The STAMINA prostate cancer lifestyle programme is to be rolled out across eight NHS trusts after landmark NHS trial success.

Men receiving hormone therapy as part of treatment for prostate cancer who participated in the STAMINA lifestyle intervention programme had significantly better cancer-specific outcomes, a landmark NHS trial has found.

The trial, delivered in partnership with Sheffield Hallam University, the NHS and Nuffield Health, is the largest study of its kind to date. It’s the first to integrate a lifestyle intervention programme offering supervised exercise, dietary advice and behavioural support into routine cancer care pathways at scale across the NHS. 

“STAMINA is a huge achievement, and it offers a step-change in how lifestyle programmes should be considered and integrated comprehensibly into routine prostate cancer care,” said Liam Bourke, professor of cancer research and STAMINA research team director at Sheffield Hallam University. “The trial is the first to be designed to work in the NHS from day one. This makes the study really unique and ensures that the positive outcomes of the research will be delivered exactly where they need to be – to NHS patients during routine care.”

Trial outcomes

As part of the STAMINA study, 700 men who were receiving androgen deprivation therapy (ADT) treatment were recruited to participate across 15 NHS hospitals in England. 

ADT treatment lowers testosterone production to slow the growth of prostate cancer and control the disease. But it also causes adverse effects including fatigue, increased central obesity, loss of muscle mass, reduced bone density, cardiovascular risk, and psychological distress, and significantly affects quality of life.

Study findings indicate the STAMINA lifestyle intervention approach can mitigate the debilitating side effects of ADT therapy. Participants experienced less deterioration in prostate cancer-related quality of life (26%), less fatigue (30%), and improved overall cancer-related quality of life (37%), when compared to an optimised version of usual prostate cancer care.

The men participating in the STAMINA lifestyle programme received supervised aerobic and resistance exercise sessions for 12 months, dietary advice, behavioural support, and complimentary gym membership. Adherence to the exercise programme was high, with 80% of men attending their scheduled sessions over the 12 months. Those participants had better cancer-specific outcomes, such as improved quality of life, and reported experiencing less fatigue, the trial found.

Analysis of the cost-effectiveness of the STAMINA programme, designed to be prescribed alongside routine prostate cancer care, found it provided benefits at a cost significantly below the threshold for NHS cancer funding. Programme costs were £13,920 per QALY (quality-adjusted life year) and cost per participant per year was £1,000.

Huge step forward

“The importance of optimising quality of life for men with prostate cancer cannot be overstated,” said Derek Rosario, chief investigator of STAMINA and consultant urological surgeon at Sheffield Teaching Hospitals NHS Trust. “As well as the direct individual benefit, we know that optimising quality of life and mitigating fatigue through exercise has potential beneficial effects on overall survival.”

Describing STAMINA as the “first lifestyle intervention integrated into routine cancer care at scale across the NHS in England”, he said the trial findings are a “huge step forward” and will have an immediate impact for patients. The findings will also provide “compelling evidence for clinicians who have been crying out for an evidence-based intervention to recommend to their patients on ADT who present all the time with devastating treatment-related side effects,” he said.

“The evidence from this trial also satisfies NICE recommendations and those of expert reference groups across the world in mitigating devastating, but essential treatment-related side effects of those on ADT,” he said.

Outcomes from the trial should serve as a template for integrating lifestyle interventions into cancer care in other complex health systems internationally, the trial’s investigators said.

Following the success of the STAMINA trial, Nuffield Health has launched a cancer activity programme in partnership with eight NHS trusts to provide a version of the STAMINA intervention to eligible NHS prostate cancer patients. There are also plans to expand the programme to NHS breast and bowel cancer patients.

The eight trusts are: Sheffield Teaching Hospitals, Nottingham University Hospitals, Royal Surrey, Surrey & Sussex Healthcare, The Christie, University Hospitals Plymouth, University Hospitals of Derby & Burton, and University Hospitals Bristol and Weston.