Exercise preferences among patients with head and neck cancer: Prevalence and associations with quality of life, symptom severity, depression, and rural residence

Factors influencing physical activity in individuals with head and neck cancer: a scoping review

OBJECTIVES

Higher physical activity (PA) levels are associated with better quality of life in people with head and neck cancer (HNC). Despite this positive association, most individuals with these cancer types have a sedentary or low-activity lifestyle. Limited knowledge exists regarding the factors that influence PA in this group. Therefore, we reviewed and mapped the available literature on factors that may influence PA in people with HNC.

DESIGN

We conducted a scoping review based on the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for scoping reviews.

DATA SOURCES

CINHAL, the Cochrane Library, EMBASE, PsycINFO, MEDLINE and Scopus were searched from inception to July 2023.

ELIGIBILITY CRITERIA

We included qualitative and quantitative studies that stated factors such as barriers, facilitators, beliefs, perceptions and views influencing PA in individuals with HNC. Furthermore, views and recommendations of healthcare professionals involved in the care of people affected by HNC and researchers in this domain were eligible for data extraction.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and synthesised by one reviewer according to the predefined items including characteristics, barriers, facilitators, beliefs, perceptions and views of people being affected and views and recommendations of experts. Quantitative data were charted descriptively, and qualitative data were analysed and summarised using a basic content analysis approach.

RESULTS

Of the 1351 publications, we included 19 in our review. Publications mainly focused on barriers to PA, with some studies reporting facilitators and collecting data on patients' and healthcare professionals' views on PA. Most research teams made recommendations for promoting PA in people with HNC.Characteristics associated with activity levels included age, cancer type and stage, morbidity level and attitude towards being active. Prevalent barriers consisted of health-related factors, including fatigue, pain and nutritional issues, alongside personal and environmental impediments such as time constraints, lack of interest or motivation. Facilitating factors for PA included perceived or experienced mental and health-related benefits. Consensus among patients, healthcare professionals and researchers highlighted the necessity for enhanced information and education, emphasising individualised approaches to promote PA throughout the cancer continuum.

CONCLUSIONS

Numerous factors affect PA in individuals with HNC. Future research should concentrate on screening and addressing risk factors for sedentary behaviour and activity barriers and on optimal design and delivery of interventions to incorporate PA promotion into the care pathway.

Physical Activity, Alcohol, and Cigarette Use in Urological Cancer Patients over Time since Diagnosis

Urological cancers represent a substantial global public health concern, exerting far-reaching effects on both individuals and their families. There is an urgent need to comprehensively understand the transformations in patients' lifestyles and behaviors, given their critical role in the treatment process and overall well-being. This study, involving 128 urological cancer patients, aims to investigate changes in physical activity levels, problematic drinking behaviors assessed through the Alcohol Use Disorders Identification Test (AUDIT), and smoking habits assessed using the Fagerström Test for Nicotine Dependence (FTND) over four distinct time intervals over the subsequent three years from the time of diagnosis and among individuals diagnosed more than three years ago. The results reveal a significant decrease in physical activity levels between study intervals (p < 0.0001), declining from 69% to 45% between the first and second post-diagnosis assessments. Furthermore, the highest levels of problematic substance use, indicated by mean scores, were noted in the first year following diagnosis (AUDIT: 4.20, p = 0.01; FTND: 4.83, p = 0.08). Given the significant impact of physical activity on the prospects of recovery, it is imperative to delve more deeply into the factors contributing to this decline and devise targeted interventions for its improvement. In the context of substance use, it is essential to ascertain whether the initially high levels are a result of coping with the cancer diagnosis or represent a turning point at which patients modify their behaviors and cease their addiction. A more thorough understanding of this phenomenon would enhance the effectiveness of precisely focused interventions.

Effect of exercise across the head and neck cancer continuum: a systematic review of randomized controlled trials

PURPOSE

This study aims to systematically explore the impact of physical exercise as supportive therapy for head and neck cancer.

METHODS

A systematic search on PubMed/MEDLINE, Cochrane, and SPORTDiscus was conducted. Randomized controlled trials exploring the effects of a physical exercise intervention in comparison with usual care on outcomes in patients with head and neck cancer were selected. The RoB 2 tool was used to determine the study quality. The extracted data are reported as qualitative synthesis.

RESULTS

Among the 527 records examined, nine studies were included. No trials investigating exercise as prehabilitation were found, whereas eight studies involving 452 patients with head and neck cancer were conducted during anticancer treatment. Most trials did not report improvements in body mass index or body composition, while 2/4 and 3/5 investigations found a significant increase in muscle strength and cardiorespiratory fitness, respectively. Regarding the patients' reported outcomes, 4 out of 7 studies observed enhancements in some domains of quality of life, and two trials out of 3 detected an amelioration in fatigue following the exercise intervention. Analyzing the exercise programs, it seems that combining aerobic and resistance training could be more beneficial compared to a single type of full-body exercise in counteracting physical decline and controlling symptoms in the anticancer therapy phase. One trial has investigated the effect of resistance exercise on patients who had terminated the anticancer treatments, reporting significant improvements in lean mass, muscle strength, and quality of life.

CONCLUSION

Exercise may be a promising approach in patients with head and neck cancer. Future studies are needed to consolidate these results.

Feasibility of a supervised and home-based tailored exercise intervention in head and neck cancer patients during chemoradiotherapy

OBJECTIVE

Chemoradiotherapy (CRT) for head and neck cancer (HNC) is associated with high toxicity that adversely affects physical functioning, body composition, fatigue, quality of life and treatment outcomes. Exercise interventions during treatment might counteract these negative effects. We therefore assessed the feasibility of an exercise programme for HNC patients during CRT.

METHODS

Forty patients were offered a tailored 10-week endurance and resistance training with supervised and home-based sessions. Feasibility endpoints were (1) adherence (main outcome): ≥60% attendance; (2) recruitment: ≥30%; (3) retention rate: ≥85% and (4) compliance rate: ≥60%. Physical performance, muscle strength, body composition, quality of life and fatigue were assessed pre- and post-intervention.

RESULTS

Overall adherence was 54%. The recruitment rate was 36%, and the retention rate was 65%. Compliance to the supervised intervention protocol was 66%. Statistically significant decreases were found in mean grip strength, fat-free mass and clinically relevant deteriorations on several domains of quality of life, and fatigue subscales were found.

CONCLUSION

We conclude that this exercise programme for HNC patients during CRT in its current form is feasible for only a minority of patients. We suggest adaptations to improve adherence and retention rates for a definitive multicentre trial.

TRIAL REGISTRATION

This study is registered at the Netherlands Trial Register (NTR7305), 6 June 2018, retrospectively registered.

