A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors

Paul Little; Katherine Bradbury; Beth Stuart; Jane Barnett; Adele Krusche; Mary Steele; Elena Heber; Steph Easton; Kirsten A. Smith; Joanna Slodowska-Barabasz; Liz Payne; Teresa Corbett; Laura Wilde; Guiqong LIly Yao; Sebastien Pollet; Jazzine Smith; Judith Joseph; Megan Lawrence; Dankmar Böhning; Tara Cheetham-Blake; Diana Eccles; Claire Foster; Adam William Alfred Geraghty; Geraldine Leydon; Andre Matthias Müller; Richard D. Neal; Richard Osborne; Shanaya Rathod; Alison Richardson; Chloe Grimmett; Geoffrey Sharman; Roger Bacon; Lesley Turner; RIchard Stephens; Kirsty Rogers; James Raftery; Shihua Zhu; Karmpaul Singh; Frances Webley; Gareth Griffiths; Jaqui Nutall; Trudie  Chalder; Clare Wilkinson; Ella Watson; Lucy Yardley

doi:10.3399/BJGP.2023.0262

A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors

Paul Little
, Katherine Bradbury
, Beth Stuart
, Jane Barnett
, Adele Krusche
, Mary Steele
, Elena Heber
, Steph Easton
, Kirsten A. Smith
, Joanna Slodowska-Barabasz
, Liz Payne
, Teresa Corbett
, Laura Wilde
, Guiqong LIly Yao
, Sebastien Pollet
, Jazzine Smith
, Judith Joseph
, Megan Lawrence
, Dankmar Böhning
, Tara Cheetham-Blake

Diana Eccles, Claire Foster, Adam William Alfred Geraghty, Geraldine Leydon, Andre Matthias Müller, Richard D. Neal, Richard Osborne, Shanaya Rathod, Alison Richardson, Chloe Grimmett, Geoffrey Sharman, Roger Bacon, Lesley Turner, RIchard Stephens, Kirsty Rogers, James Raftery, Shihua Zhu , Karmpaul Singh, Frances Webley, Gareth Griffiths, Jaqui Nutall, Trudie Chalder, Clare Wilkinson, Ella Watson, Lucy Yardley

North Wales Medical School

University of Southampton
Oxford Brookes University
National University of Singapore
University of Exeter
Dorset Cancer Centre, Poole, UK.
Southern Health NHS Foundation Trust, Southampton, UK.
Public & Patient Inclusion
University of Calgary
Kings College London
University of Bristol

Research output: Contribution to journal › Article › peer-review

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Abstract

Background
Many cancer survivors following primary treatment have prolonged poor quality of life.
Aim. To determine the effectiveness of a bespoke digital intervention to support cancer survivors.
Design. Pragmatic parallel open randomised trial.
Setting. UK general practices.
Methods. People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed ‘generic’ digital NHS support (‘LiveWell’;n=906), 2) a bespoke complex digital intervention (‘Renewed’;n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) ‘Renewed-with-support’ (n=903): ‘Renewed’ with additional brief email and telephone support.
Results. Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n’s respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified.
Conclusion. Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs.

Original language	English
Journal	British Journal of General Practice
Early online date	20 Dec 2023
DOIs	https://doi.org/10.3399/BJGP.2023.0262
Publication status	E-pub ahead of print - 20 Dec 2023

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.3399/BJGP.2023.0262

RENEWED mainresultspaperBJGPcleanAccepted author manuscript, 427 KBLicence: CC BY

Cite this

Little, P., Bradbury, K., Stuart, B., Barnett, J., Krusche, A., Steele, M., Heber, E., Easton, S., Smith, K. A., Slodowska-Barabasz, J., Payne, L., Corbett, T., Wilde, L., Yao, G. LI., Pollet , S., Smith, J., Joseph, J., Lawrence, M., Böhning, D., ... Yardley, L. (2023). A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors. British Journal of General Practice. Advance online publication. https://doi.org/10.3399/BJGP.2023.0262

@article{6b5ea7ed69614dfcb20498675afc97b6,

title = "A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors",

abstract = "Background Many cancer survivors following primary treatment have prolonged poor quality of life. Aim. To determine the effectiveness of a bespoke digital intervention to support cancer survivors. Design. Pragmatic parallel open randomised trial. Setting. UK general practices. Methods. People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed {\textquoteleft}generic{\textquoteright} digital NHS support ({\textquoteleft}LiveWell{\textquoteright};n=906), 2) a bespoke complex digital intervention ({\textquoteleft}Renewed{\textquoteright};n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) {\textquoteleft}Renewed-with-support{\textquoteright} (n=903): {\textquoteleft}Renewed{\textquoteright} with additional brief email and telephone support. Results. Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n{\textquoteright}s respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95\% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified. Conclusion. Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs. ",

