LB093 - ENACT-65: INTEGRATED NUTRITION AND EXERCISE SUPPORT IN OLDER ADULTS WITH METASTATIC CANCER – TRIAL IN PROGRESS

LB093

ENACT-65: INTEGRATED NUTRITION AND EXERCISE SUPPORT IN OLDER ADULTS WITH METASTATIC CANCER – TRIAL IN PROGRESS

K. S. Hustad^1,*, A. Hiensch², M. Andresen³, J. Arends⁴, J. Belloso⁵, D. Cardenas-Braz⁶, A. Cervantes⁷, B. Ewals⁸, C. Greil⁹, A. Kok¹⁰, J.-Å. Lund^11,12,13, S. Olde-Damink^14,15,16, J. Siveke^17,18, T. S. Solheim^19,20, M. Stuiver²¹, L. Thorsen^22,23, A. Urruticoechea⁵, S. Kaasa¹, A. May^2,21, B. Laird¹

¹European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway, ²Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, ³Titan Software AS, Stathelle, Norway, ⁴Department of Medicine I, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, ⁵Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain, ⁶Nutrition Unit, Gustave Roussy, Villejuif, France, ⁷INCLIVA Health Research Institute, Valencia, Spain, ⁸International Society of Geriatric Oncology, Geneva, Switzerland, ⁹Department of Medicine I, Medical Centre-University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany, ¹⁰Department of Dietetics, University Medical Center Utrecht, Utrecht, Netherlands, ¹¹Clinic for Cancer Treatment and Rehabilitation, Møre and Romsdal Health Trust,, ¹²Department of Health Sciences Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, ¹³MATRIX, Norwegian Centre for Clinical Cancer Research, Oslo, Norway, ¹⁴Department of Surgery, Maastricht University Medical Centre, ¹⁵NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands, ¹⁶Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Essen, ¹⁷Bridge Institute of Experimental Tumor Therapy, West German Cancer Center and National Center for Tumor Diseases site West, University Hospital Essen, Essen, ¹⁸Division of Solid Tumor Translational Oncology, German Cancer Research Center and German Cancer Consortium , Heidelberg, Germany, ¹⁹Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, ²⁰Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway, ²¹Division of Psychosocial Research and Epidemiology and Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, Netherlands, ²²Department of Oncology, Oslo University Hospital, ²³Department of Clinical Service, Oslo University Hospital, Oslo, Norway

Rationale: Older adults with cancer are at high risk of malnutrition, which negatively affects treatment tolerance, quality of life (QoL), and survival. Although guidelines recommend integrated nutritional and exercise support, implementation in routine oncology care is inconsistent, and robust evidence for improved clinical outcomes is limited. ENACT-65 aims to determine whether a digitally supported integrated nutritional and exercise intervention can improve QoL and survival in older adults with advanced cancer.

Methods: ENACT-65 is a multicentre pragmatic RCT funded by the European Union Horizon Europe programme. We will recruit 394 patients aged ≥65 years with metastatic non-small cell lung cancer or colorectal cancer receiving systemic anticancer therapy across five European countries. Participants will be randomised 1:1 to integrated nutrition and exercise support or usual care. The six-month intervention combines a digitally supported nutritional care pathway with exercise. Nutritional support includes guideline-based malnutrition screening and assessment, individualised dietary counselling to optimise protein and energy intake, symptom management, and weekly patient-reported outcome monitoring, enabling early identification of nutritional risk, symptom burden and timely intervention. Co-primary outcomes are overall survival and QoL (EORTC QLQ-C30 summary score). Secondary outcomes include treatment tolerance, nutritional status, frailty, and physical function. Mixed methods will be used to understand adherence and its determinants as well as lived experience with the intervention.

Results: Recruitment is planned to begin in 2027.

Conclusion: ENACT-65 has the potential to accelerate implementation of evidence-based nutritional care pathways combined with exercise in oncology practice while generating high-quality evidence for their impact on clinical and patient-reported outcomes.

Disclosure of Interest: None declared