Nurse-Led Counseling Intervention of Postoperative Home-Based Exercise Training Improves Shoulder Pain, Shoulder Disability, and Quality of Life in Newly Diagnosed Head and Neck Cancer Patients

This randomized controlled trial investigated the effectiveness of the nurse-led counseling intervention (NLCI) of postoperative home-based exercise training (HBET) on functional outcomes in patients with newly diagnosed head and neck cancer (NDHNC). Forty NDHNC patients were randomly and equally divided into the control and intervention groups. Both groups received routine care, and were instructed to undergo a HBET program with 40 min moderate-intensity exercise 3–4 times per day for 12 weeks after their surgery. Only the intervention group received the NLCI with a bedside demonstration, coaching, consultation, and a weekly telephone follow-up. Shoulder pain (SP), shoulder disability (SD), and quality of life (QOL) scores were assessed using questionnaires at 2 weeks presurgery and at several timepoints postsurgery. Over the 12-week study period, all three scores remained relatively stable in the control group. By contrast, the SP, SD, and QOL scores significantly improved in the intervention group. The generalized estimating equation analysis revealed a significant time effect, group effect, and group–time interaction. The analysis of covariance revealed that all three scores significantly improved in the intervention group compared with those in the control group at 12 weeks postsurgery. We concluded that the NLCI of postoperative HBET improved the SP, SD, and QOL of NDHNC patients.

Perception and Performance of Physical Activity Behavior after Head and Neck Cancer Treatment: Exploration and Integration of Qualitative and Quantitative Findings

Maintaining or increasing physical activity (PA) may prevent loss of muscle mass and strength after completion of head and neck cancer (HNC) treatment. However, the exercise level of HNC patients may not meet PA guidelines. We aimed to explore HNC survivors' views on PA, their report of PA, and to compare these with objectively measured PA. Combined qualitative and quantitative data of HNC survivors were explored post-treatment. Data from semi-structured interviews, questionnaires, and objective measurements of PA were collected, analyzed, and integrated. This resulted in the identification of five themes related to prioritizing, day-to-day life, intention, positive feelings, and social support, respectively, in nine HNC survivors (male: n = 5; age: 52-67 years). Objectively measured PA levels were sedentary to low. The lack of intention to increase PA may be related to HNC survivors' perception that their current activity level is sufficient, despite low levels of measured PA. While some participants feel they need no help with PA, others are insecure about possible harms. Healthcare professionals may be able to help improve PA in HNC survivors with a tailored approach that reduces fear of harm and helps to incorporate higher intensity PA in daily activities.

Exercise participation, barriers, and preferences in Korean prostate cancer survivors

Objective: To identify patterns of physical activity (PA) participation, exercise preference, and barriers of stage 2-3 prostate cancer survivors across cancer trajectories based on selected demographic and medical variables.Design: The current study is a descriptive cross-sectional study which included data from a total of 111 prostate cancer survivors, at Shinchon Severance Hospital, Seoul, Korea. The survey includes PA levels before and after prostate cancer diagnosis, exercise barriers, and preferences.Results: Moderate- to vigorous-intensity PA levels were significantly lower after cancer diagnosis (vigorous PA:41.9 ± 123.1 min/week vs. 4.6 ± 29.8 min/week, p < 0.001; moderate PA: 159.9 ± 240.0 min/week vs. 56.8 ± 129.7 min/week, p < .001) compared to their PA level before cancer diagnosis. Perceived exercise barriers were distinctly different according to participants' age and time since surgery. The two most prevalent exercise barriers among prostate cancer survivors <65 years were lack of time (28.6%) and poor health (26.5%), whereas the exercise barriers for prostate cancer survivors aged ≥65 years were lack of exercise facilities (21.4%) and lack of exercise information (17.9%). Furthermore, within 6 months after surgery, prostate cancer survivors perceived poor health (29.5%) and pain at the surgery site (29.5%) to be the two most prevalent exercise barriers. 6 months after surgery, prostate cancer survivors perceived lack of time (21.3%) and poor health (14.8%) to be the two most prevalent exercise barriers. Walking, pelvic floor and Kegel exercises were three most preferred exercises among prostate cancer survivors in our study, which uniquely differ according to time since surgery.Conclusion: This study showed significant reduction in PA levels among prostate cancer survivors and their perceived exercise barriers were distinct according to their age and time since surgery. Therefore, PA and exercise recommendation should be specific to their personal characteristics such as age and time since surgery.

Interest and preferences for physical activity programming and counselling among cancer patients aged over 70 years receiving oncological treatments

OBJECTIVE

The objective of this study is to assess the physical activity interest and preferences of cancer patients aged over 70 years during oncological treatments and to explore how demographic characteristics may modulate preferences.

METHODS

From April to May 2018, this cross-sectional study collected data from self-administered questionnaire regarding physical activity interest and preferences in cancer patients receiving oncological treatments in a regional cancer centre.

RESULTS

A total of 144 patients completed the questionnaire. Two thirds (n = 95) showed interest in participating in dedicated physical activity programme during oncologic treatments. Patients preferred to exercise in group activities, under the supervision of an exercise instructor, once a week, at a moderate intensity, for 30 min session, in a community fitness centre. Women significantly preferred exercises to improve flexibility (p = 0.03) and to receive counselling in a group (p = 0.03), whereas men preferred to practise strength training (p = 0.02) and to receive counselling with brochures (p = 0.02). As age increases, participants were significantly more inclined to practise physical activity to improve their balance (p = 0.01).

CONCLUSION

These preliminary results will facilitate the design of programmes considering current physical activity preferences in older adults with cancer, which could ensure better adherence to physical activity programmes and, in turn, improved health outcomes.

Physical activity levels, exercise preferences, and exercise barriers in Korean children and adolescents after cancer treatment

PURPOSE

The purpose of the current study was to explore physical activity (PA) levels, exercise preferences, and perceived barriers to PA in childhood cancer survivors.

METHODS

This cross-sectional study surveyed 120 childhood cancer survivors aged 8-18 years from the pediatric oncology center in South Korea between March and August 2017. The modified Exercise & Quality of Life questionnaire, Korea Youth Risk Behavior Web-based Survey, and Godin Leisure-Time Questionnaire were used to assess PA levels, preferences, and exercise barriers.

RESULTS

Among 120 participants (72 boys, 48 girls) whose average age at the time of the survey was 14.57 ± 3.00 years and the average age at diagnosis was 8.22 years, the three most common diagnoses were acute leukemia (43.3%), brain tumor (13.3%), and malignant lymphoma (10.8%). Only 16 participants (5%) met the PA recommendations for children (at least 60 min of moderate PA per day). The most preferred sporting activities included soccer, basketball, strengthening exercises, badminton, dance, and taekwondo. They generally had positive attitudes toward exercise, and more than 63% of participants intended to exercise the following month. The five most prevalent perceived barriers to exercise were lack of time, poor health, reluctance to sweat, lack of exercise skills, and no exercise partners.

CONCLUSIONS

While most childhood cancer survivors did not meet the PA recommendation, most of them agreed that exercise was beneficial, and they intended to participate in the exercise. Exercise and PA programs should be tailored to the personal health and preferences of childhood cancer survivors.

