Exploring the Concept of Palliative Rehabilitation: The Active PalliativeRehabilitation in Lung Cancer (APRIL) Study

Background: Evidence underpinning palliative rehabilitation is needed. APRIL was a sixweek home based intervention comprising physical activity (walking and musclestrengthening) and nutritional advice supported by weekly phone review and personalisedgoal setting. This intervention aimed to enhance quality of life, promote and maintainphysical function and relieve dietary symptoms.Aim: To develop and explore a novel rehabilitation intervention of physical activity andnutritional guidance for people with advanced inoperable non-small cell lung cancer(NSCLC) receiving palliative systemic therapy.Methods: The MRC Framework for Developing and Evaluating Complex Interventions wasused to design this multiphase mixed methods cohort study. APRIL was developed based onconsensus agreement. EORTC QLQ-C15-PAL, MFI-20, PGSGA and functional outcomemeasurements (6MWT, STS60) were undertaken at baseline, intervention end and six weekspost completion. Semi structured interviews with patients and healthcare professionals(HCPs) explored experiences of APRIL; these were thematically analysed.Results: Forty nine patients receiving palliative systemic therapy for NSCLC were screenedFebruary to December 2013. Of the 19 eligible patients, seven declined and one becameineligible pre consent. Two patients withdrew before week six and one before week 12leaving a final cohort of eight. Qualitative findings are presented under the themes ‘Livingwith and beyond an advanced cancer diagnosis: experiences of the APRIL Programme’ forpatient participants and ‘Palliative Rehabilitation: exploring the concept’ for HCPs.Conclusion: The palliative rehabilitation approach of APRIL was valued by participantsinvolved in this feasibility cohort study and HCP attitudes to palliative rehabilitation altered.Robust evaluation studies within this population are compromised by the ability to recruitsufficient numbers and with issues arising from missing data, response shift and attrition.