Integrating physical activity support into routine NHS breast cancer care: iCAN

Research question: Is it feasible for physical activity to be integrated into routine breast cancer care? Background: Breast cancer is one of the leading causes of death among women in the UK.

Unequivocal evidence from multiple systematic reviews confirms that physical activity during chemotherapy is safe, helps patients cope better with cancer treatment and associated side effects, reduces the risk of cancer recurrence and ultimately can improve chances of survival.

Physical activity for those living with and beyond cancer was endorsed by the World Health Organisation in 2019 through the development of guidelines.

However, physical activity support is not part of the NHS cancer care pathway in the UK and patients are not routinely informed about the potential harm of inactivity on their chances of survival.

Our interviews with oncologists and cancer nurses across the UK (n=11) highlighted that they believe physical activity should be discussed with all patients during treatment, but they lacked the knowledge and resources to confidently promote activity.

Ironically, patients (n=15) in our interviews requested this guidance and that it be delivered by a member of their medical team alongside access to digital resources to support the completion of home-based physical activity.

Aims: This proposal is comprised of three related work packages that aim to highlight the importance and assess the feasibility of the routine promotion of physical activity for patients with breast cancer treated in the NHS.

Methods: Work package one will use UK Biobank data to explore physical activity (using device measured outcomes) in participants following a cancer diagnosis and whether activity status is associated with hospitalisations. Further exploration of the data will seek to indicate the potential impact of inactivity on hospitalisations.

Work package two will expand on previous findings from our interviews with patients and healthcare professionals and conduct co-design workshops (n=3) with a diverse sample of patients with breast cancer (n=30).

Findings from the workshops will inform the content and format of digital resources to facilitate physical activity promotion by healthcare professionals within routine care.

Working with healthcare professionals (n=15), this work package will develop a training module to aid brief conversations with patients promoting physical activity within cancer care consultations.

Work package three will involve conducting a feasibility RCT to assess the feasibility of healthcare professionals routinely promoting physical activity in NHS breast cancer consultations by signposting patients towards digital resources developed in WP2.

Patients with lived experience of breast cancer will be involved throughout the study as members of the research team, will support research activities and dissemination of the findings.

Anticipated impact and dissemination: The successful delivery and feasibility of the proposed research will indicate the potential impact of physical activity on NHS patients and resources, produce bespoke digital resources for patients and a training module for healthcare professionals. Findings will inform future NHS policy and provide evidence for an effectiveness trial.

Findings will be disseminated nationally and internationally and with patients, stakeholders including policy makers, NHS Trusts and charities.