The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial with embedded feasibility study

• Published in: Health services and delivery research 2016-08, Vol.4 (24), p.1-232
• Main Authors: Hubbard, Gill, Munro, Julie, O’Carroll, Ronan, Mutrie, Nanette, Kidd, Lisa, Haw, Sally, Adams, Richard, Watson, Angus JM, Leslie, Stephen J, Rauchhaus, Petra, Campbell, Anna, Mason, Helen, Manoukian, Sarkis, Sweetman, Gillian, Treweek, Shaun
• Format: Article
• Language: English
• Subjects: bowel cancer; cancer rehabilitation; cardiac rehabilitation; colorectal cancer; feasibility study; physical activity; pilot trial; randomised controlled trial
• ISSN: 2050-4349; 2050-4357
• DOI: 10.3310/hsdr04240

Background: Colorectal cancer (CRC) survivors are not meeting the recommended physical activity levels associated with improving their chances of survival and quality of life. Rehabilitation could address this problem. Objectives: The aims of the Cardiac Rehabilitation In Bowel cancer study were to assess whether or not cardiac rehabilitation is a feasible and acceptable model to aid the recovery of people with CRC and to test the feasibility and acceptability of the protocol design. Design: Intervention testing and feasibility work (phase 1) and a pilot randomised controlled trial with embedded qualitative study (phase 2), supplemented with an economic evaluation. Randomisation was to cardiac rehabilitation or usual care. Outcomes were differences in objective measures of physical activity and sedentary behaviour, self-reported measures of quality of life, anxiety, depression and fatigue. Qualitative work involved patients and clinicians from both cancer and cardiac specialties. Setting: Three colorectal cancer wards and three cardiac rehabilitation facilities. Participants: Inclusion criteria were those who were aged > 18 years, had primary CRC and were post surgery. Results: Phase 1 (single site) – of 34 patient admissions, 24 (70%) were eligible and 4 (17%) participated in cardiac rehabilitation. Sixteen clinicians participated in an interview/focus group. Modifications to trial procedures were made for further testing in phase 2. Additionally, 20 clinicians in all three sites were trained in cancer and exercise, rating it as excellent. Phase 2 (three sites) – screening, eligibility, consent and retention rates were 156 (79%), 133 (67%), 41 (31%) and 38 (93%), respectively. Questionnaire completion rates were 40 (97.5%), 31 (75%) and 25 (61%) at baseline, follow-up 1 and follow-up 2, respectively. Forty (69%) accelerometer data sets were analysed; 20 (31%) were removed owing to invalid data. Qualitative study: CRC and cardiac patients and clinicians were interviewed. Key themes were benefits and barriers for people with CRC attending cardiac rehabilitation; generic versus disease-specific rehabilitation; key concerns of the intervention; and barriers to participation (CRC participants only). Economic evaluation: The average out-of-pocket expenses of attending cardiac rehabilitation were £50. The costs of cardiac rehabilitation for people with cancer are highly dependent on whether it involves accommodating additional patients in an already existing ser