数字干预（更新版）对基层医疗中癌症幸存者症状管理、健康状况及生活质量的支持：一项随机对照试验
Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial.
作者信息
Little Paul, Bradbury Katherine, Stuart Beth, Barnett Jane, Krusche Adele, Steele Mary, Heber Elena, Easton Steph, Smith Kirsten A, Slodowska-Barabasz Joanna, Payne Liz, Corbett Teresa, Wilde Laura, Yao Guiqing Lily, Pollet Sebastien, Smith Jazzine, Joseph Judith, Lawrence Megan, Böhning Dankmar, Cheetham-Blake Tara, Eccles Diana, Foster Claire, Geraghty Adam Wa, Leydon Geraldine, Müller Andre Matthias, Neal Richard D, Osborne Richard, Rathod Shanaya, Richardson Alison, Grimmett Chloe, Sharman Geoffrey, Bacon Roger, Turner Lesley, Stephens Richard, Rogers Kirsty, Raftery James, Zhu Shihua, Singh Karmpaul, Webley Frances, Griffiths Gareth, Nutall Jaqui, Chalder Trudie, Wilkinson Clare, Watson Eila, Yardley Lucy
机构信息
Primary Care Research Centre, University of Southampton, Southampton, UK.
Department of Psychology, University of Southampton, Southampton, UK.
出版信息
Br J Gen Pract. 2025 May 2;75(754):e357-e365. doi: 10.3399/BJGP.2023.0262. Print 2025 May.
BACKGROUND
Many cancer survivors following primary treatment have prolonged poor quality of life.
AIM
To determine the effectiveness of a bespoke digital intervention to support cancer survivors.
DESIGN AND SETTING
This was a pragmatic parallel open randomised trial in UK general practices (ISRCTN:96374224).
METHOD
People having finished primary treatment (≤10 years previously) for colorectal, breast, or prostate cancers, with European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) score ≤85, were randomised by online software to: 1) detailed 'generic' digital NHS support ('LiveWell'; = 906); 2) a bespoke complex digital intervention ('Renewed'; = 903) addressing symptom management, physical activity, diet, weight loss, and distress; or 3) 'Renewed with support' ( = 903): 'Renewed' with additional brief email and telephone support.
RESULTS
Mixed linear regression provided estimates of the differences between each intervention group and generic advice. At 6 months all groups improved (primary time point: for the generic, Renewed groups, and Renewed with support were 806, 749, and 705, respectively), with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both the Renewed groups. By 12 months there were small improvements in EORTC QLQ-C30 for Renewed with support (versus generic advice: 1.42, 95% confidence interval [CI] = 0.33 to 2.51); both Renewed groups improved global health (12 months: Renewed: 3.06, 95% CI = 1.39 to 4.74; Renewed with support: 2.78, 95% CI = 1.08 to 4.48), dyspnoea, constipation and enablement, and lower primary care NHS costs (in comparison with generic advice [£265]: Renewed was -£141 [95% CI = -£153 to-£128] and Renewed with Support was -£77 [95% CI = -£90 to -£65]); and for Renewed with support improvement in several other symptom subscales. No harms were identified.
CONCLUSION
Cancer survivors' quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short-term benefit, but additional longer-term improvement in global health, enablement, and symptom management, with substantially lower NHS costs.
背景
许多接受过初始治疗的癌症幸存者长期生活质量不佳。
目的
确定一种定制的数字干预措施对支持癌症幸存者的有效性。
设计与设置
这是一项在英国全科医疗中进行的务实平行开放随机试验（国际标准随机对照试验编号：96374224）。
方法
完成结直肠癌、乳腺癌或前列腺癌初始治疗（≤10年前）且欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ-C30）得分≤85的患者，通过在线软件随机分为：1）详细的“通用”数字NHS支持（“活得健康”；n = 906）；2）一种定制的复杂数字干预措施（“重焕生机”；n = 903），涉及症状管理、体育活动、饮食、体重减轻和心理困扰；或3）“有支持的重焕生机”（n = 903）：“重焕生机”并额外提供简短的电子邮件和电话支持。
结果
混合线性回归提供了每个干预组与通用建议之间差异的估计值。在6个月时，所有组均有改善（主要时间点：通用组、“重焕生机”组和“有支持的重焕生机”组分别为806、749和705），EORTC QLQ-C30在组间无显著差异，但两个“重焕生机”组的总体健康状况改善更多。到12个月时，“有支持的重焕生机”组的EORTC QLQ-C30有小幅改善（与通用建议相比：1.42，95%置信区间[CI] = 0.33至2.51）；两个“重焕生机”组的总体健康状况均有改善（12个月：“重焕生机”组：3.06，95% CI = 1.39至4.74；“有支持的重焕生机”组：2.78，95% CI = 1.08至4.48），呼吸困难、便秘及功能状况改善，且NHS初级医疗成本降低（与通用建议[265英镑]相比：“重焕生机”组为-141英镑[95% CI = -153至-128英镑]，“有支持的重焕生机”组为-77英镑[95% CI = -90至-65英镑]）；“有支持的重焕生机”组在其他几个症状子量表上也有改善。未发现有害影响。
结论
癌症幸存者的生活质量通过详细的通用在线支持得到改善。精心开发的定制数字支持在短期内提供的额外益处有限，但在总体健康、功能状况和症状管理方面有额外的长期改善，且NHS成本大幅降低。
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