Patients' views of physical activity whilst living with and beyond head and neck cancer

Exercise is an important component of recovery following cancer. Head and neck cancer (HNC) patients typically report low levels of engagement in exercise initiatives. The aim of this study was to give insight into HNC patients' reflections on how and why they would be interested in participating in an exercise programme. A stratified sample of 51 patients based on age, gender and initial interest in an exercise programme was selected from 430 postal survey respondents. Twenty-five took part in a semi-structured telephone interview. There was responder bias with females, younger patients, and those already participating in or interested in an exercise programme being over-represented. The responders in this study highlighted issues related to physical activity levels, perceived ability to meet physical activity guidelines for cancer survivors, perceived exercise benefits, perceived exercise barriers, and advice to others diagnosed with cancer. The findings support the premise of personalized interventions tailored towards the specific needs of the patient, supported by patient peers to emphasize the benefits and help motivate patients to take part. In order to promote engagement in exercise there needs to be collaborative, culturally sensitive and individualized approaches, in order to address the specific barriers experienced by HNC patients.

Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm

PURPOSE

Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm.

METHODS

From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format.

RESULTS

We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains.

CONCLUSIONS

The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.

Exercise Levels and Preferences in Cancer Patients: A Cross-Sectional Study

BACKGROUND

Despite the benefits related to physical exercise, large numbers of cancer patients are not sufficiently active.

METHODS

To investigate exercise levels and preferences in cancer patients, a cross-sectional study was conducted on a random sample of 392 cancer outpatients who anonymously completed a questionnaire investigating general and medical characteristics, and expressed willingness to participate in exercise programs. Current exercise levels were estimated with the Leisure Score Index (LSI).

RESULTS

Most patients (93%) were insufficiently active but 80% declared an interest in exercise programs. Patients preferred oncologist-instructed programs and specified particular exercise needs. Multivariate logistic regression showed that willingness to exercise was associated with education (OR: 1.87; 95% CI: 1.15-3.04 beyond age 14 years vs. up to 14 years) and current physical activity (OR: 1.92; 95% CI: 1.92-3.63 for sweat-inducing activity >2 times/week vs. <1 time/week). Patients given chemotherapy were less inclined to exercise (OR: 0.45; 95% CI: 0.23-0.86) than those who did not. LSI was lower if cancer stage was advanced (β: -0.36; 95% CI: -0.75 to -0.02) than if it was in remission. High LSI was also associated with longer education, lower BMI, and longer time after diagnosis.

CONCLUSION

Cancer patients are insufficiently active but are willing to participate in personalized exercise programs. Information from this survey may help in designing personalized interventions so these patients will achieve sufficient exercise.

Feasibility and Effects of a Supervised Exercise Program Suitable for Independent Training at Home on Physical Function and Quality of Life in Head and Neck Cancer Patients: A Pilot Study

Introduction: Head and neck cancer patients often suffer from physical and cognitive impairments after cancer treatment. During rehabilitation, exercise therapy can improve physical function and quality of life (QoL). Surveys demonstrated patients' preference for home training with low- to moderate-intensity. This study was conducted in order to develope a suitable home-based training program. Therefore, the feasibility and effects of a low- to moderate-intensity exercise intervention on physical functions and QoL were evaluated. Methods: Training was conducted as supervised group training and consisted of mobilization, coordination, resistance, stretching, and relaxation exercises. The intervention lasted 12 weeks with 2 training sessions per week. Feasibility, attendance rate, physical function (eg, range of motion, 6-minute walk test [6MWT]), and QoL (eg, EORTC QLQ-30) were analyzed. Results: Ten out of 12 participants completed the intervention (83%) with an average attendance rate of 83%. Participants showed significant improvements in selected physical functions. For example, head rotation increased by 11.2° (P = .042), walking distance in the 6MWT increased by an average of 43.3 m (P = .010), and the global QoL scale improved by 8.2 points (P = .059). Additionally, there were positive changes in the physical function scale (P = .008), cognitive function scale (P = .015), and social function scale (P = .031) of the EORTC QLQ-30. Conclusion: Data indicate that the exercise program was feasible and had positive effects on physical function and QoL. Future research will analyze the effects of a home-based exercise program on physical function and QoL in a large-scale study.

Is pain part of a systemic syndrome in head and neck cancer?

Head and neck cancers (HNC) represent 5% of all malignancies worldwide with about 180,000 cancer deaths per year. Patients with HNC are characterized by a systemic inflammatory state, generally associated with worse outcomes. Treatment-related toxicity is common among HNC patients and causes systemic consequences such as fatigue or cognitive dysfunction. The therapeutic treatments of HNC involve the release in circulation of inflammatory systemic mediators, whose effects trigger a vicious circle that may lead to functional and behavioral alterations. The areas of the head and neck are highly sensitive to pain. Literature data confirm that in HNC patients, pain is one of the most distressing symptoms across all the phases of treatment. Pain is associated with worse general conditions, depression, fatigue, impaired cognitive functions, and lower survival rate. The treatment of advanced HNC cases is multimodal and requires a multidisciplinary psycho-socio-pharmacological approach mediated by a team of experts. The pharmacological approach in management of HNC patients with pain is fundamental and involves the use of opioids, NSAIDs, steroids, or other drugs. Opioids in pain management therapy in patients with HNC could allow the pain level to be adequately monitored, thus improving quality of life. The integration of opioid and non-opioid therapy as well as non-pharmacological interventions is essential for the rehabilitation of physical, social, and psychological functions and to achieve pain control in patients with HNC. Opioid treatment is the mainstay for pain control, being used both for background and breakthrough cancer pain (BTcP) episodes. Fentanyl, easily absorbed and generally well tolerated, appears to be a possible choice due to its versatility. Non-pharmacological interventions, such as tailored yoga, physical exercise, and acupuncture, may have a role in pain management in patients with HNC.

Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study

INTRODUCTION

Cancer care has expanded from a disease-focused, survival-oriented model to an approach that now considers how survivors can live well in the aftermath of intensive therapy, where they may deal with significant changes to their bodies, mental health or emotional well-being. Research evidence supports the benefit of exercise during and following cancer treatments for cancer-related symptoms, physical functioning and fitness, and health-related quality of life. To move this efficacy evidence into practice, we designed and launched a 5-year study to evaluate the relative benefit from implementing a clinic-to-community-based cancer and exercise model of care.

METHODS AND ANALYSIS

A hybrid effectiveness and implementation trial design is being used to evaluate the effectiveness of delivery of community-based exercise and to collect data on implementation of the programme. The study opened in January 2017, with estimated completion by January 2022. The programme will be delivered in seven cities across the province of Alberta, Canada, with sites including three academic institutions, six YMCA locations, Wellspring Edmonton and Calgary, and six municipal fitness centres. Participants are adult cancer survivors (n=2500) from all tumour groups and stages and at any time point along their cancer treatment trajectory, up to 3 years post treatment completion. Survivors take part in a minimum of 60 min of mild-to-moderate intensity full body exercise twice weekly for a 12-week period. The primary effectiveness outcome is the proportion of participants meeting or exceeding 150 min of moderate intensity exercise per week at 1-year follow-up. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework will be utilised to capture individual-level and organizational-level impact of the exercise programme at 12 and 24 weeks and 1-year follow-up. The cohort of survivors participating in the study will allow for long-term (>5-year) evaluation of rates of cancer recurrence and secondary cancers beyond the funding period.

