Background

Cost-effectiveness is important in the prioritisation between interventions in health care. Exercise is cost-effective compared to usual care during oncological treatment; however, the significance of exercise intensity to the cost-effectiveness is unclear. In the present study, we aimed to evaluate the long-term cost-effectiveness of the randomised controlled trial Phys-Can, a six-month exercise programme of high (HI) or low-to-moderate intensity (LMI) during (neo)adjuvant oncological treatment.

Methods

A cost-effectiveness analysis was performed, based on 189 participants with breast, colorectal, or prostate cancer (HI: n = 99 and LMI: n = 90) from the Phys-Can RCT in Sweden. Costs were estimated from a societal perspective, and included cost of the exercise intervention, health care utilisation and productivity loss. Health outcomes were assessed as quality-adjusted life-years (QALYs), using EQ-5D-5L at baseline, post intervention and 12 months after the completion of the intervention.

Results

At 12-month follow-up after the intervention, the total cost per participant did not differ significantly between HI (€27,314) and LMI exercise (€29,788). There was no significant difference in health outcome between the intensity groups. On average HI generated 1.190 QALYs and LMI 1.185 QALYs. The mean incremental cost-effectiveness ratio indicated that HI was cost effective compared with LMI, but the uncertainty was large.

Conclusions

We conclude that HI and LMI exercise have similar costs and effects during oncological treatment. Hence, based on cost-effectiveness, we suggest that decision makers and clinicians can consider implementing both HI and LMI exercise programmes and recommend either intensity to the patients with cancer during oncological treatment to facilitate improvement of health.

BackgroundResistance exercise has a beneficial impact on physical function for patients receiving oncological treatment. However, there is an inter-individual variation in the response to exercise and the tolerability to high-intensity exercise. Identifying potential moderating factors, such as inflammation and treatment type, for changes in muscle strength is important to improve the effectiveness of exercise programs. Therefore, we aimed to investigate if inflammation and type of oncological treatment moderate the effects of exercise intensity (high vs. low-moderate) on muscular strength changes in patients with breast (BRCA) or prostate cancer (PRCA).MethodsParticipants with BRCA (n = 286) and PRCA (n = 65) from the Physical training and Cancer study (Phys-Can) were included in the present study. Participants performed a combined resistance- and endurance exercise program during six months, at either high or low-moderate intensity. Separate regression models were estimated for each cancer type, with and without interaction terms. Moderators included in the models were treatment type (i.e., neo/adjuvant chemotherapy-yes/no for BRCA, adjuvant androgen deprivation therapy (ADT)-yes/no for PRCA)), and inflammation (interleukin 6 (IL6) and tumor necrosis factor-alpha (TNF alpha)) at follow-up.ResultsFor BRCA, neither IL6 (b = 2.469, 95% CI [- 7.614, 12.552]) nor TNF alpha (b = 0.036, 95% CI [- 6.345, 6.418]) levels moderated the effect of exercise intensity on muscle strength change. The same was observed for chemotherapy treatment (b = 4.893, 95% CI [- 2.938, 12.724]). Similarly, for PRCA, the effect of exercise intensity on muscle strength change was not moderated by IL6 (b = - 1.423, 95% CI [- 17.894, 15.048]) and TNF alpha (b = - 1.905, 95% CI [- 8.542, 4.732]) levels, nor by ADT (b = - 0.180, 95% CI [- 11.201, 10.841]).ConclusionsThe effect of exercise intensity on muscle strength is not moderated by TNF alpha, IL6, neo/adjuvant chemotherapy, or ADT, and therefore cannot explain any intra-variation of training response regarding exercise intensity (e.g., strength gain) for BRCA or PRCA in this setting.Trial registration: ClinicalTrials.gov NCT02473003.

BackgroundEnterocutaneous fistula is a rare but complex and serious condition that is both physically and psychologically demanding for the person affected. Infection, fistula dressing problems, electrolyte and fluid imbalance and malnutrition render the individual in need of long periods of in-hospital care and homecare. This place great demands on patients, families, and healthcare professionals. More research is needed to bridge the gap between hospital and home-based healthcare services. AimTo explore healthcare professionals experiences of providing care for patients with enterocutaneous fistula in hospital and in homecare. Material and methodsA qualitative descriptive study design based on five focus group interviews involving 20 healthcare professionals. Data was analysed using content analysis. ResultsThree categories with seven corresponding subcategories were developed; 1) Providing care for patients with enterocutaneous fistula in the hospital and at home was complex and time and resource consuming. Participants were struggling with practical issues and lacked disease-specific knowledge and skills; 2) Caring requires an integrated approach but it was challenging to work interprofessionally and cope with barriers in collaboration between providers; 3) Building long lasting relationships with patients and their families was fundamental to the caring process. Participants needed to hide their own feelings related to smell and appearance of the fistula as well as frustration when the fistula dressing did not hold without leaking. The healthcare professionals expressed that the involvement of the patient and their close family was important when proving care, likewise, to have a great understanding of the patients suffering. DiscussionThe care of patients with enterocutaneous fistula is complex and means engagement for long periods, both in hospital and in home-based healthcare. Regular team meetings of the multidisciplinary team, careful planning before discharge and providing person-centred care can facilitate the care process.

