Supporting Women with Endometrial Cancer to be Physically Active: the WILDCAT study

Background Endometrial (womb) cancer is the most prevalent gynaecological cancer.

Endometrial cancer survivors have up to 16-times higher risk of death than women of equivalent age in the general population, and mortality rates are 80-90% higher in Black women than white women. This elevated risk is due to cardiovascular disease, which is preventable.

For endometrial cancer survivors, being physically active post-diagnosis is associated with a 20-30% reduction in cardiovascular disease, better quality of life, reduced cancer-related fatigue, reduced cancer recurrence, and improved survival.

However, endometrial cancer survivors are the least physically active of all cancer survivors, with 88% in the UK not meeting recommended physical activity guidelines.

There is currently no support for physical activity in patients with endometrial cancer in the NHS; patients have told us this is a crucial unmet need in their survivorship care.

Aim Adapt and refine an intervention package to support a diverse group of endometrial cancer survivors to be physically active. Objectives 1.

Understand barriers and facilitators to physical activity in endometrial cancer survivors as potentially modifiable determinants of behaviour (WS1). 2. Synthesise evidence of effective physical activity interventions for this population (WS2). 3.

Use co-design principles to adapt and refine an intervention package, incorporating general guidance and tailored components (WS3).

Methods and timeline Workstream 1 (Months 1-18) - Understand the behaviour Conduct semi-structured interviews with 33 endometrial cancer survivors to explore barriers and facilitators to physical activity. Typological analysis will identify clusters of similar needs and preferences to facilitate intervention tailoring.

Patient-reported barriers will also inform the development of endometrial cancer-specific guidance for exercise instructors nationwide in WS3.

Workstream 2 (Months 1-18) - Identify intervention options Conduct a mixed-methods systematic review focusing on physical activity interventions in endometrial cancer survivors.

Data extracted will include characteristics of interventions/components effective in increasing physical activity, diversity of samples, and behavior change techniques used.

Workstream 3 (Months 11-34) - Intervention development and refinement Co-design workshops with key stakeholders, healthcare professionals and patients from diverse backgrounds to adapt an intervention package that includes general guidance and tailored components. User-test the intervention components to investigate safety, acceptability, fidelity and willingness to engage.

Conduct a final co-design workshop to refine the intervention package based on user feedback.

Anticipated impact and dissemination Peer-reviewed publications and presentations at national, and international conferences.

Dissemination through easy-read infographics, engaging social media content, newsletters, and an infographic for summarising results.

Co-produced with my diverse Patient Advisory Group, the strategy includes engaging community groups to facilitate knowledge exchange.

Integration of endometrial cancer-specific guidance into national Cancer Rehabilitation (CanRehab) manual used by over 700 fitness instructors in the UK, facilitated by existing collaborations with CanRehab and Macmillan. Insights may benefit patients with other gynecological cancers and those undergoing post-operative recovery.

Learnings on EDI in research could offer valuable contributions to inform best practice for inclusion in applied health research.