Lifestyle coaching is feasible in fatigued brain tumor patients: A phase I/feasibility, multi-center, mixed-methods randomized controlled trial

Alasdair G Rooney; William Hewins; Amie Walker; Mairi Mackinnon; Lisa Withington; Sara Robson; Claire Torrens; Lisa E M Hopcroft; Antony Clark; Garry Anderson; Helen Bulbeck; Joanna Dunlop; Michelle Welsh; Aimee Dyson; Julie Emerson; Carol Cochrane; Robert Hill; Jade Carruthers; Julia Day; David Gillespie; Christopher Hewitt; Emanuela Molinari; Mary Wells; Catherine McBain; Anthony J Chalmers; Robin Grant

doi:10.1093/nop/npac086

Lifestyle coaching is feasible in fatigued brain tumor patients: A phase I/feasibility, multi-center, mixed-methods randomized controlled trial

Neurooncol Pract. 2022 Oct 14;10(3):249-260. doi: 10.1093/nop/npac086. eCollection 2023 Jun.

Authors

Alasdair G Rooney^{1

2

3}, William Hewins^{1

3}, Amie Walker^{1

4}, Mairi Mackinnon⁴, Lisa Withington⁵, Sara Robson⁵, Claire Torrens⁶, Lisa E M Hopcroft⁷, Antony Clark⁷, Garry Anderson⁸, Helen Bulbeck⁹, Joanna Dunlop^{7

10

3}, Michelle Welsh^{7

11}, Aimee Dyson⁵, Julie Emerson⁵, Carol Cochrane⁹, Robert Hill⁷, Jade Carruthers⁷, Julia Day^{7

10

3}, David Gillespie^{1

3}, Christopher Hewitt¹², Emanuela Molinari¹³, Mary Wells^{7

14}, Catherine McBain⁵, Anthony J Chalmers^{4

13}, Robin Grant^{1

3}

Affiliations

¹ Centre for Clinical Brain Sciences, University of Edinburgh, UK.
² The Robert Fergusson Unit, Royal Edinburgh Hospital, Edinburgh, UK.
³ Department of Clinical Neurosciences, Edinburgh Centre for Neuro-Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK.
⁴ Neuro-Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK.
⁵ Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
⁶ Nursing, Midwifery, and Allied Health Professions Research Unit, University of Stirling, Stirling, UK.
⁷ Scottish Clinical Trials Research Unit (SCTRU), Public Health Scotland, Edinburgh, UK.
⁸ V3 Health, Linlithgow, UK.
⁹ brainstrust, the Brain Cancer People, UK.
¹⁰ Community Rehabilitation and Brain Injury Service, Livingston, UK.
¹¹ Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK.
¹² Clinical Health Psychology, Astley-Ainslie Hospital, Edinburgh, UK.
¹³ Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK.
¹⁴ Imperial College Healthcare NHS Trust, London, UK.

Abstract

Background: There are no effective treatments for brain tumor-related fatigue. We studied the feasibility of two novel lifestyle coaching interventions in fatigued brain tumor patients.

Methods: This phase I/feasibility multi-center RCT recruited patients with a clinically stable primary brain tumor and significant fatigue (mean Brief Fatigue Inventory [BFI] score ≥ 4/10). Participants were randomized in a 1-1-1 allocation ratio to: Control (usual care); Health Coaching ("HC", an eight-week program targeting lifestyle behaviors); or HC plus Activation Coaching ("HC + AC", further targeting self-efficacy). The primary outcome was feasibility of recruitment and retention. Secondary outcomes were intervention acceptability, which was evaluated via qualitative interview, and safety. Exploratory quantitative outcomes were measured at baseline (T0), post-interventions (T1, 10 weeks), and endpoint (T2, 16 weeks).

Results: n = 46 fatigued brain tumor patients (T0 BFI mean = 6.8/10) were recruited and 34 were retained to endpoint, establishing feasibility. Engagement with interventions was sustained over time. Qualitative interviews (n = 21) suggested that coaching interventions were broadly acceptable, although mediated by participant outlook and prior lifestyle. Coaching led to significant improvements in fatigue (improvement in BFI versus control at T1: HC=2.2 points [95% CI 0.6, 3.8], HC + AC = 1.8 [0.1, 3.4], Cohen's d [HC] = 1.9; improvement in FACIT-Fatigue: HC = 4.8 points [-3.7, 13.3]; HC + AC = 12 [3.5, 20.5], d [HC and AC] = 0.9). Coaching also improved depressive and mental health outcomes. Modeling suggested a potential limiting effect of higher baseline depressive symptoms.

Conclusions: Lifestyle coaching interventions are feasible to deliver to fatigued brain tumor patients. They were manageable, acceptable, and safe, with preliminary evidence of benefit on fatigue and mental health outcomes. Larger trials of efficacy are justified.

Keywords: RCT; brain tumor; coaching; fatigue; lifestyle.

Abstract

Grants and funding