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Tjon A Joe S, Verschure-Dorsman S, Wilthagen EA, Stuiver M. Barriers and facilitators for weight management interventions in breast cancer patients: a systematic review of qualitative studies. Int J Qual Stud Health Well-being 2023; 18:2259290. [PMID: 37840321 PMCID: PMC10580791 DOI: 10.1080/17482631.2023.2259290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION This systematic review and meta-synthesis of qualitative studies provides an overview of barriers and facilitators that breast cancer patients experience in weight management interventions. METHODS We included qualitative studies describing barriers and facilitators for weight management interventions as experienced by adult breast cancer patients after the completion of initial treatment . The data was extracted and using thematic analysis. RESULTS After analysis, eleven themes were determined. Six of those themes could be linked to the Attitude, Social Influence and self Efficacy (ASE)-model. Physical and mental benefits, anticipated regret and a lack of motivation were linked to attitude. Integrating a weight management programme in daily life, stigma and fears were linked to self-efficacy. With regard to the social influence determinant, encouragement and discouragement by family members were developed as a theme. Four additional themes were conducted related to weight management behaviour; external barriers, economic barriers, cultural barriers and physical barriers. In addition, integrating weight management in cancer care was described as a separate theme. CONCLUSIONS Several disease specific issues, including feeling stigmatized after cancer treatment and treatment-related side effects and peer-support should be given specific attention to maximize adherence of weight management programmes.
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Affiliation(s)
- Sheena Tjon A Joe
- clinical dietitian, The Netherlands Cancer Institute, Department of dietetics, Amsterdam, The Netherlands
| | - Sara Verschure-Dorsman
- clinical dietitian, The Netherlands Cancer Institute, Department of dietetics, Amsterdam, The Netherlands
| | - Erica A. Wilthagen
- medical information specialist, Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Martijn Stuiver
- Department of Epidemiology and Data Science, CCA, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
- Associate group leader of the Cancer Survivorship group, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Almeida HRAD, Melo CDF, Araújo DF, Ferreira KPM, Pichelli AAWS, Teófilo MB. DIGNIDADE DE VIDA E MORTE: TERMINALIDADE DE PACIENTES COM CÂNCER EM ORTOTANÁSIA. PSICOLOGIA EM ESTUDO 2022. [DOI: 10.4025/psicolestud.v27i0.48002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objetivou-se apreender a percepção e os significados expressos por pacientes oncológicos em cuidados paliativos exclusivos sobre a morte, o câncer e sua experiência do processo de finitude. Contou-se com a participação de dez pacientes com câncer: cinco em atendimento domiciliar e cinco em internação hospitalar. Utilizaram-se de diferentes instrumentos e técnicas, em etapas distintas. Para a realização da Etapa 1, realizaram-se observações, por meio de visitas sistemáticas e escuta livre, guiadas por um roteiro de observação, com registro em diário de campo. Para a Etapa 2, utilizou-se o Teste de Associação Livre de Palavras (TALP), com estímulos indutores ‘Câncer’ e ‘Morte’. Os dados foram compreendidos por meio de análise descritiva (Diário de campo) e categorização (TALP). Os resultados mostram que o câncer e o seu tratamento estão associados à dor e ao medo. Os participantes apresentam dualidades entre a esperança de cura e a certeza de prognóstico reservado, e entre a aceitação e a negação da morte. A família tem papel fundamental no acolhimento e na oferta de autonomia e dignidade do paciente em processo de morte, embora também sofram com o coadoecimento. A espiritualidade/religiosidade é uma estratégia de enfrentamento utilizada pelos pacientes, reduzindo a angústia espiritual, apesar de também poder sustentar a esperança de cura e negação da morte, dificultando o processo de terminalidade. A autonomia também é um fator que contribui para a dignidade do paciente. Conclui-se que a aceitação da morte, suporte familiar e espiritual/religioso e respeito à autonomia contribuem para a ortotanásia e permitem a morte com mais dignidade.
