“I want to get myself as fit as I can and not die just yet” – Perceptions of exercise in people with advanced cancer and cachexia: a qualitative study

Abstract

Cachexia is a prevalent muscle wasting syndrome among people with advanced cancer that profoundly impacts patient quality of life (QoL) and physical function. Exercise can improve QoL, physical function, and overall health in people with cancer and may be an important addition to treatment approaches for cancer cachexia. Greater understanding of patients’ perception of exercise can help elucidate the feasibility of implementing exercise interventions for cancer cachexia and facilitate the design of patient-centered interventions. We aimed to describe the perception of exercise in patients with advanced cancer and cachexia, and capture exercise motivators, barriers, and preferences, to inform the feasibility of exercise interventions. Individual interviews (n = 20) with patients with locally advanced or metastatic cancer with cachexia were conducted and analyzed using reflexive thematic analysis. Main themes from interviews were: 1) Life is disrupted by cancer and cachexia; 2) Exercise offers hope; 3) Exercise barriers are multifaceted; and 4) Exercise access and support are important. Participants reported that their cancer and cachexia had intensely altered their lives, including ability to exercise. Exercise was perceived as important and participants described a hope for exercise to improve their health and wellbeing. Yet, several complex exercise barriers, such as burdensome cancer symptoms and the overwhelming impact of the COVID-19 pandemic, hindered exercise participation and prevented participants from fully realizing the perceived benefits of exercise. Factors believed to improve exercise engagement and overcome exercise barriers included increased exercise support (e.g., professional supervision) and accessibility (e.g., convenient locations). Patient-reported exercise barriers and preferences can inform the design of exercise interventions, particularly within future research studies aiming to establish exercise feasibility and efficacy in people with advanced cancer and cachexia.

Effect of combined therapies including nutrition and physical exercise in advanced cancer patients: A pooled analysis

“…Bland et al's qualitative study (2022) focused on how people with advanced cancer and cachexia perceive exercise and identified barriers that keep them from exercising, such as, for example, fatigue. They concluded that cancer patients should get offered a combination of home-based and supervised options for exercise: "Combining unsupervised home-based with supervised exercise, which may include incorporating telehealth, may help balance patient exercise preferences that we identified in the current study" (45).…”

PERSPECTIVEs on supervised exercise programs in people with metastatic breast cancer- a qualitative study in four European countries

“…However, the possibility to exercise seemed to be limited by disease- and treatment-related physical constraints and resulting insecurities about the appropriate exercise type, amount, and execution. Insecurities and fear have been previously reported as exercise barriers in diverse cancer populations [ 21 , 23 , 40 ], but could be even more prominent for MBC patients given the adverse effects of their typically longer treatment history, having metastases and especially the (potential) presence of bone metastases. This could also explain women’s strong wish for professional supervision when exercising.…”

“…To ensure exercise safety and effectiveness, instruction by a trained professional is advisable [ 19 , 20 ], while the content of an exercise program can be designed according to patients’ perceived barriers, facilitators, and preferences to improve exercise adherence. Previous research on this topic has largely been limited to early-stage breast cancer patients [ 21 , 22 ] or mixed cancer types [ 23 – 26 ], whose needs and preferences may differ from those of patients with MBC [ 5 , 6 ].…”

Feasibility and Effectiveness of the Exercise Program in Endometrial Cancer; Feasibility and Acceptability Survivorship Trial (EPEC-FAST)

“…The 86% adherence of our study is among the highest reported for a lifestyle intervention for endometrial cancer patients. Our high attendance rates may be explained by our individualized one-to-one sessions and the accessibility of a local gym, as they are known factors to improve exercise engagement and overcome barriers [ 17 , 38 ]. Studies by Rossi et al and Koutoukidis et al evaluating face to face interventions delivered through group sessions have reported rates of 60 to 77% [ 31 , 35 ].…”