ETHICS AND DISSEMINATION

The study was approved by the Health Research Ethics Board of Alberta. The study is funded by Alberta Innovates and the Alberta Cancer Foundation. The study will help to answer critical questions on the effectiveness of cancer-specific community-based exercise programming in both the short-term and the long-term. Collectively, the findings will help to inform the acceptability, adoption, feasibility, reach and sustainability of community-based exercise.

TRIAL REGISTRATION NUMBER

NCT02984163; Pre-results.

Head and neck cancer survivors' preferences for and evaluations of a post-treatment dietary intervention

BACKGROUND

Dietary preferences vary depending on cancer type. The purpose of this study was to report dietary intervention preferences and a study program evaluation from post-treatment head and neck cancer survivors participating in a dietary intervention.

METHODS

Between January 2015 and August 2016, 24 head and neck cancer survivors participated in a 12-week randomized clinical dietary intervention trial that promoted weekly consumption of 2.5 cups of cruciferous vegetables and 3.5 cups of green leafy vegetables. At study completion, survivors completed a preferences survey and a study program evaluation to probe interests and improvement aspects for planning future dietary intervention trials. Descriptive statistics (means and frequencies) were generated for multiple choice question responses. Responses to open-ended questions were recorded and grouped based on themes, and verified by quality assurance checks by a second study team member.

RESULTS

Twenty-three survivors completed the preferences and evaluation surveys (response rate 96%). Overall, most participants reported a preference for one-on-one telephone counseling from a registered dietitian nutritionist before beginning treatment. Ninety-six percent of participants ranked the overall study program as "very good" to "excellent," and all agreed the objectives of the study were clear, the study staff was helpful and easy to contact, and the registered dietitian nutritionist was knowledgeable.

CONCLUSIONS

Future research and dietary intervention planning for head and neck cancer survivors should focus on strategies to promote one-on-one telephone or other distance-based counseling combined with face-to-face visits, according to survivor preference.

Feasibility Outcomes of a Pilot Randomized Clinical Trial to Increase Cruciferous and Green Leafy Vegetable Intake in Posttreatment Head and Neck Cancer Survivors

BACKGROUND

Higher intakes of cruciferous vegetables (CVs) and green leafy vegetables (GLVs) in observational studies are associated with improvements in survival and cancer-related biomarkers in patients diagnosed with head and neck cancer (HNC). These results have yet to be corroborated in a randomized clinical trial (RCT).

OBJECTIVE

Determine the feasibility of implementing a 12-week RCT to increase CV and GLV intake in posttreatment HNC survivors.

DESIGN AND PARTICIPANTS

This was a two-arm RCT conducted among 24 posttreatment HNC survivors. Survivors were recruited from a southeastern, National Cancer Institute-designated Comprehensive Cancer Center between January 2015 and September 2016.

INTERVENTION

There were two groups: (1) an experimental group (n=12) receiving weekly 15- to 30-minute telephone dietary counseling from a registered dietitian nutritionist stressing 2.5 cups per week CVs and 3.5 cups per week GLVs, and (2) an attention control group (n=12) receiving weekly 15- to 30-minute telephone dietary counseling from a registered dietitian nutritionist focusing on general healthy eating for cancer survivors. Participants completed a baseline survey, three 24-hour dietary recalls, phlebotomy, and anthropometric measures prior to randomization and at the end of the 12-week study period. The experimental group also completed weekly vegetable record recalls.

MAIN OUTCOME MEASURES

Primary outcomes included feasibility, recruitment, retention, adherence, and safety. Secondary outcomes included inflammatory markers and carotenoids.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics were generated for demographic, epidemiological, and clinical variables as well as the primary feasibility outcomes. Between- and within-group comparisons of mean serum cytokine and carotenoid levels were performed using appropriate statistical tests depending on their respective distributions for the purpose of generating preliminary effect sizes.

RESULTS

Overall, 350 incident HNC cases were screened for eligibility, and 98 were eligible for study participation. Reasons for ineligibility and exclusion included deceased (n=93); wrong or inactive telephone numbers, or unable to be reached, or lost to follow-up (n=93); not meeting inclusion criteria (n=39); and too ill to participate (n=27). Of the 98 eligible HNC cases, 24 agreed to participate, for an enrollment rate of 25%. The most common reason for nonparticipation was distance (n=48), as participants were asked to report for two on-site assignments. The retention rate was 96%. Mean intervention adherence rates for weekly goals were 67% CV, 74% GLV, and 71% overall. Completion rate of weekly counseling calls was 90%. The experimental group reported an overall mean increase of 5.5 cups GLV and 3.5 cups CV per week from baseline intake, respectively. No significant between- or within-arm differences were observed for inflammatory markers or carotenoids.

CONCLUSION

A posttreatment intervention aimed at increasing CV and GLV intake in HNC survivors is feasible. A larger RCT is needed to assess the efficacy of this intervention on disease outcomes.

Physical activity programming and counseling preferences among cancer survivors: a systematic review

BACKGROUND

Physical activity (PA) participation and adherence among cancer survivors is low, despite research indicating numerous physical, psychological and emotional health benefits of exercise. Tailoring exercise programs specific to the PA preferences in cancer survivors has merit for increasing PA participation and adherence to accrue these benefits. This systematic review identifies and differentiates PA programming and counseling preferences of adult cancer survivors across various cancer survivor groups.

METHODS

PubMed, SPORTDiscus, Scopus, PsycINFO, EMBASE, Web of Science and CINAHL were electronically searched (inception to Oct 2017) and articles were identified using PRISMA guidelines. Two reviewers independently assessed identified articles to determine eligibility and then individually performed a quality assessment on all final studies. Extracted and analyzed data included participant characteristics, interest in exercise counseling and programming, as well as specific exercise and counseling preferences (e.g. location, timing, intensity).

RESULTS

Forty-one articles were included in this systematic review. Most studies assessed mixed cancer survivor groups or breast cancer survivors. Most cancer survivors felt able and interested in participating in a PA program, though starting a PA program after or before treatment was preferred. Walking was the strongest PA modality preference, and most cancer survivors preferred moderate intensity PA. Cancer survivors also indicated preferences for home-based PA that could take place in the morning. Slight preferences were found towards physical activity counseling delivered by a fitness expert from a cancer center. Both quantitative and qualitative studies were found to be of moderate to high quality based on the Appraisal Tool for Cross-Sectional Studies (AXIS) and the Consolidated Criteria for Reporting Qualitative Research (COREQ), respectively.

