Periodic Reporting for period 2 - FORTEe (Get strong to fight childhood cancer: an exercise intervention for children and adolescents undergoing anti-cancer treatment)
Okres sprawozdawczy: 2022-09-01 do 2024-02-29
Cancer is the leading cause of death from non-communicable diseases in children in Europe. Patients undergoing cancer treatment suffer from various symptoms and adverse effects, including cancer-related fatigue and lack of physical activity (https://doi.org/10.3390/children10030572). These side effects can create a vicious cycle of fatigue and physical inactivity, negatively impacting physiological functional capacities, psychosocial functioning, mental health, and quality of life. Previous studies in adult cancer patients have shown that specific exercise training can reduce morbidity and mortality. A similar effect has not been shown in children and adolescents. Personalised exercise training during childhood cancer treatment may be a promising therapy to address these issues. However, evidence on the use of exercise to reduce cancer fatigue and improve health-related quality of life in paediatric oncology is still lacking. Until now, precision exercise training has not yet been part of standard care in paediatric oncology and does therefore not reach most patients.
This is where FORTEe steps in to promote exercise therapy, which aims to make young patients stronger for fighting childhood cancer. The overall goal of the FORTEe project is to create high-level evidence for the use of precision exercise interventions in childhood cancer by conducting a large randomised, controlled trial in this field. We intend to evaluate a personalised and standardised exercise intervention in 450 children, adolescents and young adults undergoing cancer treatment in ten centres across Europe in order to generate evidence for an innovative, patient-centred exercise treatment. Experiences and expertise in paediatric exercise oncology within Europe are merged to develop specific age-adapted and personalised exercise training as well as testing protocols, which are implemented with the help of digital, innovative technologies. During the project lifetime of 5.5 years, FORTEe aims to improve clinical care for children and adolescents with cancer by providing them with access to adapted exercise training across the EU and improving their health-related quality of life.
FORTEe has the ambition to implement paediatric exercise oncology as an evidence-based standard in clinical care for all childhood cancer patients across the EU and beyond.
This is where FORTEe steps in to promote exercise therapy, which aims to make young patients stronger for fighting childhood cancer. The overall goal of the FORTEe project is to create high-level evidence for the use of precision exercise interventions in childhood cancer by conducting a large randomised, controlled trial in this field. We intend to evaluate a personalised and standardised exercise intervention in 450 children, adolescents and young adults undergoing cancer treatment in ten centres across Europe in order to generate evidence for an innovative, patient-centred exercise treatment. Experiences and expertise in paediatric exercise oncology within Europe are merged to develop specific age-adapted and personalised exercise training as well as testing protocols, which are implemented with the help of digital, innovative technologies. During the project lifetime of 5.5 years, FORTEe aims to improve clinical care for children and adolescents with cancer by providing them with access to adapted exercise training across the EU and improving their health-related quality of life.
FORTEe has the ambition to implement paediatric exercise oncology as an evidence-based standard in clinical care for all childhood cancer patients across the EU and beyond.
We have met all the requirements to start the clinical trial, established a final study protocol and developed standardised FORTEe training and testing protocols to guide the professionals conducting the trial and to tailor the exercise training to each patient's treatment and condition. The protocols will serve as the basis for future guidelines that will be developed throughout the project.
Patient recruitment, implementation of the exercise programme, data collection and follow-up in the FORTEe clinical trial started in April 2022 and are ongoing as planned. By the end of February 2024, more than 75% of the recruitment target had been achieved. In order to analyse the effects of the exercise intervention, data have been collected in a specially developed electronic database and continuously monitored to ensure data quality.
So far, various digital, innovative technologies were implemented within the FORTEe project: We developed novel applications and tools in exercise oncology and rehabilitation aiming to increase the patient’s motivation to participate in the exercise training and to run remote exercise sessions with childhood cancer patients (e.g. usable for home training sessions or exercise training during isolation). An augmented reality (AR) app was designed to allow patients to perform child- as well as age- and condition-specific exercises with an avatar. In-hospital exercise sessions are enhanced by the digital Pixformance Station. In a sub-project on qualitative social research, semi-structured interviews and participant observations were conducted, focusing on the participants' own assessment of their situation, quality of life, bodily self-image, disease burden and - if any - burden or benefit of exercise intervention.
Already at this early stage of the project, we set up mechanisms for the rapid transfer of expert knowledge between sports and exercise science, sports medicine and paediatric oncology expertise across European countries.
The FORTEe project is being promoted through the project website, the project brochure, patient flyers and various social media channels, and presented to a wide scientific and public audience through press coverage, (scientific) conferences and other outreach activities. In addition, FORTEe continued its well-established mentoring programme, matching early career researchers with senior colleagues to train and support them in their career development.
