Hybrid delivery of cluster-set resistance training for individuals previously treated for lung cancer: the results of a single-arm feasibility trial

BACKGROUND

Individuals with non-small cell lung cancer (NSCLC) are burdened by long-lasting symptoms (e.g., dyspnea and fatigue) post-treatment. These symptoms often reduce physical activity levels and increase the risk of functional decline. Though we have previously proposed cluster-set resistance training to mitigate symptom burden in lung cancer, there is currently no data on the feasibility or acceptability of this mode of exercise in cancer. Therefore, the purpose of this study was to investigate the feasibility and acceptability of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC stages I-III (i.e., early stage).

METHODS

This study aimed to recruit individuals with NSCLC stages I-III post-treatment to participate in 8 weeks of home-based resistance training, 3 days per week. The program included supervised sessions in the participants' homes and virtual supervision via videoconferencing. The primary outcome measure of feasibility was evaluated through recruitment, retention, and intervention fidelity (i.e., proportion of exercise completed, relative to what was prescribed). Intervention acceptability (i.e., ease and quality of virtual delivery, level of difficulty, and home-based approach) was assessed using a 4-point Likert-type scale from "strongly disagree" to "strongly agree".

RESULTS

Fourteen participants were recruited over a 6-month period, with 11 completing the intervention (2 withdrew due to unrelated illness, 1 withdrew due to requiring active treatment), yielding a retention rate of 79%. Characteristics of the participants who completed the intervention (n = 11) were as follows: mean age: 71 ± 10 years, mean BMI: 29.1 ± 6.5, and average time since diagnosis was 62 ± 51 months. Of completers, 27% were male, and 36% were Black; 10 were stage I (91%), and one was stage II (9%). Mean session attendance was 86.4 ± 9.5%. Mean intervention fidelity was 83.1 ± 13.1%. With regard to acceptability,  > 90% of participants positively rated all aspects of the intervention delivery. No adverse events related to exercise were recorded.

CONCLUSIONS

The hybrid delivery of a home-based resistance exercise program for individuals previously treated for early-stage NSCLC was found to be safe and feasible. Adaptations to the program for future interventions are required, particularly surrounding resistance exercise programming, and intervention delivery with home visits.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05014035 . Registered January 20, 2021.

Key takeaways for knowledge expansion of early-career scientists conducting Transdisciplinary Research in Energetics and Cancer (TREC): a report from the TREC Training Workshop 2022

The overall goal of the annual Transdisciplinary Research in Energetics and Cancer (TREC) Training Workshop is to provide transdisciplinary training for scientists in energetics and cancer and clinical care. The 2022 Workshop included 27 early-to-mid career investigators (trainees) pursuing diverse TREC research areas in basic, clinical, and population sciences. The 2022 trainees participated in a gallery walk, an interactive qualitative program evaluation method, to summarize key takeaways related to program objectives. Writing groups were formed and collaborated on this summary of the 5 key takeaways from the TREC Workshop. The 2022 TREC Workshop provided a targeted and unique networking opportunity that facilitated meaningful collaborative work addressing research and clinical needs in energetics and cancer. This report summarizes the 2022 TREC Workshop's key takeaways and future directions for innovative transdisciplinary energetics and cancer research.

Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer

Background

Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC.

Methods

Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants’ home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention.

Discussion

This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial.

Trial registration

Record not yet public

Pivoting Nursing Research and Scholarship During the COVID-19 Pandemic

BACKGROUND

The global COVID-19 pandemic has brought numerous challenges for conducting the human subjects research needed to advance science and improve health.

OBJECTIVES

The purpose of this article is to discuss how a college of nursing at a large public university in the southeast United States has responded to the challenges of conducting research during the novel COVID-19 pandemic.

METHODS

Seven faculty researchers at the University of South Carolina College of Nursing share their experiences in overcoming the unique challenges of conducting research because of the COVID-19 pandemic. Strategies to overcome the challenges posed by COVID-19 are presented within the context of the research process, career implications, communication, and maintaining morale.

RESULTS

Fears of COVID-19 and social distancing measures have hindered participant recruitment, enrollment, and involvement in ongoing studies. Increasing virtual technology use and enhancing safety precautions have assisted researchers to overcome barriers. Scholarly writing has increased for some faculty members whose studies have been stalled by the pandemic, yet others have seen a decline because of additional personal responsibilities. The careers of faculty members across all ranks have been uniquely affected by the pandemic. With most faculty working remotely, enhanced communication strategies at the university and college have supported the research enterprise. Morale has been adversely affected, but a variety of personal and collegial efforts have helped faculty cope and preserve a sense of normalcy during this devastating pandemic.