CONCLUSION

Cancer survivors have an interest in participating in PA programs with walking as the primary modality. Additionally, morning-based PA programs that can be tapered to home-based programs are desirable. However, there was wide variation in other PA preference variables, suggesting multiple program options would be beneficial. Many cancer survivors felt interested and able to participate in PA, and therefore designing PA programs that are tailored to cancer survivors is integral for optimizing recruitment and adherence, as well as enhancing health outcomes in cancer survivors.

A turning point: Head and neck cancer patients' exercise preferences and barriers before and after participation in an exercise intervention

This study examined the exercise barriers and preferences of head and neck cancer (HNC) survivors in relation to exercise experience. Participants (n = 22; 46.8% response rate) completed retrospective self-report questionnaires on demographic and medical information, exercise barriers and preferences. A subset of participants then completed semi-structured interviews (n = 18). Participants had previously engaged in the ENHANCE trial during, or immediately following, radiation treatment, an average of 22.1 ± 5.8 months before. Retrospective questionnaires revealed that before ENHANCE participation, lack of interest and time were the primary exercise barriers. After participation, there was a significant decrease in typical barriers including lack of interest (p = .008), exercise not a priority (p = .039) and exercise not in routine (p = .004). Number of barriers experienced after ENHANCE participation was negatively correlated with age, quality of life and minutes of resistance exercise training per week. After ENHANCE participation, significant increases were found in preference for exercising at a cancer centre (p = .031) and with other cancer survivors (p = .016). Four higher order themes emerged inductively from interview data analysis pertaining to preferences (i.e., class format) and three higher order themes regarding barriers (physical, psychological and external). By investigating participants' perspectives after ENHANCE participation, key factors for effective HNC exercise programme design were identified.

Survivorship Care Planning and Quality of Life

Roughly 436,000 survivors are living with a history of head and neck cancer (HNC), accounting for approximately 3% of all cancer survivors in the United States [1, 2]. With advances in treatment, long-term survival is increasingly common in HNC populations. Despite increasing awareness of survivorship issues, many challenges remain. These include lack of knowledge on late and long-term effects of treatment, and poor integration of survivorship care guidelines into oncology practice. Survivorship care plans (SCPs) are increasingly important for HNC survivors to improve quality of long-term survival. Quality survivorship care should focus on management of late and long-term effects of treatment, surveillance for cancer recurrence and second primaries, promotion of healthy lifestyle, and care coordination between providers. This chapter will describe common quality of life (QOL) issues in HNC survivorship, and review the current survivorship care guidelines in HNC.

Patient-reported physical activity and the association with health-related quality of life in head and neck cancer survivors

Purpose

This study aimed to assess patient-reported levels of physical activity (PA) and its associations with health-related quality of life (HRQoL) adjusted for important demographic, lifestyle-related, and clinical factors, among head and neck (HNC) survivors.

Methods

This cross-sectional study included 116 HNC survivors. PA was assessed with the Physical Activity Scale for the Elderly (PASE) and HRQoL with the EORTC-QLQ-C30 and EORTC-HN35. Associations were studied using univariable and multivariable regression analyses.

Results

Median PASE score was 100.3 (interquartile range 65.1;170.8) of which 54% were household, 34% leisure-time, and 12% occupational activities. Younger HNC survivors had higher levels of PA. Higher PA was significantly associated with higher global QoL (p < 0.05). Findings for physical function, role function, social function, fatigue, and pain were in line, but not statistically significant (0.05 ≤ p < 0.10).

Conclusions

Among HNC survivors, a large proportion of PA consists of household activities. Younger HNC survivors had higher PA levels, and higher PA levels were associated with higher HRQoL.

Exercise program design considerations for head and neck cancer survivors

The present study aimed to establish exercise preferences, barriers, and perceived benefits among head and neck cancer survivors, as well as their level of interest in participating in an exercise program. Patients treated for primary squamous cell carcinoma of the head and neck between 2010 and 2014 were identified from the hospital database and sent a postal questionnaire pack to establish exercise preferences, barriers, perceived benefits, current physical activity levels, and quality of life. A postal reminder was sent to non-responders 4 weeks later. The survey comprised 1021 eligible patients of which 437 (43%) responded [74% male, median (interquartile range) age, 66 (60-73) years]. Of the respondents, 30% said 'Yes' they would be interested in participating in an exercise program and 34% said 'Maybe'. The most common exercise preferences were a frequency of three times per week, moderate-intensity, and 15-29 min per bout. The most popular exercise types were walking (68%), flexibility exercises (35%), water activites/swimming (33%), cycling (31%), and weight machines (19%). Home (55%), outdoors (46%) and health club/gym (33%) were the most common preferred choices for where to regularly exercise. Percieved exercise benefits relating to improved physical attributes were commonly cited, whereas potential social and work-related benefits were less well-acknowledged. The most commonly cited exercise barriers were dry mouth or throat (40%), fatigue (37%), shortness of breath (30%), muscle weakness (28%) difficulty swallowing (25%), and shoulder weakness and pain (24%). The present findings inform the design of exercise programs for head and neck cancer survivors.

Physical Activity Preferences for People Living With Multiple Myeloma: A Qualitative Study

BACKGROUND

Although physical activity (PA) has significant benefits for people living with multiple myeloma (MM), participation rates are low. Examination of PA preferences will provide important information to clinicians and assist in the development of interventions to increase participation in PA for people living with MM.

OBJECTIVE

The aim of this study is to gain an in-depth understanding of the PA preferences for people living with MM, including the preferred role of clinicians.

METHODS

Semistructured interviews were conducted with patients treated for MM within the preceding 2 to 12 months. Interviews were analyzed using content analysis, where coding categories were derived directly from the text data.

RESULTS

Twenty-four interviews were conducted (women, 54%; age: mean [SD], 62 [8.8] years); 16 (67%) participants had an autologous stem cell transplant. Light- to moderate-intensity PA during and after treatment was feasible, with the strongest preference for a program 2 to 8 months after treatment. The timing of information delivery was important, as was input from clinicians and organizations with knowledge of MM. Preferences for location, structure, and timing of programs varied.

CONCLUSIONS

Low- to moderate-intensity PA after treatment is likely to interest people with MM. Programs need to be flexible and consider individual differences in PA preferences, functional status, and treatment schedules.

IMPLICATIONS

An individually tailored PA program should form part of clinical care, involving clinicians and organizations with expertise in MM. Options for home-based PA are also important. Further research, including a population-based study of people living with MM, is necessary to further quantify PA preferences.

