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Trial registered on ANZCTR


Registration number
ACTRN12619001550190
Ethics application status
Approved
Date submitted
20/09/2019
Date registered
11/11/2019
Date last updated
11/11/2019
Date data sharing statement initially provided
11/11/2019
Date results information initially provided
11/11/2019
Type of registration
Retrospectively registered

Titles & IDs
Public title
Preoperative exercise intervention for individuals with early stage non-small cell lung cancer undergoing lung surgery
Scientific title
Safety and feasibility of Prehabilitation for individuals having lung cancer surgery: a pilot randomised control trial
Secondary ID [1] 299364 0
nil known
Universal Trial Number (UTN)
U1111-1240-7449
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Suspected stage I-IIIA non-small cell lung cancer (NSCLC) 314521 0
Condition category
Condition code
Cancer 312867 312867 0 0
Lung - Non small cell
Physical Medicine / Rehabilitation 313060 313060 0 0
Physiotherapy

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Intervention (Prehabilitation group):
Participants allocated to the intervention group will receive a prehabilitation program prior to surgery. This includes resistance (free weights/ resistance band exercises for upper limb and lower limb) and aerobic training (walking, bike or treadmill) of moderate intensity designed and supervised by an experienced thoracic physiotherapist using exercise training principles. For between 1-4 weeks preoperatively, intervention participants will receive;
- hospital based supervised gym sessions (3x week, each 45 min duration), one-on-one
- individualised home exercise program on days not attending hospital-based gym sessions
and education regarding a home exercise program (exercise booklet + resistance exercise band designed specifically for this study)
- 1-2 home visits
- weekly phone calls to encourage home adherence
- education: including lay information about lung cancer, the importance of staying active, diet and symptom control (e.g. breathlessness) given verbally in the initial consultation by the trial physiotherapist. This education will be provided once on the initial consultation, duration of the session will be approximately 15 minutes.
- an exercise diary to record weekly exercise sessions

The intervention will be individualised such that participants who opt not to attend the hospital gym sessions will be prescribed an exercise program (minimum 3x/week, 45min duration each session) to complete in their home with telephone and home visit follow-up. Participants will be given a stationary bike to use whilst exercising at home (if they do not already have one). Exercise intensity will be tailored to the individual and will utilise the BORG scale to monitor/progress as appropriate.

The last exercise session for the intervention group will occur in the days preceding the surgery and may differ for each participant (dependant on the day of surgery). Exercise sessions are flexible in that they can be completed on subsequent or alternate days, at the discretion of the participant.

Participants will receive standard post-operative care consisting of a thoracic surgery clinical pathway.
Intervention code [1] 315629 0
Rehabilitation
Intervention code [2] 315743 0
Treatment: Other
Comparator / control treatment
Control (no prehabilitation group):
Participants allocated to the control group will not undergo prehabilitation prior to surgery and instead will receive standard care (no exercise or preoperative physiotherapy).
Participants will receive standard post-operative care consisting of a thoracic surgery clinical pathway.
Control group
Active