Aims and Objectives Illuminate meanings of living with [or close to someone with] an enterocutaneous fistula before and after reconstructive surgery. Background Enterocutaneous fistula is a serious condition affecting the well-being and social life of both patients and families, sometimes for several years. Design A longitudinal qualitative design. Methods Patients and families (n = 14) were followed with dyadic interviews at three occasions, conducted 2017-2020. The interviews were analysed with a phenomenological-hermeneutic approach. COREQ guidelines were followed. Result Living with an enterocutaneous fistula was explained as life being put on hold, while living in a bubble for an uncertain time. This bubble meant facing an unpredictable and restricted life where the dyads were forced to take control over the situation despite being vulnerable inside, striving to resume normality. The patients dealt with never-ending symptoms such as leakage from the fistula, pain and fatigue, while the family supported with practical matters and just being close. Dependency on intravenous fluids resulted in social isolation, which caused mode swings and depressiveness. In this situation, healthcare professionals often became a substitute for other interactions, but the lack of understanding about the dyads situation, affected their trust in the healthcare. Despite all, they still had belief in the future, the patients having higher expectations than the family. Conclusions Living with an enterocutaneous fistula meant a daily life struggling with many limitations. This implies that the transition was associated with difficulties and the dyads strived to accept their situation. Relevance to Clinical Practice The findings indicate that these patients must be cared for with a multidisciplinary approach. A person-centred health plan could impact on the dyads feeling of control and thereby making them less dependent on healthcare. Every patient should have their own contact nurse and be offered psychological support. No Patient or Public Contribution Not applicable due to the current method.

Aims and Objectives Interaction between caller and telenurse in telenursing is important for caller satisfaction and subsequent compliance. Despite this, satisfaction measures with focus on interaction in telenursing are scarce and rarely anchored in nursing theory. The aim was to evaluate the psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS) with focus on data quality, factor structure, convergent validity, and reliability.Methodological Design and Justification This psychometric study was based on cross-sectional data.Research Methods, Instruments, and/or Interventions Callers to the National Medical Advisory Service in Sweden (n = 616) completed the 60-item Telenursing Interaction and Satisfaction Questionnaire based on Coxs Interaction Model of Client Health Behavior. Twenty-five of these items were selected to form the TISS in four subscales according to the model. Data quality was evaluated in terms of missing data patterns and score distributions. The factor structure was evaluated with confirmatory factor analysis for ordinal data, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test-retest reliability with intraclass correlations.Results The amount of missing data was acceptable and equally distributed. Data deviated significantly from a normal distribution. All response options were endorsed. The factor analysis confirmed the hypothesised four-factor structure; factor loadings ranged from 0.56 to 0.97 and factor correlations were high (0.88-0.96). Internal consistency (ordinal alpha = 0.82-0.97), scale reliability (0.88-0.99), and test-retest reliability (ICC = 0.77-0.86) were satisfactory for all scales.Study Limitations The study design did not allow drop-out analysis.Conclusions The TISS showed satisfactory psychometric properties in the study sample. It provides a measure that enables quantitative measurement of caller satisfaction with interaction in telenursing.

Aims and objectives The aim of this study was to explore caller satisfaction with interaction, and the association to overall satisfaction with calls. Background In the era of expanding healthcare at distance, the telephone remains a common tool for the provision of nursing care. Interaction between telenurse and caller in telenursing is vital for safety, satisfaction and adherence reasons. Few studies have quantitatively explored interaction in calls and how it relates to overall satisfaction with calls. Design Cross-sectional survey study with a deductive approach. Methods A total of 466 callers to the Swedish Medical Advisory Service completed the Telenursing Interaction and Satisfaction Questionnaire. Satisfaction with four theoretically defined components of interaction were compared using repeated measures ANOVA. Associations between satisfaction with interaction and overall satisfaction with calls were evaluated with ordinal logistic regression models with and without adjustment for age, sex, health status, waiting time, time for call, main result of the call and expectations. The study followed the STROBE checklist. Results Callers were most satisfied with affective support, followed by professional-technical competence, health information and decisional control-in that order. A summated score of satisfaction with interaction was positively and significantly associated with overall satisfaction with calls before and after adjustment for waiting time, main result of call and variables related to the individual caller. Conclusions Caller satisfaction with interaction is generally high but can be improved, especially regarding decisional control. Satisfaction with interaction is important for overall satisfaction with calls. Relevance to clinical practice This study provides support for professionals at all levels in telenursing organisations to pay attention to interactional matters. The development of best practice for telenurses needs to consider all four components of interaction to enhance satisfaction with calls.