CE: Human Papillomavirus-Related Oropharyngeal Cancer: A Review of Nursing Considerations

: The overall incidence of head and neck cancer-which includes laryngeal, hypopharyngeal, nasal cavity, paranasal sinus, nasopharyngeal, oral, oropharyngeal, and salivary gland cancers-has declined in the United States over the past 30 years with the concomitant reduction in tobacco use. Over that same period, however, the worldwide incidence of oropharyngeal cancer has escalated significantly, most notably among men and women under age 60 who live in developed countries. This epidemic rise in oropharyngeal cancer is largely attributed to certain genotypes of the human papillomavirus (HPV). In the United States, HPV prevalence in oropharyngeal tumors increased dramatically, from roughly 16% between 1984 and 1989 to nearly 73% between 2000 and 2004, and the annual incidence of HPV-positive oropharyngeal cancer is expected to surpass that of HPV-related cervical cancer by 2020.This article provides an overview of head and neck cancer-its incidence, risk factors, treatment, and posttreatment sequelae-with a focus on HPV-related oropharyngeal cancer. Unlike other forms of head and neck cancer, HPV-related oropharyngeal cancer tends to affect younger patients with few or none of the traditional risk factors and has a distinctive presentation, histology, and natural course. In order to provide appropriate patient education and to help these patients monitor and manage late and long-term treatment effects, it is important for nurses to be aware of this disease and its treatment, and of the unique survivorship issues that arise for affected patients.

Pancreatic cancer survivors' preferences, barriers, and facilitators related to physical activity and diet interventions

PURPOSE

To conduct a telephone survey establishing pancreatic cancer survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in exercise and diet intervention programming. These data will inform the development of such interventions for newly-diagnosed patients.

METHODS

Seventy-one survivors treated for resectable pancreatic adenocarcinoma from October 2011 to August 2014 were identified through an institutional cancer registry and contacted via telephone. A telephone survey was conducted to query survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in an exercise and dietary intervention program shortly after disease diagnosis. Acceptability of a technology-based visual communication (e.g., Skype™, FaceTime®) intervention was also assessed.

RESULTS

Fifty participants completed the survey (response rate 71.8 %). Over two-thirds of participants reported interest in exercise and diet intervention programming. Over half reported comfort with a technology-delivered visual communication intervention. Barriers to participation included older age and physical, personal, and emotional problems. The most common facilitator was program awareness. Outcomes for future research important to participants were supportive care and quality of life.

CONCLUSIONS

Most pancreatic cancer patients are interested in exercise and diet interventions shortly after diagnosis; however, some barriers to program participation exist.

IMPLICATIONS FOR CANCER SURVIVORS

Future research and intervention planning for pancreatic cancer survivors should focus on developing messaging and strategies that provide support for survivorship outcomes, increase survivor awareness, address lack of familiarity with technology, reduce fears about potential barriers, and help survivors overcome these barriers. In so doing, survivorship needs can be better met and quality of life improved in this understudied population.

Participation in sport and physical activity in head and neck cancer survivors: associations with quality of life

BACKGROUND

Head and neck cancer (HNC), and its treatment, is associated with significant side-effects which can affect quality of life (QOL). Physical activity (PA) is known to improve a number of QOL measures. We aimed to determine the prevalence of PA pre- and post-treatment of HNC and to determine associations with QOL.

METHODS

A questionnaire-based survey of 172 patients pre- and post-treatment for HNC.

RESULTS

A total of 62.2% of patients met current UK PA guidelines pre-treatment, reducing to 40.1% following treatment. There was a significant decrease in Metabolic equivalent task minutes/week post-treatment, with 71% of participants reporting less PA after diagnosis (P < 0.001). Swimming and cycling remained the two most practiced sports. There was a positive correlation between the post-treatment PA and QOL (P < 0.001).

CONCLUSION

These data suggest that PA may improve QOL following treatment for HNC. We believe that further studies are warranted.

Enablers and barriers in delivery of a cancer exercise program: the Canadian experience

BACKGROUND

Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding.

METHODS

Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery.

RESULTS

Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment.

CONCLUSIONS

Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada.

Exercise preferences among men with prostate cancer receiving androgen-deprivation therapy

PURPOSE/OBJECTIVES

To investigate acceptability of and preferences for physical activity participation in men receiving androgen-deprivation therapy (ADT) for prostate cancer, to identify influencing clinical and demographic factors, and to determine the percentage meeting national exercise guidelines.

DESIGN

Cross-sectional, descriptive.

SETTING

Ambulatory care clinic of a large medical center.

SAMPLE

135 men receiving ADT.

METHODS

A structured interview with a systematic procedure was used to elicit preferences for physical activity.

MAIN RESEARCH VARIABLES

Exercise preferences and acceptability; evidence-based exercise intervention.

FINDINGS

Participants expressed high levels of acceptability of and willingness to participate in aerobic (64% and 79%) and muscle-strengthening (79% and 81%) programs. Preferences were expressed for muscle-strengthening activities performed at home, either alone or in the company of a family member. Flexible, spontaneous, and self-paced programs were preferred. Significant associations were identified for distance, age, obesity, duration of ADT, and meeting American College of Sports Medicine (ACSM) and American Heart Association (AHA) guidelines. Nineteen percent of the study population met the guidelines for weekly physical activity.

CONCLUSIONS

High levels of expressed acceptance of and willingness to participate in physical activity programs as well as the small number of participants meeting ACSM and AHA guidelines suggest feasibility of and support the need for the development of exercise programs in this population.

IMPLICATIONS FOR NURSING

Incorporating patient preferences and evidence-based practice is integral to providing high-quality patient-centered care and is the foundation for appropriate intervention programs. Insight from this study will facilitate the design of programs that better reflect actual preferences of prostate cancer survivors.

KNOWLEDGE TRANSLATION

ADT-induced changes in body composition are believed to contribute to a reduction in insulin sensitivity and dyslipidemia that contribute to increased cardiovascular risk profile. Exercise has the potential to mitigate the harmful effects of ADT.

Physical activity preferences of early-stage lung cancer survivors

PURPOSE

Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors.

METHOD

As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6 years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected.

RESULTS

The majority of respondents (62 %) reported a desire to receive advice regarding physical activity, predominantly before treatment (68 %), in face-to-face interactions (95 %) with a physician (80 %), and within the context of a cancer care center (92 %). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73 %) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics.

CONCLUSIONS

The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.

Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions

Physical activity during and after cancer treatment has beneficial effects on a number of physical and psychosocial outcomes. This paper aims to discuss the existing physical activity guidelines for cancer survivors and to describe future research directions to optimize prescriptions. Studies on physical activity during and after cancer treatment were searched in PubMed, Clinicaltrials.gov, Australian New Zealand Clinical Trials Registry, and Dutch Trial registry. Physical activity guidelines for cancer survivors suggest that physical activity should be an integral and continuous part of care for all cancer survivors. However, the development of these guidelines has been limited by the research conducted. To be able to develop more specific guidelines, future studies should focus on identifying clinical, personal, physical, psychosocial, and intervention moderators explaining 'for whom' or 'under what circumstances' interventions work. Further, more insight into the working mechanisms of exercise interventions on health outcomes in cancer survivors is needed to improve the efficacy and efficiency of interventions. Finally, existing programs should embrace interests and preferences of patients to facilitate optimal uptake of interventions. In conclusion, current physical activity guidelines for cancer survivors are generic, and research is needed to develop more personalized physical activity guidelines.

