Feasibility study to assess the impact of a lifestyle intervention (‘LivingWELL’) in people having an assessment of their family history of colorectal or breast cancer

Anderson, Annie S.; Dunlop, J.; Gallant, Stephanie; Macleod, Maureen; Miedzybrodzka, Zosia; Mutrie, Nanette; O’Carroll, Ronan E.; Stead, Martine; Steele, Robert; Taylor, Rod S; Vinnicombe, Sarah; Berg, Jonathan

doi:10.1136/bmjopen-2017-019410

Cited by 26 publications

(53 citation statements)

References 31 publications

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“…Though modifiable environmental risk factors such as weight and exercise80 are common to both sporadic and familial CRC, individuals with familial risk may benefit from discussion about modifiable factors in order to potentially reduce their level of risk 81 82. There is emerging evidence of the benefit of targeted lifestyle modification in those with an FHCC 83…”

Section: Prevention and Lifestyle Modification In Familial Crcmentioning

confidence: 99%

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Monahan

Bradshaw²,

Dolwani

et al. 2019

Gut

282

294

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Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual’s lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.

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Section: Prevention and Lifestyle Modification In Familial Crcmentioning

confidence: 99%

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Monahan

Bradshaw²,

Dolwani

et al. 2019

Gut

282

294

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“…These findings also highlight the importance of lifestyle advice versus discussion of single variables. Our recent pilot trial of a lifestyle intervention in patients referred to family history clinics , suggesting that a lifestyle programme for people with a family history of cancer is feasible to conduct and acceptable to participants, and the indicative results suggest favourable outcomes. However, post intervention interviews with participants highlighted the importance of providing a credible rationale for lifestyle change, which underlines the need for health professionals working in this area to introduce and endorse the importance of a range of risk factors in multicomponent interventions.…”

Section: Discussionmentioning

confidence: 94%

Lifestyle in patients at increased risk of colorectal cancer

Anderson

Caswell

Mowat

et al. 2019

J Human Nutrition Diet

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Background The present study aimed to assess modifiable risk factors in patients at high risk for colorectal cancer (CRC) and their experience of lifestyle advice. Methods A questionnaire study was conducted in high‐risk CRC patients attending for surveillance colonoscopy. Current lifestyle behaviours [smoking, alcohol, diet (fruit and vegetables, wholegrains, red meat, processed meat), physical activity and bodyweight] related to CRC were ascertained, and experience on receiving, seeking and desire for advice was queried. Results In total, 385 study invitations were sent and 208 (54%) questionnaires were returned. The majority of participants (72%) were estimated to have a body mass index beyond the healthy range, 89% achieved a fibre score indicative of a low plant‐based diet and 91% reported eating processed meat. Overall, 36% were achieving at least four recommendations and 2% were adhering to all recommendations examined. The main area in which participants reported receiving advice on was body weight (33%) and 31% reported that they had personally sought information on this topic, although the data suggest that 72% of people may benefit from such guidance. Fewer participants reported receiving (18–26%) and seeking (15–17%) dietary advice on fruits, vegetables and wholegrains. Many participants said they would find lifestyle information useful, notably in relation to body fatness (43%) and physical activity (38%). Conclusions The development of a process for supporting lifestyle change in this patient group, comprising individuals who are already engaging in positive health practices (regular colonoscopy surveillance), could usefully be identified and tested.

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“…While our recent intervention study 40 has tested the feasibility of undertaking lifestyle interventions in people at high risk of colorectal (and breast) cancer, this study (to the best of our knowledge) is the first to have offered a comprehensive lifestyle intervention at diagnosis with support before, during and after treatment in patients with colorectal cancer. Although the study is small and was undertaken in a single NHS health board, the results have highlighted a wide range of issues that would need to be addressed in a full trial of a multicomponent intervention.…”

Section: Discussionmentioning

confidence: 99%

Feasibility study to assess the delivery of a lifestyle intervention (TreatWELL) for patients with colorectal cancer undergoing potentially curative treatment

et al. 2018

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ObjectivesTo assess the feasibility of delivering and evaluating a lifestyle programme for patients with colorectal cancer undergoing potentially curative treatments.Study designNon-randomised feasibility trial.SettingNational Health Service (NHS) Tayside.ParticipantsAdults with stage I–III colorectal cancer.InterventionThe programme targeted smoking, alcohol, physical activity, diet and weight management. It was delivered in three face-to-face counselling sessions (plus nine phone calls) by lifestyle coaches over three phases (1: presurgery, 2: surgical recovery and 3: post-treatment recovery).Primary outcomeFeasibility measures (recruitment, retention, programme implementation, achieved measures, fidelity, factors affecting protocol adherence and acceptability).Secondary outcomesMeasured changes in body weight, waist circumference, walking and self-reported physical activity, diet, smoking, alcohol intake, fatigue, bowel function and quality of life.ResultsOf 84 patients diagnosed, 22 (26%) were recruited and 15 (18%) completed the study. Median time for intervention delivery was 5.5 hours. Coaches reported covering most (>70%) of the intervention components but had difficulties during phase 2. Evaluation measures (except walk test) were achieved by all participants at baseline, and most (<90%) at end of phase 2 and phase 3, but <20% at end of phase 1. Protocol challenges included limited time between diagnosis and surgery and the presence of comorbidities. The intervention was rated highly by participants but limited support from NHS staff was noted. The majority of participants (77%) had a body mass index>25 kg/m2 and none was underweight. Physical activity data showed a positive trend towards increased activity overall, but no other changes in secondary outcomes were detected.ConclusionsTo make this intervention feasible for testing as a full trial, further research is required on (a) recruitment optimisation, (b) appropriate assessment tools, (c) protocols for phase 2 and 3, which can build in flexibility and (d) ways for NHS staff to facilitate the programme.Trial registration numberISRCTN52345929; Post-results.

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Feasibility study to assess the impact of a lifestyle intervention (‘LivingWELL’) in people having an assessment of their family history of colorectal or breast cancer

Cited by 26 publications

References 31 publications

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Lifestyle in patients at increased risk of colorectal cancer

Feasibility study to assess the delivery of a lifestyle intervention (TreatWELL) for patients with colorectal cancer undergoing potentially curative treatment

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