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Stelten S, van Lonkhuijzen LRCW, Hartman YAW, van Driel WJ, Winkels RM, Kenter GG, Buffart LM, Hoedjes M. Experiences, adherence and satisfaction with a combined exercise and dietary intervention for patients with ovarian cancer undergoing chemotherapy: A mixed-methods study. Gynecol Oncol 2022; 165:619-628. [PMID: 35337672 DOI: 10.1016/j.ygyno.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study examined experiences, adherence and satisfaction with a combined exercise and dietary intervention in patients with ovarian cancer and their healthcare professionals (HCPs) as part of the randomized PADOVA trial. METHODS A mixed-methods approach was used in 24 patients with ovarian cancer receiving first-line chemotherapy who were randomly allocated to a combined exercise and dietary intervention or usual care with counseling sessions post-treatment. Qualitative data on intervention experiences, adherence and satisfaction was collected using semi-structured interviews with patients and their HCPs (n = 18 physical therapists; n = 5 dietitians). Quantitative data on adherence and satisfaction was collected to provide context to qualitative data. RESULTS Exercise relative dose intensity ranged from 36 to 100% (median 72%) and patients attended 33-133% (median 100%) of the prescribed dietary counseling sessions. Patients appreciated guidance on exercise and nutrition and perceived benefits including improved physical fitness, quality of life, peer support and recovery after surgery and/or chemotherapy cycles. Both patients and HCPs were satisfied with the intervention and perceived that participation exceeded prior expectations. Median patient satisfaction score with the intervention was 8.5 out of 10. Suggestions for improving the intervention included further personalization of the number, content and scheduling of the sessions to preferences of patients and HCPs. Patients in the usual care group reported counseling sessions post-chemotherapy to be too little too late. CONCLUSIONS Patients with ovarian cancer adhered well to the intervention. Numerous perceived benefits of the intervention were reported by patients and HCPs. Good adherence and positive experiences support successful implementation in clinical practice.
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Affiliation(s)
- S Stelten
- Radboud University Medical Center, Department of Physiology, Radboud Institute of Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, Netherlands
| | - L R C W van Lonkhuijzen
- Amsterdam UMC, Univ(ersity) of Amsterdam, Department of Obstetrics and Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Y A W Hartman
- Radboud University Medical Center, Department of Physiology, Radboud Institute of Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, Netherlands
| | - W J van Driel
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), Plesmanlaan 121, 1066 CX Amsterdam, Netherlands
| | - R M Winkels
- Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - G G Kenter
- Amsterdam UMC, Univ(ersity) of Amsterdam, Department of Obstetrics and Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands; The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), Plesmanlaan 121, 1066 CX Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, Cancer Center Amsterdam, Center for Gynecologic Oncology Amsterdam (CGOA), de Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - L M Buffart
- Radboud University Medical Center, Department of Physiology, Radboud Institute of Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, Netherlands.
| | - M Hoedjes
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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Elshahat S, Treanor C, Donnelly M. Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review. Int J Behav Nutr Phys Act 2021; 18:50. [PMID: 33823832 PMCID: PMC8025326 DOI: 10.1186/s12966-021-01116-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It has been posited that physical activity (PA) has the potential to improve health outcomes and the health-related quality of life of people living with or beyond cancer. Despite the well-documented health benefits of PA, there is a low level of PA among cancer patients. A systematic scoping review was conducted to investigate attitudes, perceptions, preferences and barriers vs. facilitators to cancer patients' PA participation. METHODS A systematic search was performed across four automated databases (PubMed, Embase, PsycINFO and Medline) in keeping with the PRISMA guideline. All cancer types were included, and any age/gender groups were eligible. Both qualitative and quantitative studies were included. The Health Belief Model provided a conceptual framework for the conduct of the scoping review as well as guiding thinking to inform evidence-based interventions. RESULTS Ninety-eight articles were included in this review. Nearly half of the studies focused on mixed cancer sites; breast cancer was the most commonly examined cancer type (19%). Post-treatment was the most commonly investigated stage (33%), followed by studies of mixed stages of the cancer trajectory (27%), the acute treatment stage (23%) and pre-treatment stage (1%). Patient treatment stage was not reported in 16% of studies. Cancer patients reported positive attitudes to PA and recognized its benefits for health and wellbeing. Cancer-related side effects (e.g. fatigue) were a leading physiological barrier to PA participation, whereas effective symptom management techniques/tools acted as a powerful facilitator. Psychosocial barriers included low motivation and kinesiophobia, and perceived health benefits and social support/guidance by healthcare providers were significant facilitators. Inaccessible fitness facilities hindered cancer patients' PA engagement though the availability of tailored amenities appeared to be a strong facilitator. PA preferences varied in terms of type, place, time, company and source of information and pointed to the need for individualized PA programs. CONCLUSIONS There is a need for further research to identify barriers and facilitators to PA that are faced by patients with particular cancer types. Recommended PA promoting-strategies involve including exercise science professionals in healthcare teams and ensuring that fitness facilities are accessible.
