Exercise as a supportive care strategy in men with prostate cancer receiving androgen deprivation therapy at a regional cancer centre: a survey of patients and clinicians

Abstract

Purpose To understand how frequently exercise is discussed and/or prescribed as a supportive care measure and the barriers and facilitators to exercise uptake for men with prostate cancer receiving androgen deprivation therapy (ADT) at a regional cancer centre. Methods An observational, cross-sectional study was conducted at a regional cancer centre in three stages: (1) Retrospective chart review of men with prostate cancer undergoing ADT to identify the frequency of discussion and/or prescription of supportive care measures; (2) prospective patient survey exploring barriers and facilitators to exercise; and (3) prospective clinician survey exploring barriers, facilitators and awareness of exercise guidelines in men with prostate cancer. Results Files of 100 men receiving ADT (mean age 73 years; mean ADT duration =12 months) in the medical oncology ( n = 50) and radiation oncology ( n = 50) clinics were reviewed. Exercise was discussed with 16% of patients and prescribed directly to 5%. Patient survey ( n = 49). 44.2% of patients reported participating in exercise at a high level. Common barriers to exercise participation included fatigue (51.0%), cancer/treatment-related weakness (46.9%) and joint stiffness (44.9%). 36.7% of patients reported interest in a supervised exercise program. Clinician survey ( n = 22). 36.4% identified one or more exercise guidelines, and 40.9% correctly identified national exercise guidelines. Clinicians reported low knowledge of referral pathways to a supervised exercise program (27.3%). Clinicians believe physiotherapists (95.5%) are most suited to exercise prescription and 72.7% stated that exercise counselling should be part of supportive care. Limited time (63.6%) and patient safety (59.1%) were the two most common barriers to discussing exercise with patients. Clinicians reported that only 21.9% of their patients asked about exercise. The most endorsed facilitators to increase exercise uptake were patient handouts (90.9%) and integration of exercise specialists into the clinical team (86.4%). Conclusion Despite a third of patient respondents indicating an interest in a supervised exercise program, only 16% of patients with prostate cancer undergoing ADT at a regional cancer centre engaged in a discussion about exercise with their treating clinicians. Physical limitations and fatigue were the greatest barriers for patients. Clinicians indicated a need for more clinician education and better integration of exercise specialists into clinical care. A tailored, integrated approach is needed to improve the uptake of exercise in men with prostate cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06512-2.

What are the post‐treatment information needs of rural cancer survivors in Australia? A systematic literature review

“…Information on maintaining a healthy lifestyle was identified as lacking for rural cancer survivors in seven studies 22,39–44 . Specifically, there was a clear need for more information on diet and exercise, with six studies reporting unmet needs for information on these topics 22,39–43 .…”

“…Many studies suggested that written care plans or information sheets were needed for rural cancer survivors 28,29,39,44,50,56,66 . These were thought to be particularly useful for referring back to at a later time 56,66 .…”

“…Information on maintaining a healthy lifestyle was identified as lacking for rural cancer survivors in seven studies. 22,[39][40][41][42][43][44] Specifically, there was a clear need for more information on diet and exercise, with six studies reporting unmet needs for information on these topics. 22,[39][40][41][42][43] For example, Rowe et al, 2022 showed that less than 60% of rural cancer survivors reported receiving information about diet (n = 125/215) and exercise (n = 120/215) after treatment.…”

Exercise Cardio-Oncology: Exercise as a Potential Therapeutic Modality in the Management of Anthracycline-Induced Cardiotoxicity

“…There is a clear gap between research into the benefits of exercise throughout the cancer care continuum and the incorporation of exercise into the standard of care. Elbourne, Soo (151) reported that fewer than 30% of clinicians working with prostate cancer survivors were aware of referral pathways for a supervised exercise program, and less than 16% of clinicians engaged in conversations with survivors about exercise (151). Though the integration of exercise as adjuvant medicine into the cancer treatment plan was low, nearly 73% of the clinicians in the study agreed that exercise counseling should be incorporated into cancer care (151).…”

“…Elbourne, Soo (151) reported that fewer than 30% of clinicians working with prostate cancer survivors were aware of referral pathways for a supervised exercise program, and less than 16% of clinicians engaged in conversations with survivors about exercise (151). Though the integration of exercise as adjuvant medicine into the cancer treatment plan was low, nearly 73% of the clinicians in the study agreed that exercise counseling should be incorporated into cancer care (151). In a similar survey by the American Society of Clinical Oncology, 78.9% of oncology clinicians supported recommending physical activity to cancer survivors, yet less than 23% referred survivors to exercise programming (152).…”