Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors

Eng, Lawson; Pringle, Dorothy; Su, Jie; Shen, Xiaowei; Mahler, Mary; Niu, Cuijuan; Charow, Rebecca; Tiessen, Kyoko; Lam, Christine; Halytskyy, Oleksandr; Naik, Hiten; Hon, Henrique; Irwin, Margaret; Pat, Vivien; Gonos, Christina; Chan, Catherine W. T.; Villeneuve, Jodie; Harland, Luke; Shani, Ravi M.; Brown, M. Catherine; Selby, Peter; Howell, Doris; Xu, Wei; Liu, Geoffrey; Alibhai, Shabbir M.H.; Jones, Jennifer

doi:10.1007/s00520-018-4239-5

Cited by 66 publications

(60 citation statements)

References 47 publications

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“…In our study, a pathological score of FACFT-Fas an indicator of fatigue-turned out to be the strongest negative predictor of motivation for PA. This important result is in line with several studies investigating barriers to PA in ACP [25,26] and cancer survivors [19,21,23]. These authors described fatigue as a main barrier of PA.…”

Section: Discussionsupporting

confidence: 87%

“…These results were in concordance with several studies. Eng et al [23] examined PA behavior, perceptions and perceived barriers to PA in a study cohort of 1003 cancer survivors. In this study, patients with a sedentary lifestyle before diagnosis rarely improved their activity level after diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Depression, no motivation, fears, lack of knowledge about PA and QoL and no awareness of exercise program were mentioned as psychological barriers. Environmental and social related barriers were employment situation, access to facilities, bad weather and lack of time [18][19][20][21][22][23]. However, these findings cannot be transferred to the needs and requirements of ACP, since cancer survivors and ACP differ significantly regarding their life circumstances.…”

Section: Introductionmentioning

confidence: 99%

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Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients

et al. 2020

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Background: In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it. Methods: Outpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting moderate/severe tiredness/weakness during self-assessment (MIDOS II) were enrolled. We assessed Fatigue-(FACF-F) and Depression (PHQ8) Scores, demographics, cancer-specific parameters, motivation for PA, physical, psychological and social barriers. Results: 141 of 440 eligible patients (32.0%) with different diagnoses agreed to participate. Patients frequently reported "I feel weakened due to my tumor therapy" (n = 108; 76.6%), physical symptoms (tiredness, weakness, dyspnea, joint-problems, pain, nausea [n = 107; 75.9%]) and fatigue (n = 99; 70.2%) as barriers to PA. However, no significant group differences regarding these barriers were found between physically active and inactive patients. Social barriers were rarely chosen. Motivated patients were 5.6 times more likely to be physically active (p < 0.001), also motivation turned out to be the strongest predictor for a physically active behavior (β = 1.044; p = 0.005). Motivated attitude towards PA was predicted by fatigue (β = − 2.301; p = 0.008), clinically relevant depression (β = − 1.390, p = 0.039), knowledge about PA and quality of life (QoL) (β = 0.929; p = 0.002), PA before diagnosis (β = 0.688; p = 0.005 and Interest in exercise program (β = 0.635; p = 0.008). Conclusion: "I feel weakened due to my tumor therapy" is the most reported barrier to PA among both, physically and inactive patients. Motivation for PA is the strongest predictor of performing PA. Interest in PA, knowledge about PA/ QoL and PA before diagnosis are main predictors of a motivated attitude. Absence/presence of social barriers did not associate with motivation, fatigue and depression proved to be a negative predictor. Programs including information, motivational counseling and individualized training should be offered for ACP to overcome barriers and reduce fatigue.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients

et al. 2020

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“…For each health behavior, patients were asked to rate the perceived impact of each behavior on three survivorship outcomes: quality of life, 5-year overall survival, and fatigue after a cancer diagnosis using a 7-point Likert scale (1 = "make much worse", 4 = "no effect", to 7 = "make much better"). [18][19][20][21]…”

