Digital intervention (Renewed) to support symptom management, wellbeing, and quality of life among cancer survivors in primary care: a randomised controlled trial.

Abstract

Many cancer survivors following primary treatment have prolonged poor quality of life. To determine the effectiveness of a bespoke digital intervention to support cancer survivors. This was a pragmatic parallel open randomised trial in UK general practices (ISRCTN:96374224). 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'; <i>n</i> = 906); 2) a bespoke complex digital intervention ('Renewed'; <i>n</i> = 903) addressing symptom management, physical activity, diet, weight loss, and distress; or 3) 'Renewed with support' (<i>n</i> = 903): 'Renewed' with additional brief email and telephone support. Mixed linear regression provided estimates of the differences between each intervention group and generic advice. At 6 months all groups improved (primary time point: <i>n</i> 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. 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.