Predictors of attendance during an exercise program for cancer survivors

Exercise Therapy in Oncology

BACKGROUND

The diagnosis and treatment of cancer are highly stressful. Exercise therapy is often used to mitigate the adverse effects of treatment. But how good is the evidence base, and what has changed in recent years? In this narrative review, we present the current data and what it implies for the care of adults with cancer.

METHODS

This review is based on data from meta-analyses and systematic reviews concerning 16 relevant clinical endpoints (outcomes) of exercise therapy for cancer patients.

RESULTS

The literature evaluated for this paper reveals that targeted exercise therapy is feasible and safe under appropriate supervision. It is highly effective for improving eight endpoints (anxiety, depression, fatigue, quality of life, physical function, secondary lymphedema after breast cancer, urinary incontinence, post-mastectomy pain syndrome in breast cancer) and may also have a beneficial effect on sleep quality, cardiotoxicity, and cognitive function. Less conclusive studies are currently available with respect to chemotherapy-induced polyneuropathy, nausea/vomiting, and bone health. There is currently insufficient data to suggest any benefit with respect to sexual function and risk factors for falling.

CONCLUSION

The data shows that exercise therapy for cancer patients is safe and has manifold effects on selected clinically relevant parameters. Further studies should be performed regarding the possible utility of exercise therapy against treatment-related side effects for which the evidence is currently insufficient. On the basis of the currently available and already existing recommendations, quality-assured exercise therapy can be recommended to cancer patients suffering from a wide range of neoplastic conditions.

Cancer-related fatigue mediates the relationships between physical fitness and attendance and quality of life after participation in a clinical exercise program for survivors of cancer

PURPOSE

Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer, negatively impacting health-related quality of life (HRQoL). Exercise improves CRF, HRQoL, and physical fitness in survivors. Prospective research trials have shown that exercise-associated fitness improvements effects on HRQoL are mediated by CRF; however, this has not been investigated in a pragmatic real-world setting. This study utilizes data from a large heterogenous population of survivors participating in a clinical exercise program to investigate this mediation effect, as well as effects of program attendance.

METHODS

Data were collected from 194 survivors completing the BfitBwell Cancer Exercise Program (July 2016-February 2020). Changes in HRQoL, CRF, and fitness were calculated and program attendance collected. Basic correlation analyses were performed. Linear regression analyses were performed to assess mediation by CRF.

RESULTS

All measures of CRF, HRQoL, and physical fitness significantly improved following the exercise program. Improvements in physical fitness were significantly correlated with improvements in HRQoL (r = 0.15-0.18), as was program attendance (r = 0.26) and CRF (r = 0.59). The effects of physical fitness and program attendance on HRQoL were at least partially mediated by the effects of CRF.

CONCLUSION

This study extends research findings on how exercise programs improve HRQoL in survivors of cancer to a real-world setting. Results indicate that clinical exercise programs should target reductions in CRF in survivors (during or after treatment) through improvements in physical fitness to improve HRQoL and that high attendance should be encouraged regardless of fitness changes.

Design and implementation of a standard care programme of therapeutic exercise and education for breast cancer survivors

BACKGROUND

Breast cancer survivors (BCS) face several symptoms and are at higher risk of weight gain following diagnosis. Current literature shows that both exercise and diet play a key role in recovery of BCS. However, there is a gap between current guidelines and the real-world context. The aim of this article is to describe the process behind a free, not-for-profit community-based therapeutic exercise and education programme (TEEP) for BCS in the clinical setting.

METHODS

The "Onco-Health Club" (OHC) consists of therapeutic exercise (TE) intervention aimed at ameliorating cancer-related fatigue (CRF) and improving QoL and physical function. TE is supplemented with nutritional education, providing information about the Mediterranean diet. To this end, patients are recruited from an oncologist and are referred to a physiotherapist and a nutritionist for baseline assessment. TEEP consists of a 3-month intervention, delivered twice a week in a group format with 1 h of TE and 30 min of nutritional education. BCS then have a final assessment and are advised to continue with a healthy lifestyle. Data about referral, compliance and assessment were collected.

RESULTS

From May 2017 to February of 2020, a total of 158 patients were recruited from 8 cohorts and 142 initially started the OHC. From 119 that joined the program, 96 patients were considered to have finished it with good adherence (assistance > 80%). BCS significantly improved their QoL, as well as upper and lower limb's function, and increased their level of physical activity. CRF tended to decrease (p = 0.005).

CONCLUSIONS

This study obtained data on recruitment, compliance, and possible limitations of these kinds of programmes in a real-world context. Further research is needed in order to optimize patient engagement and compliance, as well as to determine the transferability of these programmes in the clinical setting.

TRIAL REGISTRATION

NCT03879096, Registered 18th March 2019. Retrospectively registered.

Clinical and Demographic Factors Associated With Follow-Up in a Hospital-Based Exercise Oncology Program

Objective:

Despite the numerous benefits of regular exercise participation for cancer survivors, nearly 60% of survivors do not meet current guidelines. Hospital-based exercise oncology programs may be one strategy to promote exercise engagement as survivors have expressed a preference for exercise programs associated with a cancer hospital. However, follow-up rates in hospital-based exercise oncology programs can be low. Follow-up assessments are a critical component of exercise oncology programs as they determine survivor progress, allow for revision of exercise prescriptions, and demonstrate the effectiveness of the exercise program. Therefore, the purpose of this study was to identify clinical and demographic factors associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program.

Methods:

We analyzed data collected from 2016 to 2019 (n = 849) from the Huntsman Cancer Institute’s hospital-based exercise oncology program, the Personal Optimism with Exercise Recovery (POWER) program. Cancer survivors completed an assessment at the start of POWER and were encouraged to attend a 12-week follow-up assessment. Factors associated with not attending a 12-week follow-up assessment were identified using logistic regression.

Results:

Multiple myeloma cancer survivors were more likely (OR 2.33; 95% CI 1.09, 4.98) to not attend a 12-week follow-up assessment, whereas endometrial cancer survivors were less likely (OR 0.39; 95% CI 0.18, 0.87). Greater travel time (OR 2.69; 95% CI: 1.83, 3.96) and distance (OR 2.37; 95% CI: 1.61, 3.49) were associated with not attending a 12-week follow-up assessment. Immunotherapy (OR 1.66; 95% CI 1.02, 2.72), waist circumference (OR 1.01; 95% CI 1.00, 1.02), overweight status per body mass index (OR 1.62; 95% CI 1.11, 2.38), and male sex (OR 1.70; 95% CI 1.23, 2.35) were associated with an increased likelihood of not attending a 12-week follow-up assessment. Survivors with a higher baseline quality of life (OR 0.96; 95% CI 0.93, 0.99) and peak oxygen consumption (OR 0.97; 95% CI 0.95, 0.99) were less likely not to attend a 12-week follow-up assessment.

Conclusions:

Both clinical and demographic factors were associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. Understanding factors related to follow-up assessment attendance in exercise oncology programs can inform the development of targeted interventions to improve follow-up rate thus maximizing exercise support for cancer survivors.