Healthy Eating and Active Lifestyle After Bowel Cancer: Feasibility of a Randomised Controlled Trial

Abstract

Background: Evidence from cohort studies indicates that a healthy lifestyle can improve cancer survival. However, evidence from randomised controlled trials is lacking. This study aimed to investigate the feasibility of HEAL ABC lifestyle intervention in patients after colorectal cancer (CRC) surgery and treatment. Methods: This was a mixed-methods, feasibility randomised controlled trial (RCT) based on World Cancer Research Fund Prevention Guidelines (WCRF/AICR), the Health Action Process Approach theory and Motivational Interviewing technique. Thirty-five participants were recruited and allocated to the usual care control group or a telephone-based intervention with printed resources and a website. Data on anthropometry, diet, physical activity, quality of life, and behaviour change were collected in both groups at baseline, three months post-intervention, and six-month follow-up. Data were analysed with Stata using means, confidence intervals and multiple regression model (V14, StataCorp LLC, College Station, TX). A subgroup of participants took part in in-depth interviews and framework analysis was used to analyse data. Results: Recruitment was challenging (35 recruited, 31 ineligible, 37 eligible but declined). In total, 34 participants completed the three months intervention (97% retention rate), and 31 (89%) completed six months follow up. The adherence to the intervention calls was 100%. The intervention was reported to be acceptable to participants. Participants suggested that three to six months after surgery or treatment is needed before they are ready to make lifestyle changes. Participants reported feeling left alone post-treatment and asked for further support with diet and exercise. Intervention met their needs with the content, guidance and kept them accountable towards their lifestyle goals. The WCRF/AICR score improved in the intervention group compared to control (R2 1.1, 95%CI 0.5 to 1.6, p=0.0001) at three months, and at six months (R2 0.9, 95%CI 0.1-1.7, p=0.03). The DQI-I score improved in the intervention group compared to control (R2 8.9, 95%CI 3.3 to 14.5, p=0.003) at three months, and at six months (R2 8.2, 95%CI 1.1 to 15.3, p=0.02). Total physical activity improved compared to baseline (R2 27.0, 95%CI 5.5 to 48.4, p=0.02), but no significant difference between groups was observed. Conclusion: New strategies are needed to recruit CRC survivors to RCTs. The HEAL ABC intervention was feasible to deliver, positively rated and reported as beneficial by participants, supporting them in healthy lifestyle changes after CRC.

Date of Award	11 Apr 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Sorrel Burden (Supervisor), Christopher Todd (Supervisor) & Anne Marie Sowerbutts (Supervisor)