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A service of the National Library of Medicine, National Institutes of Health. < Prev Next > Digital intervention to support cancer survivors: the CLASP research programme Programme Grants for Applied Research, No. 14.04 Paul Little , Katherine Bradbury , Beth Stuart , Jane Barnett , Adele Krusche , Mary Steele , Elena Heber , Steph Easton , Kirsten Smith , Joanna Slodowska-Barabasz , Liz Payne , Teresa Corbett , Guiqing Lily Yao , Sebastien Pollet , Jazzine Smith , Judith Joseph , Megan Lawrence , Dankmar Böhning , Tara Cheetham-Blake , Diana Eccles , Claire Foster , Adam WA Geraghty , Geraldine Leydon , Andre Matthias Müller , Richard D Neal , Richard Osborne , Shanaya Rathod , Alison Richardson , Chloe Grimmett , Geoffrey Sharman , Roger Bacon , Lesley Turner , Richard Stephens , Tamsin Burford , Laura Wilde , Karen Middleton , Megan Liddiard , Kirsty Rogers , James Raftery , Shihua Zhu , Karmpal Singh , Frances Webley , Gareth Griffiths , Trudie Chalder , Clare Wilkinson , Eila Watson , and Lucy Yardley . Author Information and Affiliations Authors Paul Little , 1 ,* Katherine Bradbury , 2 Beth Stuart , 1 Jane Barnett , 1 Adele Krusche , 2 Mary Steele , 1 Elena Heber , 2 Steph Easton , 2 Kirsten Smith , 2 Joanna Slodowska-Barabasz , 2 Liz Payne , 2 Teresa Corbett , 3 Guiqing Lily Yao , 4 Sebastien Pollet , 2 Jazzine Smith , 2 Judith Joseph , 2 Megan Lawrence , 5 Dankmar Böhning , 6 Tara Cheetham-Blake , 7 Diana Eccles , 5 Claire Foster , 8 Adam WA Geraghty , 1 Geraldine Leydon , 1 Andre Matthias Müller , 9 Richard D Neal , 10 Richard Osborne , 11 Shanaya Rathod , 12 Alison Richardson , 7,13 Chloe Grimmett , 7 Geoffrey Sharman , 14 Roger Bacon , 14 Lesley Turner , 14 Richard Stephens , 14 Tamsin Burford , 14 Laura Wilde , 15 Karen Middleton , 1 Megan Liddiard , 1 Kirsty Rogers , 1 James Raftery , 16 Shihua Zhu , 16 Karmpal Singh , 17 Frances Webley , 5 Gareth Griffiths , 5 Trudie Chalder , 18 Clare Wilkinson , 19 Eila Watson , 20 and Lucy Yardley 2,21 . Affiliations 1 Primary Care Research Centre, University of Southampton, Southampton, UK 2 Department of Psychology, University of Southampton, Southampton, UK 3 Solent University Southampton, Southampton, UK 4 Biostatistics Research Group, University of Leicester, Leicester, UK 5 Southampton Clinical Trials Unit, University of Southampton, Southampton, UK 6 Mathematical Sciences, University of Southampton, Southampton, UK 7 School of Health Sciences, University of Southampton, Southampton, UK 8 Macmillan Survivorship Research Group, University of Southampton, Southampton, UK 9 Saw Swee Hock Public School of Health, National University of Singapore, Singapore 10 College for Medicine and Health, University of Exeter, Exeter, UK 11 Dorset Cancer Centre, Poole, UK 12 Southern Health NHS Foundation Trust, Southampton, UK 13 University Hospital Southampton NHS Foundation Trust, Southampton, UK 14 Patient and Public Involvement team for the CLASP project, Primary Care Research Centre, University of Southampton, Southampton, UK 15 Faculty of Health & Life Sciences, Coventry University, Coventry, UK 16 Health Economics Analysis Team, University of Southampton, Southampton, UK 17 Department of Psychology, University of Calgary, Calgary, Canada 18 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK 19 School of Health Sciences, Bangor University, Bangor, UK 20 Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK 21 School of Psychological Science, University of Bristol, Bristol, UK * Corresponding author ; Email: [email protected] Southampton (UK): National Institute for Health and Care Research ; 2026 Mar . Copyright and Permissions Copyright © 2026 Little et al. This work was produced by Little et al . under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/ . For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. Search term Abstract Background: There are increasing numbers of cancer survivors who have finished their primary treatment, but whose quality of life remains consistently poor over years. There is limited evidence for pragmatic, brief interventions to support cancer survivors in primary care, where most patients are managed. Objective: To develop, trial and assess the effectiveness and cost-effectiveness of a digital intervention to support cancer survivors (named ‘Renewed’) designed to require minimal health service resources. Design: Qualitative development of the intervention, then open randomised controlled trial, with a process analysis and health economic analysis. Setting: United