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Martínez Aguirre-Betolaza A, Dobaran Amezua A, Yagin FH, Cacicedo J, Olasagasti-Ibargoien J, Castañeda-Babarro A. Do Oncologists Recommend the "Pill" of Physical Activity in Their Practice? Answers from the Oncologist and Patients' Perspectives. Cancers (Basel) 2024; 16:1720. [PMID: 38730668 PMCID: PMC11083921 DOI: 10.3390/cancers16091720] [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: 04/10/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES The purposes of this current questionnaire-based study were to analyse whether oncologists prescribed PA to their patients in Spain, as well as the type of exercise recommended, the variables that influence whether or not to recommend it and to compare these recommendations with the values reported by their patients. METHODS Two online questionnaires were designed for this study. The first one, filled in by the oncologists (n = 93), contained aspects such as the attitude or barriers to promoting PA. The second was designed for patients with cancer (n = 149), which assessed PA levels and counselling received from oncologists, among other facets. RESULTS The majority of oncologists (97%) recommend PA during their consultations. Instead, only 62% of patients reported participating in exercise within the last 7 days. Walking was the most common form of exercise, reported by 50% of participants. Patients who received exercise recommendations from their oncologist walked for more days (p = 0.004; ES = 0.442) and more minutes per day (p = 0.022; ES = 0.410). The barriers most highlighted by patients were lack of time and not knowing how to perform PA. CONCLUSION Oncologists and patients seem to be interested and able to participate in PA counselling and programmes. However, there was a discrepancy between what was reported by oncologists and expressed by patients in terms of recommendations for PA and the modality itself.
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Affiliation(s)
- Aitor Martínez Aguirre-Betolaza
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.M.A.-B.); (A.D.A.); (J.O.-I.)
| | - Ander Dobaran Amezua
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.M.A.-B.); (A.D.A.); (J.O.-I.)
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey;
| | - Jon Cacicedo
- Department of Radiation Oncology, Cruces University Hospital, BioCruces Health Research Institute, Osakidetza, 48903 Barakaldo, Spain;
| | - Jurgi Olasagasti-Ibargoien
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.M.A.-B.); (A.D.A.); (J.O.-I.)
| | - Arkaitz Castañeda-Babarro
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.M.A.-B.); (A.D.A.); (J.O.-I.)
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2
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Byeon JY, Lee MK, Park DH, Yeon SJ, Jee SH, Lee CW, Yang SY, Kim NK, Vallance J, Courneya KS, Jeon JY. A qualitative exploration of exercise motivation among colorectal cancer survivors: an application of the theory of planned behavior. Support Care Cancer 2024; 32:176. [PMID: 38381248 DOI: 10.1007/s00520-024-08362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE The purpose of this qualitative study was to use semi-structured interviews and thematic analysis to elicit key influencing factors (i.e., behavioral, normative, and control beliefs) related to physical activity and exercise in colorectal cancer survivors. METHODS Colorectal cancer survivors (N = 17) were recruited from exercise programs designed for colorectal cancer survivors at the Yonsei Cancer Center, Seoul, South Korea. A purposive sampling method was used. Interview questions were informed by the theory of planned behavior (TPB). Semi-structured face-to-face interviews were conducted, and open-ended questions addressed the research question. Interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS Participants were on average 2.2 years post-treatment. The mean age of the sample was 55.9 years. Key behavioral, normative, and control beliefs emerged in the data. For behavioral beliefs, colorectal cancer survivors believed that exercise would result in physical and psychological improvements, and improve their bowel problems. For normative beliefs, most colorectal cancer survivors wanted their oncologists' approval for participation of exercise. Family members, more specifically the spouse, were also influencing factors for colorectal cancer survivors adopting physical activity. The most frequently mentioned control belief was that supervised exercise with an exercise specialist made exercise participation easier. CONCLUSIONS AND IMPLICATIONS Beliefs identified in this study can inform TPB-based physical activity interventions tailored for colorectal cancer survivors. While information alone may not lead to behavior change, integrating these beliefs with other influential factors can potentially enhance intervention efficacy and promote physical activity in this population.
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Affiliation(s)
- Ji Yong Byeon
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Mi Kyung Lee
- Frontier Research Institute of Convergence Sports Science, FRICSS, Yonsei University, Seoul, Korea
| | - Dong-Hyuk Park
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Su Jin Yeon
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Sun Ha Jee
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Chul Won Lee
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Nam-Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Jeff Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Justin Y Jeon
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea.
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, Korea.
