Implementation of Physical Intervention Key for CRC Survivors

A 12-week physical activity intervention strategy may help to improve the functional well-being of patients with colorectal cancer (CRC) after treatment, according to data from the Smart Pace trial presented at the 2018 Gastrointestinal Cancers Symposium.

“CRC affects over 1.3 million people in the United States and is the second leading cause of cancer death,” study author Erin L Van Blarigan, ScD, Assistant Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, said in an interview with CURE, a sister publication of Oncology Nursing News. “Identifying modifiable lifestyle factors that can improve survival in CRC patients and survivors would have a great impact on public health.”

Because physical activity after diagnosis has proven to lower mortality rates in these patients, it is important for nurses to help implement feasible and acceptable interventions after CRC diagnoses.

“A feasible intervention is something that patients and providers will actually do,” explained Blarigan. “For example, we are finding that supervised exercise is often not a feasible intervention, because of the burden on patients to travel to a particular gym location to exercise at set times of the week. In contrast, telephone interventions have been shown to be feasible.”

Researchers from the University of California, San Francisco and the Dana-Farber Cancer Institute evaluated the feasibility and acceptability of a device- and telephone-specific physical activity intervention in patients with CRC, and if it could improve survival outcomes and health-related quality of life.

The 2-arm, randomized-controlled pilot study included men and women who previously completed treatment for CRC, and were considered cancer-free at enrollment. In the intervention arm, 20 participants received print materials on physical activity for cancer survivors, a Fitbit Flex™ and daily text messages to support increased physical activity for 12 weeks. Nineteen patients in the control arm received the print materials and a Fitbit Flex™ after study completion.

Feasibility, meaning device wear time and text response rate, and acceptability in the intervention arm served as the primary endpoint. The researchers also investigated change in physical activity. All participants completed the RAND Short Form Survey (SF-36) and the Functional Assessment of Cancer Therapy — Colorectal (FACT-C) at baseline and again at 12 weeks.

The intervention arm wore the Fitbit Flex™ for approximately 74 out of the 84-day experiment and responded to about 34 of the 46 text messages sent. The researchers found that Fitbit Flex™ wear was stable over time, but text message responses declined significantly as the study went on.

Sixteen patients responded to the surveys assessing feasibility and acceptability, of which the majority strongly agreed that the Fitbit Flex™ motivated them to exercise, half were very satisfied with the experience and 88% said they would continue to wear the device after the study ended.

Blarigan highlighted the importance of nurses speaking with their patients about meeting physical activity recommendations. In addition, it is just as important for survivors to ensure they exercise for 150 minutes per week.

“Getting a device that tracks your physical activity may be one way that individuals can motivate themselves to meet that recommendation, but other ways include blocking time out in their calendars to exercise, exercising with a friend or family member or dog, and putting out their exercise clothes to remind themselves each day of their commitment to themselves to spend some time moving,” she added.

The researchers noted larger randomized studies are needed to determine if a digital physical activity intervention can definitively improve the functional well-being of CRC survivors, and more importantly, if this intervention can make sustainable improvements over time.

“It would be of interest to determine if digital health tools can effectively motivate inactive patients to exercise more, and in turn, whether the increased exercise has an impact on biological or clinical outcomes for patients,” said Blarigan.