title: The deliverability, acceptability, and perceived effect of the Macmillan approach to weight loss and eating difficulties: a phase II, cluster-randomized, exploratory trial of a psychosocial intervention for weight- and eating-related distress in people with advanced cancer.
abstract: BACKGROUND
  Up to 80% of people with cancer will develop weight loss and anorexia during the advanced stages of the disease. The Macmillan Weight and Eating Studies (2000-2009) have used the Medical Research Council complex interventions framework to develop the first psychosocial intervention for weight- and eating-related distress (WRD and ERD) in people with advanced cancer and their carers: The Macmillan Approach to Weight and Eating (MAWE).
  
  
  OBJECTIVE
  This article reports the findings of a Phase II trial of MAWE that investigated its deliverability, acceptability, and patient-perceived effect on WRD and ERD.
  
  
  METHODS
  The Phase II trial, conducted in 2006-2007, was of cluster-randomized design, with two community palliative care teams randomized to different arms. It used mixed methods to compare an intervention group (n=25), the MAWE group, which was supported by MAWE-trained clinical nurse specialists, with a group that received usual care (n=25), the control group.
  
  
  RESULTS
  MAWE was deliverable in clinical practice and acceptable to patients. Unplanned exposure of the MAWE group to the intervention before an initial measure of WRD and ERD proved problematic to the trial process. Despite this, quantitative and qualitative analyses indicate that MAWE does not exacerbate WRD and ERD and may help patients with advanced cancer live with the weight loss and anorexia that are the symptoms of cancer cachexia syndrome.
  
  
  CONCLUSIONS
  A follow-on randomized controlled trial of MAWE is warranted but should be of a revised design.
authors.affiliation: School of Health Sciences, University of Southampton, Southampton, United Kingdom. J.B.Hopkinson@soton.ac.uk
authors.forename: Jane B
authors.initials: JB
authors.lastname: Hopkinson
authors.forename: Debbie R
authors.initials: DR
authors.lastname: Fenlon
authors.forename: Ikumi
authors.initials: I
authors.lastname: Okamoto
authors.forename: David N M
authors.initials: DN
authors.lastname: Wright
authors.forename: Issy
authors.initials: I
authors.lastname: Scott
authors.forename: Julia M
authors.initials: JM
authors.lastname: Addington-Hall
authors.forename: Claire
authors.initials: C
authors.lastname: Foster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000209:etiology / Q000451:nursing*; D001835:Body Weight; D002100:Cachexia / Q000209:etiology / Q000451:nursing*; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000451:nursing*