Physical activity preferences among a population-based sample of colorectal cancer survivors

PURPOSE/OBJECTIVES

To identify the key physical activity (PA) programming and counseling preferences of colorectal cancer (CRC) survivors.

DESIGN

Population-based, cross-sectional mailed survey.

SETTING

Alberta, Canada.

SAMPLE

600 CRC survivors.

METHODS

CRC survivors randomly identified through the Alberta Cancer Registry in Canada completed a mailed survey (34% response rate).

MAIN RESEARCH VARIABLES

Self-reported PA, medical and demographic variables, and PA preferences.

FINDINGS

Most CRC survivors indicated that they were interested and able to participate in a PA program. The most common PA preferences of CRC survivors were to receive PA counseling from a fitness expert at a cancer center, receive PA information in the form of print materials, start a PA program after cancer treatment, do PA at home, and walk in both the summer and winter. In addition, oncologists and nurses were identified as preferences from whom CRC survivors would like to receive PA information. Chi-square analyses identified that age, education, annual family income, and current PA were the demographic variables most consistently associated with PA preferences.

CONCLUSIONS

The majority of CRC survivors expressed an interest in participating in a PA program and key PA preferences were identified. Those preferences may be useful for developing and implementing successful PA interventions for CRC survivors.

IMPLICATIONS FOR NURSING

Oncology nurses are in a unique position to promote PA for CRC survivors. Therefore, understanding CRC survivor PA preferences is essential to assist nurses in making appropriate PA recommendations or referrals.

KNOWLEDGE TRANSLATION

Although CRC survivors' PA participation rates are low, they may have an interest in receiving PA programming and counseling. CRC survivors have indicated a preference to receive PA information from individuals within their cancer support team (e.g., fitness specialist at a cancer center, oncologist, nurses). The PA preferences identified by CRC survivors are important for the development of successful PA interventions.

Health behaviors predict higher interleukin-6 levels among patients newly diagnosed with head and neck squamous cell carcinoma

BACKGROUND

Health behaviors have been shown to be associated with recurrence risk and survival rates in patients with cancer and are also associated with interleukin-6 (IL-6) levels, but few epidemiologic studies have investigated the relationship of health behaviors and IL-6 among cancer populations. The purpose of the study is to look at the relationship between five health behaviors, viz.: smoking, alcohol problems, body mass index (BMI; a marker of nutritional status), physical activity, and sleep and pretreatment IL-6 levels in persons with head and neck cancer.

METHODS

Patients (N = 409) were recruited in otolaryngology clinic waiting rooms and invited to complete written surveys. A medical record audit was also conducted. Descriptive statistics and multivariate analyses were conducted to determine which health behaviors were associated with higher IL-6 levels controlling for demographic and clinical variables among patients with newly diagnosed head and neck cancer.

RESULTS

While smoking, alcohol problems, BMI, physical activity, and sleep were associated with IL-6 levels in bivariate analysis, only smoking (current and former) and decreased sleep were independent predictors of higher IL-6 levels in multivariate regression analysis. Covariates associated with higher IL-6 levels were age and higher tumor stage, whereas comorbidities were marginally significant.

CONCLUSION

Health behaviors, particularly smoking and sleep disturbances, are associated with higher IL-6 levels among patients with head and neck cancer.

IMPACT

Treating health behavior problems, especially smoking and sleep disturbances, may be beneficial to decreasing IL-6 levels, which could have a beneficial effect on overall cancer treatment outcomes.

Clinical review of physical activity and functional considerations in head and neck cancer patients

Patients facing head and neck cancer treatment are profoundly vulnerable to physiologic and functional disability. Exercise and nutrition have been shown to have many benefits in cancer patients, but much of this work has been performed in groups of breast, colon, and prostate cancer patients. Limited data exists regarding the role of exercise and nutrition in the management of head and neck cancer patients given their unique set of challenges relating to the cancer as well as its treatment. In this paper, we review the existing literature about general or recreational physical exercise as well as nutrition in this patient population as it pertains to lean muscle body composition, functional well-being, and overall quality of life.

Stages of change, barriers, benefits, and preferences for exercise in RA patients: a cross-sectional study

OBJECTIVES

To determine the distribution of exercise stages of change in a rheumatoid arthritis (RA) cohort, and to examine patients' perceptions of exercise benefits, barriers, and their preferences for exercise.

METHODS

One hundred and twenty RA patients who attended the Rheumatology Unit of a University Hospital were asked to participate in the study. Those who agreed were administered a questionnaire to determine their exercise stage of change, their perceived benefits and barriers to exercise, and their preferences for various features of exercise.

RESULTS

Eighty-nine (74%) patients were finally included in the analyses. Their mean age was 58.4 years, mean RA duration 10.1 years, and mean disease activity score 2.8. The distribution of exercise stages of change was as follows: precontemplation (n = 30, 34%), contemplation (n = 11, 13%), preparation (n = 5, 6%), action (n = 2, 2%), and maintenance (n = 39, 45%). Compared to patients in the maintenance stage of change, precontemplators exhibited different demographic and functional characteristics and reported less exercise benefits and more barriers to exercise. Most participants preferred exercising alone (40%), at home (29%), at a moderate intensity (64%), with advice provided by a rheumatologist (34%) or a specialist in exercise and RA (34%). Walking was by far the preferred type of exercise, in both the summer (86%) and the winter (51%).

CONCLUSIONS

Our cohort of patients with RA was essentially distributed across the precontemplation and maintenance exercise stages of change. These subgroups of patients exhibit psychological and functional differences that make their needs different in terms of exercise counselling.

Physical activity and neuropsychiatric symptoms of Parkinson disease

Neuropsychiatric symptoms of Parkinson disease (PD) such as fatigue, depression, and apathy are common and detract from quality of life. There is little published on the impact of physical activity on the neuropsychiatric symptoms of PD. A convenience sample of 45 patients with PD (mean age = 66.1 years; 33% female) completed questionnaires on physical activity, neuropsychiatric symptoms, and specific exercise preferences. Covarying for age and gender, higher levels of physical activity were associated with significantly less fatigue, as well as a trend for less apathy and depression and greater positive affect. Exercise preferences included moderate intensity (73%), at home (56%), in the morning (73%), scheduled (69%), options for varied activities (73%), and preference for both structured/supervised (50%), and unsupervised/self-paced (50%) programs. Preferred activities included the use of aerobic exercise equipment, resistance training, and yoga. Developing and tailoring exercise programs that incorporate specific preferences may result in more effective interventions for patients with PD.

Exercise in clinical cancer care: a call to action and program development description

A large and convincing body of evidence demonstrates the benefits of exercise for cancer survivors during and after treatment. Based on that literature, more cancer survivors should be offered exercise support and programming. Unfortunately, exercise programs remain an exception rather than the norm in cancer care. Not surprisingly, common barriers to the implementation of exercise programs in oncology include limited resources, expertise, and awareness of benefits on the part of patients and clinicians. To improve the accessibility and cost-effectiveness of cancer exercise programs, one proposed strategy is to combine the resources of hospital and community-based programs with home-based exercise instruction. The present paper highlights current literature regarding exercise programming for cancer survivors, describes the development of an exercise program for cancer patients in Toronto, Canada, and offers experiential insights into the integration of exercise into oncologic care.

