Evidence map›Paper›PMID 42237427›Full record

ArticlePilot and feasibility studies2026

A feasibility randomised controlled trial of water-only fasting prior to CAPOX chemotherapy for stage 2/3 colorectal cancer.

Georgia Herbert, Clare England, Ellie Shingler, Rachel M Barker, Claire M Perks, Aidan Searle, Alex Whitmarsh, Andy Ness, Mark Saunders, Charlotte Atkinson

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Article in Pilot and feasibility studies, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Georgia HerbertNIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
Clare EnglandNIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
Ellie ShinglerNIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
Rachel M BarkerCancer Endocrinology Group, Learning & Research Building, Bristol Medical School, Southmead Hospital, Translational Health Sciences, Bristol, BS10 5NB, UK. mdrmh@bristol.ac.uk.ORCID http://orcid.org/0000-0003-0309-2708
Claire M PerksCancer Endocrinology Group, Learning & Research Building, Bristol Medical School, Southmead Hospital, Translational Health Sciences, Bristol, BS10 5NB, UK.
Aidan SearleNIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
Alex WhitmarshNIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
Andy NessNIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
Mark SaundersThe Christie NHS Foundation Trust, Wilmslow Road, Manchester, M204BX, UK.
Charlotte AtkinsonNIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCapecitabine and Oxaliplatin (CAPOX) chemotherapy is a standard treatment for stage 2/3 colorectal cancer but is associated with dose-limiting toxicities. Short-term fasting may protect healthy cells from chemotherapy-related side effects via differential stress resistance. However, it is not known whether it is possible to recruit to a trial of short-term fasting in this population, or whether participants would adhere to the intervention. The aim was to test the feasibility and acceptability of a pre-chemotherapy, 36-h, water-only fast prior to the first three cycles of chemotherapy in people receiving CAPOX chemotherapy for stage 2/3 colorectal cancer.

methodsA two-armed randomised controlled feasibility trial with an embedded qualitative interview study conducted in two NHS foundation trust hospital sites in England. Participants were randomly allocated, in a 1:1 ratio using random permuted blocks, by a secure online randomisation system, to either a 36-h fast immediately prior to chemotherapy administration or standard dietary advice. The intervention was delivered during chemotherapy cycles 1-3. Primary outcomes were adherence, recruitment, retention, data completion, and acceptability. Secondary outcomes included chemotherapy side effects, quality of life, metabolic and inflammatory markers, appetite, and sarcopenia.

resultsSeventy-nine patients were screened, of whom44 were eligible. Twelve consented and were randomised (intervention: n = 6; control: n = 6). The retention rates for chemotherapy cycles 1, 2, and 3 were 100%, 83%, and 83% for the intervention group and 100%, 100%, and 100% for the control. Five out of six participants adhered to the fast. The trends observed in levels of insulin-like growth factor I (IGF-I) and insulin-like growth factor binding proteins 2 and 3 (IGFBP-2 and IGFBP-3) were consistent with effective fasting. Qualitative findings indicated that fasting was achievable but sometimes perceived as an additional burden alongside chemotherapy. Recruitment challenges were influenced by site-level factors, including competing priorities, COVID-19-related disruptions, and perceptions of the intervention.

conclusionThe SWiFT study was feasible to deliver and adherence to the fast was high. In a future definitive trial, success in recruitment appears to depend more on specific local factors rather than the intervention being unattractive to most potential participants.

trial registrationISRCTN, ISRCTN17994717, registered 23 October 2018, https://www.isrctn.com/ISRCTN17994717.

Indexed as

CAPOXChemotherapyColorectal cancerFastingFeasibility trial

Identifiers

PMID42237427
PMCPMC13449517

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.