Patient recruitment, implementation of the exercise programme, data collection and follow-up in the FORTEe clinical trial started in April 2022 and are ongoing as planned. By the end of February 2024, more than 75% of the recruitment target had been achieved. In order to analyse the effects of the exercise intervention, data have been collected in a specially developed electronic database and continuously monitored to ensure data quality.
So far, various digital, innovative technologies were implemented within the FORTEe project: We developed novel applications and tools in exercise oncology and rehabilitation aiming to increase the patient’s motivation to participate in the exercise training and to run remote exercise sessions with childhood cancer patients (e.g. usable for home training sessions or exercise training during isolation). An augmented reality (AR) app was designed to allow patients to perform child- as well as age- and condition-specific exercises with an avatar. In-hospital exercise sessions are enhanced by the digital Pixformance Station. In a sub-project on qualitative social research, semi-structured interviews and participant observations were conducted, focusing on the participants' own assessment of their situation, quality of life, bodily self-image, disease burden and - if any - burden or benefit of exercise intervention.
Already at this early stage of the project, we set up mechanisms for the rapid transfer of expert knowledge between sports and exercise science, sports medicine and paediatric oncology expertise across European countries.
The FORTEe project is being promoted through the project website, the project brochure, patient flyers and various social media channels, and presented to a wide scientific and public audience through press coverage, (scientific) conferences and other outreach activities. In addition, FORTEe continued its well-established mentoring programme, matching early career researchers with senior colleagues to train and support them in their career development.
Although exercise training has shown benefits in adult as well as childhood cancer patients during and after cancer treatment, no international common standards for the implementation of paediatric exercise oncology have been established so far. Furthermore, only a few hospitals offer exercise programs as an optional add-on to the standard of care. To date, there are no multicentre randomised controlled clinical trials investigating paediatric exercise oncology during intensive cancer therapy. With FORTEe, the scientific basis for optimizing exercise interventions and its establishment as a routine treatment will be provided.
The FORTEe consortium will pool their knowledge and expertise in order to create a vast amount of data to demonstrate that “exercise is medicine” and should be an integral part of clinical practice.
In future, paediatric exercise oncology should be considered as a viable addition to the already established supportive cancer care.
Moreover, precision exercise therapy is a personalised, but simultaneously highly-standardised treatment concept and thus comparable to drug therapies. Analogous to the correct choice and dosage of a pharmaceutical agent (e.g. antiemetics, analgetics, etc.), the exercise type and training load have to be individually adapted to the patient’s condition and needs. Prescribing exercise like a “pill” in the right “dosage”, might become a highly effective instrument in childhood cancer care for the prevention, treatment and management of the acute side-effects of cancer treatment and its sequelae.
Moreover, FORTEe develops adapted exercise technology supporting the digital transformation of health and care. Using digital tools and applications, FORTEe has started to elaborate common standards that enable exercise training in the patient's home during cancer treatment and during isolation or physical distancing measurements.
Consequently, results will be transferrable to further populations and not only childhood cancer patients could benefit from the results of the FORTEe trial, but also patients suffering from other non-communicable diseases or chronic (paediatric) health conditions such as asthma, diabetes mellitus, obesity, congenital heart disease etc.
FORTEe will provide a basis for the development of clinical practice guidelines in paediatric exercise oncology. The establishment of a comprehensive and standardised exercise therapy for childhood cancer patients all over Europe would be an essential step towards improving and equalizing the standards in patient care and a breakthrough for all children suffering from cancer.
The FORTEe consortium will pool their knowledge and expertise in order to create a vast amount of data to demonstrate that “exercise is medicine” and should be an integral part of clinical practice.
In future, paediatric exercise oncology should be considered as a viable addition to the already established supportive cancer care.
Moreover, precision exercise therapy is a personalised, but simultaneously highly-standardised treatment concept and thus comparable to drug therapies. Analogous to the correct choice and dosage of a pharmaceutical agent (e.g. antiemetics, analgetics, etc.), the exercise type and training load have to be individually adapted to the patient’s condition and needs. Prescribing exercise like a “pill” in the right “dosage”, might become a highly effective instrument in childhood cancer care for the prevention, treatment and management of the acute side-effects of cancer treatment and its sequelae.
Moreover, FORTEe develops adapted exercise technology supporting the digital transformation of health and care. Using digital tools and applications, FORTEe has started to elaborate common standards that enable exercise training in the patient's home during cancer treatment and during isolation or physical distancing measurements.
Consequently, results will be transferrable to further populations and not only childhood cancer patients could benefit from the results of the FORTEe trial, but also patients suffering from other non-communicable diseases or chronic (paediatric) health conditions such as asthma, diabetes mellitus, obesity, congenital heart disease etc.
FORTEe will provide a basis for the development of clinical practice guidelines in paediatric exercise oncology. The establishment of a comprehensive and standardised exercise therapy for childhood cancer patients all over Europe would be an essential step towards improving and equalizing the standards in patient care and a breakthrough for all children suffering from cancer.