Outcomes
Primary outcome [1] 321477 0
Composite primary outcome: Feasibility
assessed as the number screened, number consenting (number of refusals), patient reported satisfaction with exercise program using semi-structured qualitative interviews (structured telephone interview of varying duration), adherence to program (number of gym/home exercise and home walking sessions completed out of the total available)
Timepoint [1] 321477 0
At conclusion of the prehabilitation program
Primary outcome [2] 321478 0
- Safety: study specific questionnaire documenting number of minor and major adverse events (fall/collapse, participant becomes acutely unwell, significant haemodynamic changes, new onset of chest pain, SpO2 < 85% or 10% drop below resting SpO2, respiratory rate > 35 breaths/min, participant temperature > 38 degrees) as reported by the trial researchers , length of time between surgical consult to recruitment and length of prehabilitation (days)
Timepoint [2] 321478 0
At conclusion of the prehabilitation program
Secondary outcome [1] 375067 0
Number and type of postoperative pulmonary complications (PPC) measured via the Melbourne Group Scale (MGS) version 2
Timepoint [1] 375067 0
Hospital discharge
Secondary outcome [2] 375068 0
Functional exercise capacity: measured via Incremental Shuttle Walk Test (ISWT), an externally paced walking test measuring exercise tolerance
Timepoint [2] 375068 0
Baseline
Preoperative (after prehabilitation)
Hospital Discharge
30-days post surgery
Secondary outcome [3] 375069 0
Muscle strength: measured via a hand-held dynamometer - a simple, quick measurement of muscle strength. Areas tested include; hand grip, rotation cuff strength (arm abduction) and quadriceps strength (knee extension)
Composite secondary outcome
Timepoint [3] 375069 0
Baseline
Preoperative (after prehabilitation)
Hospital discharge
30 days post surgery
Secondary outcome [4] 375070 0
Self reported Physical Activity Levels - measured via questionnaire - International Physical Activity Questionnaire (IPAQ)
Timepoint [4] 375070 0
Baseline
30-days post surgery
Secondary outcome [5] 375071 0
Health-related Quality of Life - measured via questionnaire - European Organisation for the Research and Treatment of Cancer Questionnaire lung cancer specific measurement tool (EORTC QLQ-C30-LC13)
Timepoint [5] 375071 0
Baseline
30-days post surgery
Secondary outcome [6] 375072 0
Mood - measured via questionnaire - Hospital Anxiety and Depression Questionnaire (HADS)
Timepoint [6] 375072 0
Baseline
Preoperatively (after prehabilitation)
Hospital discharge
30-days post surgery
Secondary outcome [7] 375573 0
Postoperative Length of Stay (LOS) - measured via data linkage to medical records
Timepoint [7] 375573 0
Hospital discharge

Eligibility
Key inclusion criteria
Inclusion criteria:
- suspected stage I-IIIA NSCLC presenting for surgical consult
- age > 18 years
- functional exercise capacity < 70% predicted (6MWT) (recruiting those who are most likely to benefit
- primary treating surgeon approval
Minimum age
18 Years
Maximum age
No limit
Gender
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Exclusion criteria:
- unstable psychiatric/cognitive disorder
- major comorbidities preventing participation in the exercise
- unable to give informed consent
- non-english speaking

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Following informed consent and baseline assessment, participants will be randomised 1:1 to either the intervention or control group. Randomisation will be remotely and independently performed using random number generation and stratified group allocation will be concealed.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using randomisation table created by computer software (computerised sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?


The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint(s)
Safety/efficacy
Statistical methods / analysis
The analysis will be by intention-to-treat principles: all randomised patients will have data collection until the end of the study or they withdraw, and all patients will be included in the analyses. Baseline characteristics will be summarised by group and reported as mean (SD) for normally distributed data, median (IQR) for non-normally distributed data or as proportions. Analysis of the primary outcome, feasibility and timing of the prehabilitation program, will involve reporting of the proportion of participants screened who consented, the proportion of exercise sessions prescribed which were performed, the number of minor or major adverse events, length of time to recruitment and length of prehabilitation.
Data from semi-structured interviews will be collated and summarised. Qualitative data will be transcribed verbatim, entered into a qualitative data management software program and thematic analyses undertaken to identify: program satisfaction, key barriers and facilitators of physical activity and factors impacting adherence over time.
Analyses of secondary outcomes immediately prior to surgery will be undertaken by two group comparison using either parametric or non-parametric (or bootstrapping) methods depending on assumptions of data. Analysis of the outcomes involving 4 time points will use linear mixed models in which the subject is a random effect and treatment group/time are fixed effects. Alpha will be set at 0.05 for all analyses and all tests will be two-sided.

Recruitment
Recruitment status
Stopped early
Data analysis
Data analysis is complete
Reason for early stopping/withdrawal
Participant recruitment difficulties
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
VIC
Recruitment hospital [1] 14846 0
St Vincent's Hospital (Melbourne) Ltd - Fitzroy
Recruitment postcode(s) [1] 28099 0
3065 - Fitzroy

