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Exercise during stem cell transplantation for haematological cancer - exploring the feasibility of embedding exercise within a clinical pathway in multiple myeloma

McCourt, Orla; (2022) Exercise during stem cell transplantation for haematological cancer - exploring the feasibility of embedding exercise within a clinical pathway in multiple myeloma. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

The benefit of physical activity during and after cancer treatment has been demonstrated. There is a growing evidence base indicating that structured exercise interventions delivered before and during cancer treatment (‘prehabilitation’) can have positive effects on physical and psychological wellbeing before, reduce deterioration during, and increase rate of recovery following treatment. There is emerging evidence for exercise prior to and during stem cell transplantation in haemato-oncology patients. Guidelines recommend prehabilitation and rehabilitation as integral components of the treatment pathway in multiple myeloma, for whom autologous stem cell transplantation (ASCT) is a preferred first line treatment. However, provision of rehabilitation and structured physical activity support is lacking in haemato-oncology clinical services in the United Kingdom. This thesis aimed to explore the feasibility of embedding exercise within haematooncology clinical pathways, with a focus on ASCT in multiple myeloma. It describes multimethods research that includes: feasibility and outcomes data from a pilot randomised controlled trial of a prehabilitation and rehabilitation intervention embedded within the multiple myeloma ASCT pathway; qualitative interview data on the experiences of myeloma patients who were approached for and declined or took part in exercise research after referral for ASCT; and data from a national survey of haematology health professionals on their beliefs and understanding of exercise during haemato-oncology treatment. Additionally, the impact of the COVID-19 pandemic, the adaptation of the pilot trial and how this allowed for evaluation of feasibility of both face-to-face and remotely delivered exercise support will be described. The pilot trial recruited 50 of 109 (46%) eligible participants with an attrition rate of 34%, mainly related to failure to undergo ASCT. Loss of follow-up for other reasons was low, with 33 of 39 (85%) participants who underwent ASCT completing an assessment at final timepoint. Secondary outcomes indicate benefit of physiotherapist-led exercise prior to, during and after ASCT with improvements in quality of life, fatigue, functional capacity and PA evident on admission for ASCT and 3 months post-ASCT. Eighteen people with myeloma (56% male, mean age 62 years) who declined participation in the trial and sixteen who took part in the trial were interviewed for the qualitative studies. Themes from analysis of the decliners’ study highlighted that travel was the most common reason for declining but it was more than a logistical challenge and that participants welcomed the personalised approach to being asked to participate in research but their recall of research information was variable. Other important findings included the impact of reduced physical activity due to treatment, that there is a lack of support to counteract this and that patients with myeloma may be underreporting common side-effects of treatment to their clinical teams because these are expected despite their impact on engagement in daily activities. Themes from analysis of the pilot trial completers study indicated both altruistic and personal motivations for participating and remaining in the trial but that allocation to control group brought about disappointment and may have led to contamination. There were also disparities in the experience of recovery from ASCT between those who took part in the intervention and those who did not. Participants also recalled the impact of diagnosis and early treatment on physical activity and that they saw exercise as important for preparation and recovery from ASCT. 156 health-professionals completed the survey study. Beliefs of health professionals regarding the role of physical activity during and after treatment for haematological cancer were generally positive. A third (31%) reported knowing relevant guidance related to physical activity for people with cancer and nearly half (47%) reported providing physical activity advice routinely to their patients. Those reporting familiarity with guidance were more likely to give advice. However, misalignment existed between guidelines and advice given by professionals to their patients. Findings from this thesis suggest that it is feasible to embed a prehabilitation and rehabilitation intervention into the myeloma ASCT pathway, indicating possible benefit and that health professionals and patients are accepting and supportive of greater physical activity support during and after haemato-oncology treatment.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Exercise during stem cell transplantation for haematological cancer - exploring the feasibility of embedding exercise within a clinical pathway in multiple myeloma
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10161730
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