Kingdom primary care Interventions: Development of the intervention: We systematically reviewed the relevant qualitative and quantitative literature to inform initial intervention planning, intervention content and design features of a digital intervention. This was followed by iterative development and optimisation of intervention content and the human support component – in qualitative studies of the views of cancer survivor, and of National Health Service, volunteer and charity workers. Main trial: Participants: People who had finished primary treatment for colorectal, breast or prostate cancer with lower quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 score < 85) within the last 10 years. Participants were randomised to one of three groups: (1) ‘generic’ advice: detailed digital National Health Service support for healthier living (‘Living Well’), (2) a bespoke digital intervention (‘Renewed’) addressing symptom management, physical activity, diet, weight, distress and/or fear of recurrence, or (3) ‘Renewed’ plus support (additional brief support by e-mail, telephone, or face to face) Main outcome measures: Primary outcome: European Organization for Research and Treatment of Cancer QLQ-C30 (overall score). Secondary outcomes: subscales of European Organization for Research and Treatment of Cancer QLQ-C30 (global self-rated health; functional subscales; symptom subscales), EuroQol-5 Dimensions, five-level version, psychological measures and costs. Results: At the primary time point of 6 months, there were clinically important improvements in European Organization for Research and Treatment of Cancer QLQ-C30 score contrary to the expected trajectory of quality of life in this population, but with no evidence of differences between groups. By 12 months, the Renewed plus support group had continued to improve and was better than generic advice (1.42, 95% confidence intervals 0.33 to 2.51), with the largest differences in the prostate cancer subgroup. 13 of the 14 subscales also improved compared to generic advice, statistically significant for self-rated global health (Renewed: 3.06, 1.39 to 4.74; Renewed plus support: 2.78, 1.08 to 4.48), dyspnoea, constipation and enablement. For Renewed plus support, there were also statistically significant differences for physical, cognitive and emotional functioning and fatigue. Renewed and Renewed plus support were dominant given improved effectiveness combined with and lower mean primary care National Health Service costs per patient (respectively −£141, −153 to −128; −£77, −90 to −65). Limitations: Of those sent invitation letters, 14% (7883/59,295) were assessed for eligibility and 35% (2732/7883) of those assessed were eligible and agreed to participate – which is normal with the ‘cold calling’ method of invitation. The digital intervention would not suit people who find technology or the internet difficult to access, but only 25% (2649/10,697) of those who gave reasons for declining did so due to lack of internet access. The extensive generic advice available to participants in the National Health Service limited the ability to assess the specific benefits of Renewed in the short term, but nevertheless longer-term benefit and lower National Health Service costs are likely to be achieved with the bespoke intervention. Conclusions: Cancer survivors with lower quality of life given detailed generic online support improve significantly. Providing robustly developed, low-cost, bespoke digital support can provide further modest long-term improvements in enablement, symptom management and self-rated global health, with substantially lower National Health Service costs. Future work: The cost-effectiveness and benefits for symptom management on self-rated health suggest a more widespread implementation study should be undertaken. Trial registration: This trial is registered as Current Controlled Trials ISRCTN 96374224. