Outcomes of the Advanced Practice Nurse-Led Self-Care Support Program among People with Gastrointestinal Cancer and Cachexia: A Mixed-Methods Study

Cancer cachexia is a common and debilitating condition among people with gastrointestinal cancer that causes malnutrition, impaired function, and decreased quality of life. In Thailand, evidence about self-care support programs led by advanced practice nurses specifically designed for people with gastrointestinal cancer and cachexia remains limited. This evidence gap warranted the development and evaluation of a contextually appropriate intervention for Thai patients. Utilizing an explanatory sequential mixed-methods design, this study employed a quasi-experimental phase, then a qualitative descriptive phase to evaluate the Advanced practice nurse-led Self-Care Support Program for People with Gastrointestinal Cancer and Cachexia and explore participants’ experiences with the program. The program, developed based on Orem’s Self-Care Deficit Nursing Theory, was led by an advanced practice nurse at a university hospital in Bangkok, Thailand, between August 2024 and February 2025. Thirty-three participants were assigned to the study based on the clinic day they attended: 16 in the intervention group and 17 in the control group. The intervention group received the 12-week Program, and the control group received the hospital’s standard care. The screening instruments included the Thai Depression Screening Tool, the Mini-Cog test, and the Eastern Cooperative Oncology Group Performance Status Scale. The data collection instruments comprised the Personal Information Form, Bioelectrical Impedance Analysis, Cancer Fatigue Scale, Physical Function Test (6-minute walk test and handgrip strength), and Functional Assessment of Anorexia-Cachexia Therapy. Quantitative data were analyzed using descriptive statistics, independent t-tests, and Mann–Whitney U test. Then, 22 participants (12 from the intervention group and 10 from the control group) completed in-depth interviews. Qualitative interview data underwent thematic analysis. Results from the quantitative data demonstrated no significant difference between groups in body composition, fatigue, or quality of life. The intervention group demonstrated a significantly greater improvement on the 6-Minute Walk Test, whereas the control group showed a significantly greater decrease in distance. Thematic analysis of the qualitative data revealed participant experiences in two themes: 1) eating problems associated with cancer treatments and 2) exercise difficulties due to cachexia during illness and treatment. The participants discussed how treatment-related symptoms and fatigue hindered adherence to the program, and how individualized support helped them engage in eating and exercise. These findings support the use of this Program in this population group. Further evaluation of the Program in larger and more diverse samples across multiple settings is warranted before its integration into clinical practice.