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Affiliation(s)
- Sarah Elshahat
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - Charlene Treanor
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
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Cancer Patients' Long-term Experiences of Participating in a Comprehensive Lifestyle Intervention Study While Receiving Chemotherapy. Cancer Nurs 2020; 43:60-68. [PMID: 30312192 DOI: 10.1097/ncc.0000000000000650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lifestyle interventions seem promising with regard to cancer patients' potential for physical and psychological health benefits and as an empowerment tool. Nevertheless, there is a lack of knowledge concerning cancer patients' longer-term experiences of participating in comprehensive lifestyle interventions. OBJECTIVE The aim of this study was to explore cancer patients' long-term experiences of participating in a 12-month individualized comprehensive lifestyle intervention study focusing on physical activity, diet, smoking cessation, and stress management while receiving curative or palliative chemotherapy. METHODS A qualitative design with semistructured interviews of 7 curative and 7 palliative cancer patients was conducted 12 months after inclusion in lifestyle intervention. Data were analyzed following a phenomenological-hermeneutic approach. RESULTS Two main themes emerged: (1) awareness of the importance of a healthy lifestyle during cancer treatment and (2) individual follow-up; it's good to have someone to talk to. CONCLUSIONS Participation in a 12-month comprehensive lifestyle intervention is both feasible and desirable in curative and palliative patients. However, although the curative participants' motivation and perceived ability to adhere to lifestyle recommendations increased during the intervention period, the palliative participants' perceived ability to adhere decreased even though they were overall highly motivated. IMPLICATIONS FOR PRACTICE Our findings encourage the future implementation of lifestyle interventions during cancer treatment, even in cancer patients with advanced disease. However, when implementing lifestyle interventions, healthcare professionals must keep the patients' motivation, perceived ability to adhere to lifestyle recommendations, and individual needs in mind.
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Hiensch AE, Bolam KA, Mijwel S, May AM, Wengström Y. Sense of coherence and its relationship to participation, cancer-related fatigue, symptom burden, and quality of life in women with breast cancer participating in the OptiTrain exercise trial. Support Care Cancer 2020; 28:5371-5379. [PMID: 32140973 PMCID: PMC7546973 DOI: 10.1007/s00520-020-05378-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE This study examined the Sense of Coherence (SOC) of patients participating in the randomized controlled 'Optimal Training for Women with Breast Cancer' (OptiTrain) study and assessed how patient characteristics were associated with SOC. Secondary aims were to assess the association between SOC and patients' participation in this study and to determine whether SOC moderates the effect of the 16-week exercise intervention on fatigue, quality of life (QoL), and symptom burden in women with breast cancer undergoing chemotherapy. METHODS Modified Poisson regression analyses were conducted to determine the relative risk of weak-normal SOC versus strong SOC in terms of exercise session attendance, study and intervention dropout, and long absence rates. Analyses of covariance were performed to assess whether SOC moderated the effect of the exercise intervention (pinteraction ≤ 0.10). RESULTS Two hundred and forty women with early breast cancer (mean age 53 ± 10) participated in the OptiTrain study. Women with strong SOC reported less fatigue, lower symptom burden, and higher QoL. Women with weak-normal SOC were significantly more likely to drop out from the OptiTrain study and tended to have slightly poorer exercise session attendance. Women with breast cancer and weaker SOC benefitted as much from the exercise intervention, in terms of fatigue and QoL, as those with stronger SOC (pinteraction > 0.10). CONCLUSIONS Strong SOC appears to be associated with a more positive subjective state of health. Women with weak-normal SOC may need additional support to encourage participation and adherence in exercise trials. Assessing SOC may assist clinicians to identify and provide extra support for participants with weak SOC, who may be less inclined to participate in exercise programs.