- Cancer Prevention Center, Yonsei Cancer Center, Seoul, Korea.
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Schmidt MLK, Østergren P, Kvorning Ternov K, Sønksen J, Midtgaard J. Factors related to promotion of physical activity in clinical oncology practice: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 107:107582. [PMID: 36502560 DOI: 10.1016/j.pec.2022.107582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To map which factors have been considered, explored, and found to influence physical activity (PA) promotion by oncology physicians and nurses (OPN). METHODS A scoping review of empirical studies was conducted using Arksey and O'Malley's framework and the PRISMA-ScR guideline. The quality of the studies was evaluated using the QATSDD tool. RESULTS Twenty-nine publications were included. The methodological quality of the studies was low to moderate. Studies have shown a positive attitude towards PA and recommending PA. PA knowledge seems to influence PA promotion by OPNs to some extent. Structural barriers for PA promotion are the most endorsed barriers but to what extent they influence PA promotion is unclear. The demographic and professional characteristics of OPNs and their PA behavior do not seem to influence PA promotion to a greater extent. Patients' PA interest, health characteristics, and medical conditions are additional factors. Their implications for PA promotion are not fully elucidated. CONCLUSIONS The varied results across the studies, together with the methodological limitations of the studies, make it unclear to what extent the explored factors influence PA promotion by OPNs. PRACTICE IMPLICATIONS More research into what influences OPNs' engagement in PA promotion is warranted to support clinical PA promotion.
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Affiliation(s)
- M L K Schmidt
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Denmark.
| | - P Østergren
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K Kvorning Ternov
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - J Sønksen
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
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Suzuki K, Naito T, Okayama T, Yonenaga Y, Kitagawa M, Sato R, Suzuki K, Ishii T, Mitsuhashi N, Uehara R, Shimizu A, Nishizawa T, Fuseya H. Perception of the prognostic impact of physical activity among cancer survivors: a narrative review. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-022-01033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Abstract
Purpose
Little is known about cancer survivors’ perceptions of the prognostic impact of physical activity (PA) and the association between perceptions and PA. Therefore, the present narrative review aimed to identify cancer survivors' perceptions of the prognostic impact of PA, perception barriers, and association with PA.
Methods
A literature search was performed via PubMed and Scopus with search terms including “physical activity”, “cancer survivor”, and “perception” in November 2022. Inclusion criteria were studies that investigated cancer survivors’ perceptions of the prognostic impact of PA written in English. Studies were excluded for patients undergoing cancer treatment or advanced cancer patients only.
Results
Our search identified a total of 13,080 articles, and 14 studies met the inclusion criteria. The study sample size ranged from 8 to 1003 participants. Most studies showed that cancer survivors poorly understood the prognostic impact of PA. Perception barriers were cited as a lack of advice from health care professionals (HCPs). Several studies reported a positive association between the perception of the prognostic impact of PA and actual PA.
Conclusions
This narrative review revealed that most reports showed that cancer survivors have a poor perception of the prognostic impact of PA. In addition, the lack of advice from HCPs may also be contributing to the lack of perception among cancer survivors. Therefore, to increase the amount of PA among cancer survivors, it is necessary to improve the perception of the prognostic impact of PA in both cancer survivors and HCPs.
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Gupta P, Hodgman CF, Alvarez-Florez C, Schadler KL, Markofski MM, O’Connor DP, LaVoy EC. Comparison of three exercise interventions with and without gemcitabine treatment on pancreatic tumor growth in mice: No impact on tumor infiltrating lymphocytes. Front Physiol 2022; 13:1039988. [PMID: 36479351 PMCID: PMC9720271 DOI: 10.3389/fphys.2022.1039988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 10/06/2023] Open
Abstract
Exercise has been shown to slow pancreatic tumor growth, but whether exercise interventions of differing volume or intensity yield differential effects on tumor outcomes is unknown. In this study, we compared three exercise training interventions implemented with and without chemotherapy on pancreatic tumor growth in mice. Methods: Male C57BL/6 mice (6-8 weeks old) were subcutaneously inoculated with pancreatic ductal adenocarcinoma tumor cells (PDAC 4662). Upon tumor detection, mice received gemcitabine 15 mg/kg intraperitoneally 3 days/week and were assigned to exercise: high volume continuous exercise (HVCE), low volume continuous exercise (LVCE), high intensity interval training (HIIT), or sedentary (SED). HVCE ran at 12 m/min for 45 min and LVCE for 15 min, 5 days/week. HIIT ran 1-min at 20 m/min, followed by 1-min walking at 8 m/min for 20 total intervals, 3 days/week. SED did not run. Additional sets of inoculated mice were assigned to the exercise interventions but did not receive gemcitabine. Tumor volume was measured every other day for 2 weeks; tumor-infiltrating lymphocytes were assessed by flow cytometry 3-week post-inoculation. Results: Tumor growth did not differ between groups that received gemcitabine (F(3, 34) = 1.487; p = 0.235; η2 = 0.116). In contrast, tumor growth differed between groups not provided gemcitabine (F(3,14) = 3.364; p = 0.049, η2 = 0.419), with trends for slower growth in LVCE than SED (p = 0.088) and HIIT (p = 0.084). Groups did not differ in tumor infiltrating lymphocytes. Conclusion: Contrary to our hypotheses, the exercise interventions compared here did not further reduce pancreatic tumor growth beyond that provided by gemcitabine. However, in mice not receiving gemcitabine, there was a trend for reduced tumor growth in LVCE.