author = "Paul Little and Katherine Bradbury and Beth Stuart and Jane Barnett and Adele Krusche and Mary Steele and Elena Heber and Steph Easton and Smith, \{Kirsten A.\} and Joanna Slodowska-Barabasz and Liz Payne and Teresa Corbett and Laura Wilde and Yao, \{Guiqong LIly\} and Sebastien Pollet and Jazzine Smith and Judith Joseph and Megan Lawrence and Dankmar B{\"o}hning and Tara Cheetham-Blake and Diana Eccles and Claire Foster and Geraghty, \{Adam William Alfred\} and Geraldine Leydon and M{\"u}ller, \{Andre Matthias\} and Neal, \{Richard D.\} and Richard Osborne and Shanaya Rathod and Alison Richardson and Chloe Grimmett and Geoffrey Sharman and Roger Bacon and Lesley Turner and RIchard Stephens and Kirsty Rogers and James Raftery and Shihua Zhu and Karmpaul Singh and Frances Webley and Gareth Griffiths and Jaqui Nutall and Trudie Chalder and Clare Wilkinson and Ella Watson and Lucy Yardley",

year = "2023",

month = dec,

day = "20",

doi = "10.3399/BJGP.2023.0262",

language = "English",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

}

Little, P, Bradbury, K, Stuart, B, Barnett, J, Krusche, A, Steele, M, Heber, E, Easton, S, Smith, KA, Slodowska-Barabasz, J, Payne, L, Corbett, T, Wilde, L, Yao, GLI, Pollet , S, Smith, J, Joseph, J, Lawrence, M, Böhning, D, Cheetham-Blake, T, Eccles, D, Foster, C, Geraghty, AWA, Leydon, G, Müller, AM, Neal, RD, Osborne, R, Rathod, S, Richardson, A, Grimmett, C, Sharman, G, Bacon, R, Turner, L, Stephens, RI, Rogers, K, Raftery, J, Zhu , S, Singh, K, Webley, F, Griffiths, G, Nutall, J, Chalder, T, Wilkinson, C, Watson, E & Yardley, L 2023, 'A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors', British Journal of General Practice. https://doi.org/10.3399/BJGP.2023.0262

TY - JOUR

T1 - A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors

AU - Little, Paul

AU - Bradbury, Katherine

AU - Stuart, Beth

AU - Barnett, Jane

AU - Krusche, Adele

AU - Steele, Mary

AU - Heber, Elena

AU - Easton, Steph

AU - Smith, Kirsten A.

AU - Slodowska-Barabasz, Joanna

AU - Payne, Liz

AU - Corbett, Teresa

AU - Wilde, Laura

AU - Yao, Guiqong LIly

AU - Pollet , Sebastien

AU - Smith, Jazzine

AU - Joseph, Judith

AU - Lawrence, Megan

AU - Böhning, Dankmar

AU - Cheetham-Blake, Tara

AU - Eccles, Diana

AU - Foster, Claire

AU - Geraghty, Adam William Alfred

AU - Leydon, Geraldine

AU - Müller, Andre Matthias

AU - Neal, Richard D.

AU - Osborne, Richard

AU - Rathod, Shanaya

AU - Richardson, Alison

AU - Grimmett, Chloe

AU - Sharman, Geoffrey

AU - Bacon, Roger

AU - Turner, Lesley

AU - Stephens, RIchard

AU - Rogers, Kirsty

AU - Raftery, James

AU - Zhu , Shihua

AU - Singh, Karmpaul

AU - Webley, Frances

AU - Griffiths, Gareth

AU - Nutall, Jaqui

AU - Chalder, Trudie

AU - Wilkinson, Clare

AU - Watson, Ella

AU - Yardley, Lucy

PY - 2023/12/20

Y1 - 2023/12/20

N2 - Background Many cancer survivors following primary treatment have prolonged poor quality of life. Aim. To determine the effectiveness of a bespoke digital intervention to support cancer survivors. Design. Pragmatic parallel open randomised trial. Setting. UK general practices. Methods. People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed ‘generic’ digital NHS support (‘LiveWell’;n=906), 2) a bespoke complex digital intervention (‘Renewed’;n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) ‘Renewed-with-support’ (n=903): ‘Renewed’ with additional brief email and telephone support. Results. Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n’s respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified. Conclusion. Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs.

AB - Background Many cancer survivors following primary treatment have prolonged poor quality of life. Aim. To determine the effectiveness of a bespoke digital intervention to support cancer survivors. Design. Pragmatic parallel open randomised trial. Setting. UK general practices. Methods. People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed ‘generic’ digital NHS support (‘LiveWell’;n=906), 2) a bespoke complex digital intervention (‘Renewed’;n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) ‘Renewed-with-support’ (n=903): ‘Renewed’ with additional brief email and telephone support. Results. Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n’s respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified. Conclusion. Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs.

U2 - 10.3399/BJGP.2023.0262

DO - 10.3399/BJGP.2023.0262

M3 - Article

SN - 0960-1643

JO - British Journal of General Practice

JF - British Journal of General Practice

ER -

A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors

Abstract

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