Oncologist-Assisted Home Exercise Program for Advanced Colon Cancer Patients

描述(由申请人提供)：几个随机对照试验已经证明，运动可以使癌症患者的身体功能和症状受益。然而，很少有研究包括晚期疾病患者，随着更多治疗方法的开发，晚期疾病患者的寿命会更长。例如，随着最近多种新药在治疗转移性结直肠癌方面的发展，这些患者的总存活率几乎增加了两倍。运动可以帮助这些患者保持功能和控制症状，并促进他们的持续治疗，只要它是耐受的，并有效地控制疾病。这项拟议研究的目标是评估在综合癌症中心和社区肿瘤临床实践网络(CCOP)的背景下，以家庭为基础的运动干预对转移性和/或复发性结肠癌患者身体功能的影响的可行性和初步估计。该R21是为了收集数据以帮助计划大规模干预试验而提出的。R21的具体目标涉及与计划一项更大规模试验相关的三个领域：(1)效果大小：与注意力控制干预(放松训练)相比，我们的目标是估计运动干预对晚期结肠癌患者身体功能的主要结果(自我报告和操作测试)和症状的次要结果(疲劳、睡眠、疼痛、恶心、心理困扰)的影响大小；(2)可行性：拟议的研究将评估研究的可行性，包括患者依从性、计划实施、污染(例如，对照组给予的干预或锻炼程度)、患者满意度以及诊所工作人员对实施复杂性的评价。(3)理论：探索基于社会认知理论的运动依从性预测模型。我们将评估这些变量测量的心理测量学特征，估计运动干预对假设中介的影响，并探索模型变量与运动坚持性之间的关联。这项研究将招募在过去28天内开始新的化疗方案的不能切除的IV期或复发结肠癌(ECOG表现状态为0-1)的患者。参与者将被随机分配到两个手臂中的一个：(1)基于家庭的运动，包括用于监测行走的计步器和用于功能力量训练的阻力带；(2)使用横隔膜呼吸和引导可视化的放松训练。放松训练臂被纳入为注意力控制，因为拟议研究的许多结果，以及任何潜在的未来试验，都将依赖于自我报告。这两个研究小组都将收到M.D.安德森研究人员的印刷材料和电话咨询，以鼓励他们坚持这种行为，以及患者肿瘤医生关于锻炼或放松训练的重要性的信件和简短建议。参与者将在进入研究时和干预16周后完成问卷调查。他们还将在基线和16周时在诊所接受简短的体能测试。公共卫生相关性：这项研究的目标是收集关于运动干预对晚期结肠癌患者的有效性和可行性的初步信息。我们将评估与放松训练干预相比，运动干预是否会改善患者的身体功能和症状，其中患者接受电话咨询、肿瘤医生的建议、书面材料、DVD说明、计步器和阻力带。如果这种干预是有效的，它可以通过患者的肿瘤医生办公室提供给患者，并可能帮助他们在治疗期间更长的时间内保持日常生活能力和独立性。

DESCRIPTION (provided by applicant): Several randomized controlled trials have demonstrated that exercise can benefit cancer patients in terms of their physical functioning and symptoms. However, few studies have included patients with advanced disease, a group that is living longer with their disease as more treatments are developed. For example, with the recent development of multiple novel agents in the treatment of metastatic colorectal cancer, the overall survival of these patients has nearly tripled. Exercise may help these patients maintain function and manage symptoms, and facilitate their continuing therapy for as long as it is tolerated and effective in controlling disease. The goal of the proposed study is to assess the feasibility and develop preliminary estimates of effect size of a home- based exercise intervention on physical functioning of patients with metastatic and/or recurrent colon cancer in the setting of both a comprehensive cancer center and the community clinical oncology practice network (CCOP). This R21 is proposed to collect data to help plan for a large trial of the intervention. The specific aims of this R21 address three areas related to planning a larger trial: (1) Effect sizes: We aim to develop estimates of the effect size of the exercise intervention on the primary outcome of physical functioning (self-reported and performance tests) and the secondary outcomes of symptoms (fatigue, sleep, pain, nausea, psychological distress) of patients with advanced colon cancer, compared to an attention control intervention (relaxation training); (2) Feasibility: The proposed research will evaluate study feasibility, operationalized as patient adherence, program implementation, contamination (e.g., intervention given or extent of exercise in control group), patient satisfaction, and implementation complexity as rated by clinic staff. (3) Theory: To explore Social Cognitive Theory-based model of predictors of adherence to exercise. We will evaluate psychometric characteristics of the measures of these variables and estimate the effects of the exercise intervention on the hypothesized mediators, as well as explore associations between the model variables and exercise adherence. This study will recruit patients with unresectable stage IV or recurrent colon cancer (ECOG performance status 0-1) who have started a new chemotherapy regimen in the past 28 days. Participants will be randomized to one of two arms: (1) Home-based exercise including pedometers for monitoring walking and resistance bands for functional strength training; (2) Relaxation training using diaphragmatic breathing and guided visualization. The relaxation training arm is included as an attention control, since many of the outcomes for the proposed study, as well as any potential future trials, will rely on self-report. Both study arms will receive print materials and telephone counseling from M. D. Anderson study staff to encourage adherence to the behavior, as well as a letter and brief advice from the patient's oncologist about the importance of exercise or relaxation training. Participants will complete questionnaires when they enter the study and after 16 weeks of intervention. They also will undergo brief physical performance tests in the clinic at baseline and at 16 weeks. PUBLIC HEALTH RELEVANCE: The goal of this study is to gather preliminary information on the effectiveness and feasibility of an exercise intervention for patients with advanced colon cancer. We will assess whether an exercise intervention in which patients receive telephone counseling, advice from their oncologist, written materials, DVD instructions, and a pedometer and resistance bands improves the physical functioning and symptoms of patients, compared to a relaxation training intervention. If this intervention is effective, it could be provided to patients through their oncologist's office, and may help them maintain activities of daily living and independence for longer periods of time during treatment.