Section: Assessment Of Outcomesmentioning

confidence: 99%

“…However, differences in both health behaviors and perceptions of these behaviors between immigrant and native‐born cancer survivors have not been explored. Previously, our group demonstrated that patient perceptions can be associated with health behavior changes after a cancer diagnosis …”

Section: Introductionmentioning

confidence: 99%

Impact of immigration status on health behaviors and perceptions in cancer survivors

et al. 2019

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Background Health behaviors including smoking cessation, physical activity (PA), and alcohol moderation are key aspects of cancer survivorship. Immigrants may have unique survivorship needs. We evaluated whether immigrant cancer survivors had health behaviors and perceptions that were distinct from native‐born cancer survivors. Methods Adult cancer patients from Princess Margaret Cancer Centre were surveyed on their smoking, PA, and alcohol habits and perceptions of the effects of these behaviors on quality of life (QoL), 5‐year survival, and fatigue. Multivariable models evaluated the association of immigration status and region‐of‐origin on behaviors and perceptions. Results Of the 784 patients, 39% self‐identified as immigrants. Median time of survey was 24 months after histological diagnosis. At baseline, immigrants had trends toward not meeting Canadian PA guidelines or being ever‐drinkers; patients from non‐Western countries were less likely to smoke (aOR current = 0.46, aOR ex‐smoker = 0.47, P = 0.02), drink alcohol (aOR current = 0.22, aOR ex‐drinker = 0.52, P < 0.001), or meet PA guidelines (aOR = 0.44, P = 0.006). Among immigrants, remote immigrants (migrated ≥40 years ago) were more likely to be consuming alcohol at diagnosis (aOR = 5.70, P < 0.001) compared to recent immigrants. Compared to nonimmigrants, immigrants were less likely to perceive smoking as harmful on QoL (aOR = 0.58, P = 0.008) and survival (aOR = 0.56, P = 0.002), and less likely to perceive that PA improved fatigue (aOR = 0.62, P = 0.04) and survival (aOR = 0.64, P = 0.08). Conclusions Immigrants had different patterns of health behaviors than nonimmigrants. Immigrants were less likely to perceive continued smoking as harmful and were less likely to be aware of PA benefits. Culturally tailored counselling may be required for immigrants who smoke or are physically sedentary at diagnosis.

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A central role for apathy in the effectiveness of interventions for cancer‐related fatigue

et al. 2020

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Objective: Cancer-related fatigue (CRF) affects a substantial number of cancer patients and survivors. Recommendations for CRF treatments are largely based on results of randomized controlled trials. The interpretability of such results is limited to patients eligible and willing to participate in these trials. We aimed to address this limitation in a retrospective study of patients seen at a CRF clinic in a comprehensive cancer center. The objectives were to (a) determine the effectiveness of clinician-initiated interventions for CRF and identify their mediators and (b) describe the frequency and effectiveness of patient-initiated physical activity (PA) behavior for alleviating CRF and identify determinants of this PA. Methods: Data (patient-reported somatic and mood symptoms; clinical data; clinician-documented changes in medication and behavior) from n = 213 patients collected as part of the clinic's standard of care at initial clinical consult and follow-up 4 to 11 weeks later were included. Effects of clinician-initiated interventions and patient-initiated PA on change in fatigue were analyzed using linear models. Results: Of all clinician-initiated interventions, only psychostimulant start was recorded frequent enough for further investigation and was associated with reduced fatigue; this association was mediated by a reduction in apathy. PA was also associated with reduced fatigue severity. PA initiation/increase after consult was associated with lower apathy at consult. Conclusions: These results demonstrate a major role for patient apathy in the effectiveness and initiation of CRF-targeting interventions. Behavioral therapies focusing on reduction in apathy should be considered as initial treatment of CRF in those with substantial apathy.

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Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors

Abstract: Patient perceptions of PA benefits are strongly associated with improving PA levels after a cancer diagnosis. Clinician counseling should focus on patient education and changing patient perceptions.

Cited by 66 publications

References 47 publications

Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients

Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients

Impact of immigration status on health behaviors and perceptions in cancer survivors

A central role for apathy in the effectiveness of interventions for cancer‐related fatigue

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