EXERCISE PREFERENCES OF PATIENTS IN SUBSTANCE ABUSE TREATMENT

While emerging studies have demonstrated the benefit of exercise in early recovery from substance use disorders, recruitment and adherence to exercise interventions have been challenging. Tailoring interventions based on patient exercise preferences may address these concerns. Ninety-seven (N=97; age=41.6 years; 44% female) patients were recruited from an intensive substance abuse outpatient program and filled out questionnaires about their exercise preferences. Most (71%) patients were not currently engaged in an exercise program (i.e., exercising less than 20 minutes/day for 3 days/week over the last 6 months). The vast majority (95%) expressed an interest in engaging in an exercise program specifically designed for persons in substance use recovery and 89% reported wanting to initiate an exercise program within the first 3 months of sobriety. Specific exercise preferences regarding type of physical activity, exercise intervention components, and perceived benefits and barriers to exercise differed between males and females. These findings suggest low rates of regular exercise, high level of interest in engaging in exercise during early recovery, and point toward the need to tailor interventions to the unique preferences of individuals.

Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey

OBJECTIVE

To investigate the exercise barriers, facilitators and preferences of a mixed sample of cancer survivors as well as fatigue levels, quality of life (QoL) and the frequency and intensity of exercise that cancer survivors typically engage in.

METHODS

An anonymous, postal questionnaire-survey with a convenience sample of 975 cancer survivors was used. Standardised measures were used to establish fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30), exercise frequency and intensity (Leisure Score Index).

RESULTS

A 52.3% response rate (n = 456) was achieved. A total of 76.0% were female, with stage I (18.3%) or stage II (21.0%) breast cancer (64.4%), and 62.3% were ≥ 3 years post treatment. A total of 73.5% reported fatigue with 57.2% experiencing fatigue on a daily basis. A total of 68.1% had never been given any advice on how to manage fatigue. A total of 9.4% reported to engage in strenuous physical activity, 43.5% in moderate physical activity and 65.5% in mild physical activity. Respondents experienced difficulties with emotional, cognitive and social functioning and the symptoms of fatigue, insomnia and pain. Barriers that interfered with exercise 'often/very often' were mainly related to respondents' health and environmental factors. A total of 50.2% were interested in exercise and 52.5% felt able to exercise. Exercise facilitators, preferences and motivators provide some insight into cancer survivors' needs in terms of becoming more physically active.

CONCLUSIONS

Although cancer survivors continue to experience fatigue and QoL issues long after treatment completion, over half are willing and feel able to participate in exercise. Exercise barriers were mainly health related or environmental issues, however, the main barriers reported were those that had the potential to be alleviated by exercise.

Physical activity preferences in a population-based sample of kidney cancer survivors

PURPOSE

Physical activity (PA) improves quality of life in kidney cancer survivors (KCS), but PA participation rates are low. Behavior change interventions to increase PA in KCS should take into account PA preferences. The purpose of this study was to identify the PA preferences of KCS and determine any associations with selected demographic and medical variables.

METHODS

All 1,985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial registry in Alberta, Canada were mailed a survey that consisted of the Godin Leisure-Time Exercise Questionnaire and various PA preference variables. Standard demographic and medical variables were also collected.

RESULTS

Completed surveys were received from 703 of 1,654 (43%) eligible KCS. Over 80% of KCS felt they were able or may be able to participate in a PA program designed for KCS and over 70% were interested or may be interested in doing so. The most common PA preferences were to receive PA information from a fitness expert at a cancer center (55.7%), receive information via print material (50.0%), start a PA program after treatment (36.5%), exercise with a spouse (39.6%), exercise at home (52.0%), do moderate-intensity PA (58.4%), and walk in both the summer (69.4%) and winter (48.2%). Chi-square analyses uncovered that age, sex, and current PA were the personal variables most consistently associated with PA preferences.

CONCLUSION

The majority of KCS expressed an interest in doing a PA program and important preferences were identified. These preferences may be used to inform PA interventions to enhance motivation and adherence in KCS.

The comparative effectiveness of a team-based versus group-based physical activity intervention for cancer survivors

PURPOSE

Physical activity benefits cancer survivors, but the comparative effectiveness of a team-based delivery approach remains unexplored. The hypothesis tested was that a team-based physical activity intervention delivery approach has added physical and psychological benefits compared to a group-based approach. A team-based sport accessible to survivors is dragon boating, which requires no previous experience and allows for diverse skill levels.

METHODS

In a non-randomized trial, cancer survivors chose between two similarly structured 8-week programs, a dragon boat paddling team (n = 68) or group-based walking program (n = 52). Three separate intervention rounds were carried out in 2007-2008. Pre-post testing measured physical and psychosocial outcomes.

RESULTS

Compared to walkers, paddlers had significantly greater (all p < 0.01) team cohesion, program adherence/attendance, and increased upper-body strength. For quality-of-life outcomes, both interventions were associated with pre-post improvements, but with no clear-cut pattern of between-intervention differences.

CONCLUSIONS

These hypothesis-generating findings suggest that a short-term, team-based physical activity program (dragon boat paddling) was associated with increased cohesion and adherence/attendance. Improvements in physical fitness and psychosocial benefits were comparable to a traditional, group-based walking program. Compared to a group-based intervention delivery format, the team-based intervention delivery format holds promise for promoting physical activity program adherence/attendance in cancer survivors.

Factors associated with cancer survivors' selection between two group physical activity programs

INTRODUCTION

Physical activity programs have health benefits for cancer survivors, but little is known about factors that influence cancer survivors' actual choices between different physical activity programs. To address this knowledge gap, we examined factors associated with selecting between two group physical activity programs.

METHODS

The present study is nested in a non-randomized trial. After attending an orientation to learn about the programs offered, cancer survivors (n=133) selected between a dragon boat paddling team and group walking program. We measured the association between physical activity program chosen and demographic, clinical, physical and psychosocial characteristics.

RESULTS

Roughly equal proportions chose to participate in dragon boat paddling or walking (55% versus 45%). Of the many variables studied, few were associated with program selection. Compared to those who chose the walking program, those who chose the dragon boat paddling team were more likely to be Caucasians (p= .015) and younger (p= .027), and marginally significantly more like to have cancers other than breast cancer (p= .056) and have greater lower-body strength (.062).

DISCUSSIONS/CONCLUSIONS

Among a cohort of cancer survivors who were interested in physical activity programs who chose between two markedly different group physical activity programs, the two programs attracted groups of approximately the same size and with remarkably similar characteristics overall. The two most notable associations were that Caucasians and younger adults were significantly more likely to choose the dragon boat paddling program.

IMPLICATIONS FOR CANCER SURVIVORS

To meet the needs of cancer survivors, a menu of physical activity program options may be optimal.