Management of fatigue in gynaecological cancer: A feasibility study of an app-based exercise and mindfulness intervention

TL;DR

A study tested a mobile app for managing cancer-related fatigue in gynaecological cancer patients using mindfulness and exercise, finding it feasible and beneficial.

Contribution

The study demonstrates the feasibility of a digital mindfulness and exercise intervention for managing cancer-related fatigue in gynaecological cancer patients.

Findings

High retention and adherence rates showed the study protocol is feasible.

Mindfulness alone improved fatigue, sleep, and quality of life despite initial scepticism.

Combining mindfulness and exercise led to greater improvements beyond the minimal clinically important difference.

Abstract

•Digital delivery was satisfactory and acceptable but combination with health care professionals input was still preferable.•Recruitment, retention and adherence were acceptable and therefore the study protocol is feasible.•Despite scepticism, mindfulness alone had a positive effect on clinical outcomes of fatigue, sleep and quality of life.•Reciprocal effect of combining interventions resulting in increase of activity participation which may lead to larger effects.•Combination of mindfulness and exercise resulted in improvements in fatigue, sleep and QoL beyond MCID.

Digital delivery was satisfactory and acceptable but combination with health care professionals input was still preferable.

Recruitment, retention and adherence were acceptable and therefore the study protocol is feasible.

Despite scepticism, mindfulness alone had a positive effect on clinical outcomes of fatigue, sleep and quality of life.

Reciprocal effect of combining interventions resulting in increase of activity participation which may lead to larger effects.

Combination of mindfulness and exercise resulted in improvements in fatigue, sleep and QoL beyond MCID.

Cancer-related fatigue (CRF) is an issue for many people living with and beyond cancer. Evidence suggests that exercise and mindfulness may help in management of CRF, however, adherence to such interventions remains poor and there is little evidence for combining these interventions or for digital delivery. Few interventions have targeted women who have gynaecological cancer. This study developed and assessed the feasibility of digitally delivering mindfulness and exercise interventions to manage CRF in this population.

An 8-week feasibility randomised control trial was delivered via a mobile app to two groups (mindfulness only; mindfulness and exercise). Feasibility was assessed through retention, adherence and attrition rates. Participant-reported outcome measures (PROMs) for fatigue, anxiety, depression, sleep and health-related quality of life were collected pre and post intervention and analysed using descriptive statistics (mean, median, inter-quartile ranges and line graphs). Online focus groups explored patient experiences, acceptability and satisfaction with the interventions.

Twenty-five participants (mindfulness only n = 13, mindfulness and exercise n = 12) had overall retention rate of 88 %, adherence was 72.72 % and attrition was 12 %. Both groups demonstrated improvements in fatigue (mindfulness-alone; 7.8, mindfulness and exercise 14.11), anxiety (2.9; 4.87), depression (2.06; 4.26), sleep, (2.8; 2.71), and HRQOL (6.4; 10.4), based on changes in mean scores. Qualitative findings identified three main themes: benefits of participation, barriers to participation and digital delivery of the intervention.

Both groups experienced improvements in CRF, anxiety, depression, sleep and HRQoL. Retention and adherence rates were high with a good level of app engagement. Feasibility was demonstrated through retention, adherence and attrition rates and interventions were deemed acceptable. These findings suggest that a fully powered RCT is warranted. While online recruitment was challenging, the online delivery of interventions enabled broader participant inclusion and scalability.

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