prostate cancers, with European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC 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, and 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 all groups improved (primary time point: n for the generic, Renewed groups, and Renewed with support were 806, 749, and 705, respectively), with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both the Renewed groups. By 12 months there were small improvements in EORTC QLQ-C30 for Renewed with support (versus generic advice: 1.42, 95% confidence interval [CI] = 0.33 to 2.51); both Renewed groups improved global health (12 months: Renewed: 3.06, 95% CI = 1.39 to 4.74; Renewed with support: 2.78, 95% CI = 1.08 to 4.48), dyspnoea, constipation and enablement, and lower primary care NHS costs (in comparison with generic advice [£265]: Renewed was –£141 [95% CI = –£153 to–£128] and Renewed with Support was –£77 [95% CI = –£90 to –£65]); 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.

KW - cancer survivors

KW - health resources

KW - primary health care

KW - self-management

U2 - 10.3399/BJGP.2023.0262

DO - 10.3399/BJGP.2023.0262

M3 - Article

C2 - 38164562

SN - 0960-1643

VL - (In-Press)

SP - (In-Press)

JO - British Journal of General Practice

JF - British Journal of General Practice

M1 - BJGP.2023.0262

ER -

Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this