DISCUSSION

Faculty and their ability to conduct the research needed to inform clinical and public health practice have been adversely affected by the COVID-19 pandemic. Despite the challenges of conducting research during this unprecedented crisis, faculty and institutions are taking novel steps to ensure the continuity of scientific progress for improving the health and well-being of patients and populations.

After Ringing the Bell: Receptivity of and Preferences for Healthy Behaviors in African American Dyads Surviving Lung Cancer

PURPOSE

To explore receptivity of and preferences for risk-reducing health behavior changes among African American survivors of early-stage lung cancer and their family members.

PARTICIPANTS & SETTING

26 African American non-small cell lung cancer survivor-family member dyads were recruited from two cancer programs in the southeastern United States.

METHODOLOGIC APPROACH

Social cognitive theory principles guided the design and implementation of focus groups. Descriptive statistics were used to summarize the data, and thematic analysis was used to interpret the transcripts from the focus groups.

FINDINGS

The following four themes were identified.

IMPLICATIONS FOR NURSING

Participants emphasized the need for improved provider communication. Pragmatic communication interventions for providers, survivors, and family members may facilitate behavior change and improve outcomes among underserved populations.

A Qualitative Cultural Sensitivity Assessment of the Breathe Easier Mobile Application for Lung Cancer Survivors and Their Families

PURPOSE

To evaluate the cultural sensitivity of the Breathe Easier mobile health application for African American lung cancer survivors and their families. Breathe Easier is an intervention designed to teach strategies to combat symptoms related to lung cancer.

PARTICIPANTS & SETTING

12 African American lung cancer survivors and their family members were recruited from an American College of Surgeons-approved cancer program in South Carolina.

METHODOLOGIC APPROACH

Participants completed in-depth interviews, which were guided by the Cultural Sensitivity Assessment Tool and the Cultural Sensitivity Checklist. Two researchers performed open and axial coding to conceptually organize the data.

FINDINGS

Multiple culturally relevant themes emerged, including benefits, concerns, and suggestions related to content literacy and inclusiveness, as well as acceptability of and motivations for using the mobile application. However, lung cancer survivors and their family members reported being more concerned about accessing accurate survivorship information.

IMPLICATIONS FOR NURSING

Attention to health literacy, eHealth literacy, and cultural sensitivity may enhance patient outcomes, and nurses can advocate for patients regarding these communication issues.

Exploring Stigma Among Lung Cancer Survivors: A Scoping Literature Review

PROBLEM IDENTIFICATION

Lung cancer survivors face many challenges that affect their quality of life and survival. A growing concern is the layered effect of stigma related to cigarette smoking and the perceived life-threatening diagnosis of lung cancer. This experience may affect lung cancer survivors' physical, psychological, and social well-being, negatively influencing their quality of life.

LITERATURE SEARCH

CINAHL®, PubMed®, PsycINFO®, and Web of Science were searched from January 2000 through August 2017, using combinations of four keywords.

DATA EVALUATION

Extracted data included research aims, design, method, analytical approach, sample size, gender, ethnicity/race, setting, stigma measure, smoking status, and major results.

SYNTHESIS

Of 163 studies initially identified, 30 (19 quantitative, 8 qualitative, 2 theoretical reviews, and 1 mixed method) were included. Quantitative studies were analyzed by statistical significance and relevant findings. Thematic analysis was used to evaluate qualitative studies.

IMPLICATIONS FOR RESEARCH

Future research should focus on the development and testing of tailored and multilevel interventions to support the management of stigma and lessen the negative impact it has on quality of life, with special considerations for vulnerable subpopulations.

Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores

BACKGROUND

Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual's quality of life.

OBJECTIVE

The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease).

METHODS

For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps' (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity.

RESULTS

The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria.

CONCLUSIONS

This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language.

Not a Death Sentence: Perspectives of African American Women Living With Lung Cancer

PURPOSE

To conduct a descriptive, qualitative study to describe the experience of female African American lung cancer survivors, their perception of living with lung cancer, and their desire and ability to adopt positive health-related behaviors. 
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PARTICIPANTS & SETTING

The sample consisted of 18 African American women with a history of stages I-IIIa lung cancer. Three focus groups were conducted in a private conference center in two community hospitals in the southeastern United States.
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METHODOLOGIC APPROACH

A 20-item questionnaire was used to collect demographic, health status, and behavior information. A trained moderator led the audio-recorded focus group discussions using a semistructured interview guide. 
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FINDINGS

Thematic analysis of the professionally transcribed data resulted in identification of four major themes. In addition, participants experienced stigma that influenced their perspectives on living with lung cancer. 
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IMPLICATIONS FOR NURSING

Healthcare professionals should provide culturally tailored communication and support for female African American lung cancer survivors. Additional research is needed to inform the development of interventions focused on health behavior change to enhance lung cancer survivorship in this vulnerable and understudied group.