Funding & Sponsors
Funding source category [1] 303882 0
Hospital
Name [1] 303882 0
St Vincents Hospital Melbourne
Address [1] 303882 0
41 Victoria Parade
Fitzroy, VIC 3065
Country [1] 303882 0
Australia
Primary sponsor type
Hospital
Name
St Vincents Hospital Melbourne
Address
Physiotherapy Department
41 Victoria Parade
Fitzroy, VIC 3065
Country
Australia
Secondary sponsor category [1] 304022 0
University
Name [1] 304022 0
The University of Melbourne
Address [1] 304022 0
Faculty of Medicine, Dentistry & Health Sciences
Physiotherapy
Level 7, Alan Gilbert Building
161 Barry Street
Victoria, 3010
Country [1] 304022 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 304386 0
St Vincents Hospital Melbourne Human Research Ethics Commitee
Ethics committee address [1] 304386 0
St Vincents Hospital Melbourne
PO Box 2900
41 Victoria Parade
Fitzroy, VIC 3065
Ethics committee country [1] 304386 0
Australia
Date submitted for ethics approval [1] 304386 0
Approval date [1] 304386 0
04/05/2015
Ethics approval number [1] 304386 0
HREC-A 022/15

Summary
Brief summary
Brief description of the study purpose:
This pilot study will examine the feasibility, safety and trends in effectiveness of providing a preoperative hospital and home-based rehabilitation program to individuals with stages I-IIIA Non-small cell lung cancer prior to surgery.
The primary aim is to assess the feasibility of the prehabilitation program. Secondary aims are to assess postoperative outcomes (postoperative pulmonary complications and acute hospital Length of stay). Other secondary outcomes include changes in functional exercise capacity, physical activity levels, anxiety and depression and health-related quality of life.

Who is it for?
You may be eligible to participate in the study if you are over 18 years of age, have suspected stage I-IIIA lung cancer and are presenting for surgery and have no major comorbidities which would make exercise difficult.

Study details:
Participants will be randomly allocated to intervention or control groups. The intervention consists of preoperative exercise training (aerobic and resistance) for 1-4 weeks prior to lung cancer surgery. The control group will receive standard care (consisting of no preoperative exercise or physiotherapy intervention).

It is hoped that this intervention will prove to be feasible and will improve postoperative outcomes, reduced hospital length of stay and improve the preoperative management of people with non-small cell lung cancer.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 96774 0
Mrs Anna Shukla
Address 96774 0
St Vincents Hospital Melbourne
41 Victoria Parade
Fitzroy, VIC 3065
Country 96774 0
Australia
Phone 96774 0
+613 92312211
Fax 96774 0
Email 96774 0
anna.shukla@svha.org.au
Contact person for public queries
Name 96775 0
Mrs Anna Shukla
Address 96775 0
St Vincents Hospital Melbourne
41 Victoria Parade
Fitzroy, VIC 3065
Country 96775 0
Australia
Phone 96775 0
+613 92312211
Fax 96775 0
Email 96775 0
anna.shukla@svha.org.au
Contact person for scientific queries
Name 96776 0
Mrs Anna Shukla
Address 96776 0
St Vincents Hospital Melbourne
41 Victoria Parade
Fitzroy, VIC 3065
Country 96776 0
Australia
Phone 96776 0
+613 92312211
Fax 96776 0
Email 96776 0
anna.shukla@svha.org.au

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
What data in particular will be shared?
Individual participant data underlying published results
When will data be available (start and end dates)?
Immediately following publication, no end date
Available to whom?
Access to data will be assessed on a case-by-case basis
Available for what types of analyses?
for any purpose
How or where can data be obtained?
Access to data can be obtained by connecting the principle investigator
(email: anna.shukla@svha.org.au)
What supporting documents are/will be available?
No other documents available
Summary results
Have study results been published in a peer-reviewed journal?
No
Other publications
Have study results been made publicly available in another format?
No
Results – basic reporting
Results – plain English summary
Twenty-four patients were included in the pilot - 11 patients were randomized to the prehabilitation group and 13 patients to the control group. The preoperative exercise intervention was safe and feasible, no adverse events were recorded. The mean (standard deviation) time from lung cancer diagnosis to surgery was 58.8 (25.9)days. The mean adherence to the exercise intervention was 95.6%. Patients reported satisfaction with the prehabilitation program and noticed improvements in strength, exercise capacity and symptoms. Barriers to prehabilitation included; patient comorbidities, travel, symptoms (fatigue, shortness of breath) and motivation. The intervention group demonstrated trends in decreased length of stay compared to the control group 6 days vs 8 days (95% CI -4, 5 p=0.473) however this was not significant. There were no other significant between group findings.