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Affiliation(s)
- Priti Gupta
- Department of Health and Human Performance, University of Houston, Houston, TX, United States
| | - Charles F. Hodgman
- Department of Health and Human Performance, University of Houston, Houston, TX, United States
| | - Claudia Alvarez-Florez
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, MD Anderson Cancer Center, Houston, TX, United States
| | - Keri L. Schadler
- Department of Pediatrics-Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Melissa M. Markofski
- Department of Health and Human Performance, University of Houston, Houston, TX, United States
| | - Daniel P. O’Connor
- Department of Health and Human Performance, University of Houston, Houston, TX, United States
| | - Emily C. LaVoy
- Department of Health and Human Performance, University of Houston, Houston, TX, United States
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Patel A, Schofield GM, Keogh JWL. Motives for Physical Activity in Prostate Cancer Survivors: A Qualitative Exploration. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221123003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Physical activity (PA) is beneficial for both the physical and psychological health of prostate cancer (PCa) survivors. This study identified and examined motives for PA in a cross-section of PCa survivors, including both men in remission and those receiving treatment in the form of androgen deprivation therapy (ADT). Sixteen PCa survivors from Auckland, New Zealand were individually interviewed. Data were analyzed using an inductive thematic approach. Both groups of men were motivated to engage in PA post-diagnosis to obtain and experience the physical, mental, and cognitive health-related benefits associated with regular PA engagement. Past history of PA was also identified as a motive for current PA for men in remission. These findings provide important insight into how PCa survivors perceive the benefits of PA as a part of their cancer survivorship. Healthcare practitioners, exercise physiologists, and cancer support organizations can use this information to further improve PCa survivors’ quality of life and overall cancer survivorship by better promoting PA to these individuals.
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Affiliation(s)
- Asmita Patel
- South Pacific College of Natural Medicine, Auckland, New Zealand (AP); Human Potential Centre, Auckland University of Technology, Auckland, New Zealand (GMS); and Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia (JWLK)
| | - Grant M. Schofield
- South Pacific College of Natural Medicine, Auckland, New Zealand (AP); Human Potential Centre, Auckland University of Technology, Auckland, New Zealand (GMS); and Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia (JWLK)
| | - Justin W. L. Keogh
- South Pacific College of Natural Medicine, Auckland, New Zealand (AP); Human Potential Centre, Auckland University of Technology, Auckland, New Zealand (GMS); and Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia (JWLK)
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7
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Caperchione CM, Sharp P, Phillips JL, Agar M, Liauw W, Harris CA, Marin E, McCullough S, Lilian R. Bridging the gap between attitudes and action: A qualitative exploration of clinician and exercise professional's perceptions to increase opportunities for exercise counselling and referral in cancer care. PATIENT EDUCATION AND COUNSELING 2022; 105:2489-2496. [PMID: 34823926 DOI: 10.1016/j.pec.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to 1) understand factors impacting the implementation of exercise communication and referral, and 2) explore integrated clinical approaches to exercise communication and referral in cancer care. METHODS Seven focus groups (N = 53) were conducted with clinicians and exercise professionals throughout Sydney, Australia. A sub-sample of participants (n = 9) attended a half-day workshop to identifying best practice approaches for moving forward. Data were analysed using thematic content analysis. RESULTS Two themes emerged: 1) Factors impacting the knowledge-to-action gap, inclusive of limited exercise specific knowledge and training opportunities, funding structure, and current referral process, and 2) Recommendations for a consistent and efficient way forward, detailing the need for oncologist-initiated communication, distribution of cancer-exercise resources, and access to exercise professionals with cancer expertise. CONCLUSIONS This study identified factors (e.g., cancer-exercise specific training, integration of exercise physiologists) influencing exercise counselling and referral. A potential implementation-referral approach accounting for these factors and how to incorporate exercise into a standard model of cancer care, is described. Future testing is required to determine feasibility and practicality of these approaches. PRACTICAL IMPLICATIONS A pragmatic model is provided to guide implementation-referral, inclusive of oncologist-initiated communication exchange, relevant resources, and access to exercise professionals with cancer expertise.