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-0514-20001) and is published in full in Programme Grants for Applied Research ; Vol. 14, No. 4. See the NIHR Funding and Awards website for further award information. Plain language summary We aimed to make and assess a website for use in general practices to support people who have poor quality of life after their initial cancer treatment. We made our website, called ‘Renewed’, based on the few studies about websites or apps. We tested ‘Renewed’ with people who had finished their initial treatment, National Health Service staff and others, and used their feedback to improve it. Then we asked others to join a study to see how well ‘Renewed’ works. Each person invited to join the study had finished initial treatment for bowel, breast or prostate cancer but had poor quality of life. We placed them at random (by chance) into one of three groups: given general advice from the NHS website for more healthy living (‘Living Well’) given ‘Renewed’, with help designed for cancer survivors in managing symptoms, exercise, diet, weight, distress, and fear of cancer coming back given ‘Renewed’, plus brief support by e-mail, telephone or face to face. After 6 months, all groups reported better quality of life. After 12 months, the Renewed plus support group carried on improving and was a little better than general advice for quality of life. At this time both the Renewed groups had improved in their rating of their health, shortness of breath, constipation and feeling more able to manage their problems. People in the Renewed plus support group also had improved physical and emotional functioning and less fatigue. Both Renewed and Renewed plus support not only had improved outcomes but also lower costs for the NHS. This study suggests that the online support provided by the Renewed website can help improve the quality of life of people who have finished initial cancer treatment, with both better outcomes and lower costs for the National Health Service. Contents Expand All Collapse All Scientific summary Synopsis Aims, overview and context of the research programme Summary of aims and rationale Summary of research Development of Renewed Introduction Intervention development team and patient and public involvement Workstream 1 and workstream 2 objectives Workstream 1 (phase 1): collating evidence from reviews of the literature Workstream 1 (phase 2): intervention planning Workstream 2 (phase 3): intervention development and optimisation Mapping the Renewed planning and development process to the IdentifyiNg and assessing different approaches to DEveloping compleX interventions actions Workstream 1 and workstream 2 conclusions Workstream 3 evaluation of Renewed Objectives Randomised controlled trial to assess clinical and cost-effectiveness Process evaluations exploring how patients and healthcare professionals experienced and implemented the intervention in practice Conclusions Objectives The contribution of patient and public involvement Strengths, successes, limitations and challenges Summary and recommendations for future research Additional information References Appendix 1. INDEX actions report of the Renewed intervention Appendix 2. Health economic evaluation Appendix 3. Summary of patient qualitative process study: experiences of using a supported digital intervention for cancer survivors in primary care Appendix 4. Summary of patient quantitative process study: engagement and usage of the renewed intervention by patients List of abbreviations List of supplementary material Expand All Collapse All About the Series Programme Grants for Applied Research ISSN (Electronic): 2050-4330 Article history The research reported in this issue of the journal was funded by PGfAR as award number RP-PG-0514-20001. The contractual start date was in January 2016. The draft manuscript began editorial review in May 2023 and was accepted for publication in July 2025. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors’ manuscript and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this article. Last reviewed: May 2023; Accepted: July 2025. Copyright © 2026 Little et al . This work was produced by Little et al . under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/ . For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. Bookshelf ID: NBK621259 PMID: 41818494 DOI: 10.3310/PPLHG1141 < Prev Next > Share Views PubReader Print View Cite this Page Little P, Bradbury K, Stuart B, et al. Digital intervention to support cancer survivors: the CLASP research programme. Southampton (UK): National Institute for Health and Care Research; 2026 Mar. (Programme Grants for Applied Research, No. 14.04.) doi: 10.3310/PPLHG1141 PDF version of this title (2.4M) Other titles in this collection Programme Grants for Applied Research Related information NLM Catalog Related NLM Catalog Entries Recent Activity Clear Turn Off Turn On Digital intervention to support cancer survivors: the CLASP research programme Digital intervention to support cancer survivors: the CLASP research programme Your browsing activity is empty. Activity recording is turned off. Turn recording back on See more... 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