Oncology · Medical Literature
Effectiveness of combined nutrition, exercise and psychological interventions in patients with malignancy: A randomized controlled trial.
Abstract
Patients with malignancy often have a poor prognosis and dismal quality of life. This study aimed to evaluate whether a combined nutrition, exercise, and psychological intervention could improve these outcomes. In an open-label, randomized controlled trial at the First Hospital of Hebei Medical University (Oct 2021-Jun 2022), 90 patients were assigned (1:1) to a treatment group receiving 6-month cyclic combined assessments and interventions, or a control group receiving assessments only. Body composition, hand grip strength (HGS), 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and quality of life were compared at baseline and 6 months. Data were analyzed using SPSS 21.0, with p <0.05 considered significant. 90 people were enrolled, and 80 people have completed the study. Compared to controls, the intervention group showed significantly lower nutritional risk (10.0 % vs. 100 %, p <0.001) and malnutrition rates (22.5 % vs. 100 %, p <0.001). Significant improvements were observed in BMI, muscle mass, phase angle, HGS, and 6MWT distance (all p <0.001). HADS and PHQ-9 scores decreased (p <0.001). Quality-of-life scores (physical, role, emotional, social function, overall health) improved, while symptom scores (fatigue, pain, nausea/vomiting, etc.) decreased markedly (p <0.05). The control group exhibited opposite trends. Combined nutrition, exercise, and psychological interventions effectively improve nutritional status, physical and psychological well-being, and quality of life in patients with malignancy, potentially enhancing treatment tolerance and promoting rehabilitation.
Clinical relevance
Patients with malignancy are at high risk for malnutrition, functional decline, and psychological morbidity, all of which negatively impact treatment tolerance and quality of life (QoL). This RCT addresses the gap in evidence for multimodal supportive care by evaluating a structured, cyclic 6-month combined nutrition, exercise, and psychological intervention in an oncology inpatient/outpatient population. Given the near-universal rates of nutritional risk and malnutrition observed in the control arm, these findings are highly relevant to oncologists, palliative care physicians, and allied health teams managing patients with active malignancy.
Key findings
1. Nutritional risk was dramatically reduced in the intervention group versus controls at 6 months (10.0% vs. 100%, p <0.001), representing a statistically and clinically profound between-group difference. 2. Malnutrition rates were significantly lower in the intervention group compared to controls at 6 months (22.5% vs. 100%, p <0.001), underscoring the efficacy of the multimodal approach in preventing nutritional deterioration. 3. Objective measures of body composition and physical function — including BMI, muscle mass, phase angle, hand grip strength (HGS), and 6-minute walk test (6MWT) distance — all improved significantly in the intervention group (all p <0.001), while the control group exhibited deterioration. 4. Psychological burden as measured by the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9) decreased significantly in the intervention group (p <0.001), indicating meaningful reduction in anxiety, depression, and depressive symptomatology. 5. Multiple QoL domains — including physical, role, emotional, and social functioning, as well as overall health — improved significantly in the intervention group, while symptom burden scores (fatigue, pain, nausea/vomiting, and others) decreased markedly (p <0.05). 6. Of 90 enrolled patients randomized 1:1, 80 completed the 6-month study (88.9% completion rate), suggesting the intervention protocol was feasible and acceptable in this oncology population; no specific attrition-related safety data were reported in the abstract.
Practice implications
Oncology teams should consider implementing structured, cyclic multimodal supportive care programs — integrating formal nutritional assessment and intervention, supervised exercise, and psychological support — initiated early in the treatment course for patients with active malignancy, given the near-universal nutritional deterioration observed in patients receiving assessments alone. Patient selection should prioritize those at baseline nutritional risk or with functional limitations, with reassessment of body composition (including phase angle and muscle mass), grip strength, 6MWT, and validated psychological screening tools (HADS, PHQ-9) at regular intervals (e.g., every 4–6 weeks) to guide iterative intervention. These findings support integration of dietitians, physiotherapists, and psycho-oncology services as standard components of oncologic care pathways, with the goal of preserving physical function, reducing psychological morbidity, and potentially improving treatment tolerance and rehabilitation outcomes.