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Affiliation(s)
- Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia.
| | - Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia; Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Meera Agar
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia
| | - Winston Liauw
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Translational Cancer Research Network Sydney, Australia
| | - Carole A Harris
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Translational Cancer Research Network Sydney, Australia
| | - Elizabeth Marin
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Ruth Lilian
- Translational Cancer Research Network Sydney, Australia
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8
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Ladefoged Kopp Schmidt M, Østergren P, Cormie P, Sønksen J, Midtgaard J. Delivering Physical Activity Recommendations in Daily Clinical Cancer Care: An Observational Interview Study in Prostate Cancer Out-Patient Clinics Using an Empirical Ethics of Care Approach. QUALITATIVE HEALTH RESEARCH 2022; 32:1086-1098. [PMID: 35523233 DOI: 10.1177/10497323221085108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Physical activity (PA) has shown to mitigate many of the common side effects of cancer treatments. The promotion of PA by health care professionals (HCPs) can facilitate the adoption of PA by patients with cancer. Drawing on an empirical ethics of care approach, this article explores how the delivery of PA recommendations is done within clinical cancer care. Based on 175 observations of consultations between doctors, nurses and patients and interviews with 27 doctors and nurses, we show how delivering PA recommendations was related to four care practices: "adjusting information to match the patient's needs and situation," "managing current and anticipated treatment-induced side effects," "using visual aids and quantifiable data," and "maintaining a good relationship between the patient and the HCP." Drawing on these findings, we discuss strategies to strengthen the delivery of PA recommendations in clinical cancer care.
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Affiliation(s)
- Mette Ladefoged Kopp Schmidt
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, 4321University of Copenhagen, Copenhagen, Denmark
| | - Peter Østergren
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, 4321University of Copenhagen, Copenhagen, Denmark
| | - Prue Cormie
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, 2281The University of Melbourne, Melbourne, VIC, Australia
| | - Jens Sønksen
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, 4321University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, 4321University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
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9
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Exercise in lung Cancer, the Healthcare providers Opinion (E.C.H.O.): results of the EORTC Lung Cancer Group (LCG) survey. Lung Cancer 2022; 169:94-101. [DOI: 10.1016/j.lungcan.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
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10
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Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review. Int J Behav Nutr Phys Act 2022; 19:21. [PMID: 35236360 PMCID: PMC8889734 DOI: 10.1186/s12966-022-01245-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Many of the world’s population, across all age groups and abilities, are not meeting or even aware of internationally recommended physical activity (PA) and sedentary behaviour (SB) guidelines. In order to enhance awareness and uptake, guidelines should be perceived positively by targeted users. The purpose of this study was to review the literature on end-user and stakeholder perceptions of PA and SB guidelines. Methods The electronic databases APA PsycInfo, CINAHL, MEDLINE, and SPORTDiscus, using EBSCOhost Research Platform, and Web of Science were searched from inception to June, 2021 with keyword synonyms for “perceptions”, “PA guidelines”, and “SB guidelines”. Studies of any design that collected stakeholder and/or end-user responses to a PA and/or SB guideline were included and assessed for risk of bias. The PA and/or SB guideline could be any type of official form (e.g., national documents, organizational guidelines, expert consensus statements, etc.) from any country, that targets individuals at the regional, provincial/statewide, national, or international level, and includes all types of guidelines (e.g., strength, aerobic, clinical, nonclinical, screen-time, sitting, etc.). Data were extracted and analyzed using thematic synthesis. Results After screening 1399 abstracts and applying citation screening, 304 full-texts were retrieved. A total of 31 articles met the inclusion criteria. End-users and stakeholders for PA guidelines across all age groups expressed the need for simplified language with more definitions, relatable examples and imagery, and quantification of PA behaviours. There was concern for the early years and child PA guidelines leading to guilt amongst parents and the SB guidelines, particularly the recommendations to limit screen-time, being unrealistic. General age group PA guidelines were not perceived as usable to populations with differing abilities, clinical conditions, and socioeconomic status. Guidelines that targeted clinical populations, such as persons with multiple sclerosis and persons with spinal cord injury, were well received. Conclusions There is a clear need to balance the evidence base with the pragmatic needs of translation and uptake so that the guidelines are not ignored or act as a barrier to actual engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01245-9.