Purpose:While moderate-to-vigorous intensity physical activity (MVPA) is associated with various health improvements shortly after completion of exercise interventions, it remains unclear which health benefits can be expected when MVPA levels are maintained in the long term in cancer survivors. We aimed to assess the associations of (1) MVPA level at 12-month follow-up and (2) long-term MVPA patterns (from immediately post-intervention to 12-month follow-up) with different cancer-related health outcomes. Methods:In the Physical training and Cancer (Phys-Can) RCT, 577 participants diagnosed with breast (78%), prostate (19%), or colorectal (3%) cancer were randomized to 6 months of exercise during curative cancer treatment. Accelerometer-assessed physical activity and outcome data (ie, cancer-related fatigue, health-related quality of life [HRQoL], anxiety and depression, functioning in daily life, cardiorespiratory fitness, sedentary time and sleep) were collected immediately post-intervention and at 12-month follow-up. Based on the samples median of MVPA immediately post-intervention (65 minutes/day) and the changes between the 2 measurement points, 4 categories with different long-term MVPA patterns were created: High & Increasing, High & Decreasing, Low & Increasing, and Low & Decreasing. Multiple linear regression analyses were performed for the analyses. Results:A total of 353 participants were included in the analyses. At 12-month follow-up, a higher MVPA level was significantly associated with lower fatigue in 3 domains (general fatigue [& beta; = -.33], physical fatigue [& beta; = -.53] and reduced activity [& beta; = -.37]), higher cardiorespiratory fitness (& beta; = .34) and less sedentary time (& beta; = -.35). For long-term MVPA patterns, compared to the participants in the "Low & Decreasing" category, those in the "High & Increasing" category reported significantly lower fatigue in 3 domains (general fatigue [& beta; = -1.77], physical fatigue [& beta; = -3.36] and reduced activity [& beta; = -1.58]), higher HRQoL (& beta; = 6.84) and had less sedentary time (& beta; = -1.23). Conclusion:Our results suggest that long-term physical activity is essential for improving health outcomes post-intervention in cancer survivors. Cancer survivors, including those who reach recommended MVPA levels, should be encouraged to maintain or increase MVPA post-intervention for additional health benefits.

PurposeWe aimed to investigate the effects of reallocating sedentary time to an equal amount of light (LPA) or moderate-to-vigorous intensity physical activity (MVPA) on cancer-related fatigue and health-related quality of life (HRQoL) in patients with breast cancer. We also aimed to determine the daily amount of sedentary time needed to be reallocated to LPA or MVPA to produce minimal clinically important changes in these outcomes.MethodsPooled baseline data from three studies were used, including women with breast cancer who participated in the Phys-Can project. Fatigue was assessed with the Multidimensional Fatigue Inventory questionnaire (MFI; five dimensions, 4-20 scale) and HRQoL with the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30; 0-100 scale). Sedentary time and physical activity were measured with accelerometry. Isotemporal substitution modelling was used for the analyses.ResultsOverall, 436 participants (mean age 56 years, fatigue 11 [MFI], HRQoL 66 [EORTC QLQ-C30], LPA 254 min/day, MVPA 71 min/day) were included. Fatigue significantly decreased in two MFI dimensions when reallocating 30 min/day of sedentary time to LPA: reduced motivation and reduced activity (beta = - 0.21). Fatigue significantly decreased in three MFI dimensions when reallocating 30 min/day of sedentary time to MVPA: general fatigue (beta = - 0.34), physical fatigue (beta = - 0.47) and reduced activity (beta = - 0.48). To produce minimal clinically important changes in fatigue (- 2 points on MFI), the amount of sedentary time needed to be reallocated to LPA was approximate to 290 min/day and to MVPA was >= 125 min/day. No significant effects were observed on HRQoL when reallocating sedentary time to LPA or MVPA.ConclusionsOur results suggest that reallocating sedentary time to LPA or MVPA has beneficial effects on cancer-related fatigue in patients with breast cancer, with MVPA having the greatest impact. In relatively healthy and physically active breast cancer populations, a large amount of time reallocation is needed to produce clinically important changes. Future studies are warranted to evaluate such effects in broader cancer populations.