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Affiliation(s)
- Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sara Mijwel
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Booth S, Chin C, Spathis A, Maddocks M, Yorke J, Burkin J, Moffat C, Farquhar M, Bausewein C. Non-pharmacological interventions for breathlessness in people with cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1524708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sara Booth
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | - Chloe Chin
- Consultant in Palliative Medicine, Camden, Islington, ELiPSE and UCLH & HCA
| | | | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Julie Burkin
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | | | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, München, Germany
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Vassbakk-Brovold K, Berntsen S, Fegran L, Lian H, Mjåland O, Mjåland S, Nordin K, Seiler S, Kersten C. Lifestyle changes in cancer patients undergoing curative or palliative chemotherapy: is it feasible? Acta Oncol 2018; 57:831-838. [PMID: 29239243 DOI: 10.1080/0284186x.2017.1413247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This study aimed to explore the feasibility of an individualized comprehensive lifestyle intervention in cancer patients undergoing curative or palliative chemotherapy. MATERIAL AND METHODS At one cancer center, serving a population of 180,000, 100 consecutive of 161 eligible newly diagnosed cancer patients starting curative or palliative chemotherapy entered a 12-month comprehensive, individualized lifestyle intervention. Participants received a grouped startup course and monthly counseling, based on self-reported and electronically evaluated lifestyle behaviors. Patients with completed baseline and end of study measurements are included in the final analyses. Patients who did not complete end of study measurements are defined as dropouts. RESULTS More completers (n = 61) vs. dropouts (n = 39) were married or living together (87 vs. 69%, p = .031), and significantly higher baseline physical activity levels (960 vs. 489 min.wk-1, p = .010), more healthy dietary choices (14 vs 11 points, p = .038) and fewer smokers (8 vs. 23%, p = .036) were observed among completers vs. dropouts. Logistic regression revealed younger (odds ratios (OR): 0.95, 95% confidence interval (CI): 0.91, 0.99) and more patients diagnosed with breast cancer vs. more severe cancer types (OR: 0.16, 95% CI: 0.04, 0.56) among completers vs. dropouts. Improvements were observed in completers healthy (37%, p < 0.001) and unhealthy dietary habits (23%, p = .002), and distress (94%, p < .001). No significant reductions were observed in physical activity levels. Patients treated with palliative intent did not reduce their physical activity levels while healthy dietary habits (38%, p = 0.021) and distress (104%, p = 0.012) was improved. DISCUSSION Favorable and possibly clinical relevant lifestyle changes were observed in cancer patients undergoing curative or palliative chemotherapy after a 12-month comprehensive and individualized lifestyle intervention. Palliative patients were able to participate and to improve their lifestyle behaviors.
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Affiliation(s)
- Karianne Vassbakk-Brovold
- Center for Cancer Treatment, Sorlandet Hospital Trust, Kristiansand, Norway
- Department of Health and Sport Science, University of Agder, Kristiansand, Norway
| | - Sveinung Berntsen
- Department of Health and Sport Science, University of Agder, Kristiansand, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Liv Fegran
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Henrik Lian
- Department for Physical and Preventive Medicine, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Odd Mjåland
- Surgical Department, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Svein Mjåland
- Center for Cancer Treatment, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Karin Nordin
- Department of Health and Sport Science, University of Agder, Kristiansand, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Stephen Seiler
- Department of Health and Sport Science, University of Agder, Kristiansand, Norway
| | - Christian Kersten
- Center for Cancer Treatment, Sorlandet Hospital Trust, Kristiansand, Norway
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Wilhelmsson A, Roos M, Hagberg L, Wengström Y, Blomberg K. Motivation to uphold physical activity in women with breast cancer during adjuvant chemotherapy treatment. Eur J Oncol Nurs 2017; 29:17-22. [PMID: 28720261 DOI: 10.1016/j.ejon.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Physical activity (PA) is important for recovery after a breast cancer diagnosis; however, women's motivation to engage in PA can be impacted by disease and/or treatment, and can therefore be a challenge. This study explored factors associated with PA levels during chemotherapy among women with breast cancer. METHOD The study had a cross-sectional descriptive and comparative design using a study-specific questionnaire. One hundred women with breast cancer receiving adjuvant chemotherapy were included. Data were analysed by Pearson's correlation coefficient and linear regression. The open question was subjected to manifest content analysis. RESULTS Identified factors associated with engaging in PA during chemotherapy treatment were: being physically active before diagnosis, and the information given by the oncology nurse before the treatment start. The physically active women experienced higher psychological wellbeing, less fatigue, and faster recovery after treatment. They also experienced an overall feeling of fitness. CONCLUSION It seems that PA is associated with less fatigue, better recovery between chemotherapy treatments, and a better mental condition leading to wellbeing. Information given by the oncology nurse may be an important factor for being physically active. Women with breast cancer need to get specific advice about and support in engaging in PA to feel better during chemotherapy treatment. Further research is required to develop guidelines for advice about and support regarding PA during chemotherapy treatment.
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Affiliation(s)
- Anna Wilhelmsson
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Maria Roos
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Lars Hagberg
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yvonne Wengström
- Neurobiology Care Science and Society, Nursing, Karolinska Institute, & Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
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