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11
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Caperchione CM, Stolp S, Phillips JL, Agar M, Sharp P, Liauw W, Harris CA, McCullough S, Lilian R. Cancer survivors' exercise beliefs, knowledge, and behaviors: An Australian National Survey. Asia Pac J Clin Oncol 2022; 18:625-633. [PMID: 35098655 DOI: 10.1111/ajco.13729] [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: 07/29/2021] [Accepted: 11/03/2021] [Indexed: 11/02/2022]
Abstract
AIMS This study aimed to (1) explore the perceptions of people living with cancer about exercise in general and exercise as an adjunct form of cancer care, (2) explore their perceptions regarding exercise counselling needs and preferences, and (3) investigate how these perceptions of exercise as an adjunct form of cancer care shape survivors exercise levels postcancer diagnosis. METHODS A cross-sectional design and online survey were used to recruit cancer survivors via cancer-related networks throughout Australia. Two factor analyses were conducted to examine the structure and reduce the number of variables pertaining to exercise during and after the cancer treatment. Extracted components were used in one-way analysis of variance to compare differences in physical activity levels postcancer diagnosis. RESULTS Participants (N = 288) had very positive perceptions of exercise, yet only 50% of participants would prefer to receive exercise counselling. Those who were more active postcancer diagnosis had higher exercise beliefs than those who were similarly active (p = 0.04, r = 0.27) and less active (p = 0.03, r = 0.24) postdiagnosis. Those who were less active also had lower exercise knowledge than those who were similarly active (p = 0.01, r = 0.31) and more active (p = 0.03, r = 0.26). Safety beliefs did not significantly differ between cancer survivors' activity levels (p = 0.16) CONCLUSION: This survey highlights the potential benefits of a concentrated effort in connecting survivors to relevant services and resources, and utilizing cancer clinicians to communicate with survivors about the role of exercise in cancer care.
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Affiliation(s)
- Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sean Stolp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane L Phillips
- School of Nursing, Queensland University of Technology, Brisbane, QLD.,IMPACCT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meera Agar
- IMPACCT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Winston Liauw
- Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
| | - Carole A Harris
- Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
| | - Susan McCullough
- Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
| | - Ruth Lilian
- Translational Cancer Research Network Sydney, Sydney, New South Wales, Australia
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12
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Meyer-Schwickerath C, Köppel M, Kühl R, Rivera JB, Tsiouris A, Huber G, Wiskemann J. Health care professionals' understanding of contraindications for physical activity advice in the setting of stem cell transplantation. Support Care Cancer 2022; 30:9151-9161. [PMID: 36031656 PMCID: PMC9420674 DOI: 10.1007/s00520-022-07336-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/18/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Most patients receiving a hematopoietic stem cell transplantation (HSCT) are able to tolerate and benefit from physical activity (PA). Therefore, it is important that health care professionals (HCPs) advise patients to perform PA before, during, and after transplantation. By understanding which medical conditions and safety issues are associated with the (non-) promotion of PA, concrete actions and interventions can be planned and implemented. METHODS Physicians (N = 51), nurses (N = 52), and physical therapists (N = 26) participated in a nationwide cross-sectional online survey. HCPs' understanding of 15 medical conditions as contraindications for PA was assessed. Significant group differences were determined using chi-square analysis. RESULTS Acute infection was the only condition which was considered as contraindication by all HCPs (62.7%). Cachexia (78%), having a stoma (91%), or port (96.2%), psychological problems (88.4%), and leukopenia (83.3%) were not considered as contraindications. Six conditions were rated inconsistently between the groups, whereas physicians had the least concerns regarding PA. Physicians with an additional training in PA perceived a platelet count of ≤ 50,000/μl significantly less often as contraindication (p < 0.05). CONCLUSION The large number of potentially-answers especially in nursing staff and physical therapists might reflect caution or uncertainty. There is a clear need for a good multidisciplinary cooperation between all HCPs in order to support patients to confidently engage in PA. Furthermore, education possibilities and evidence-based courses to build knowledge regarding safety concerns should be the standard practice in the setting of HSCT. The investigative nature of the paper indicates that certain trends should be interrogated in a causal-longitudinal design.
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Affiliation(s)
- Corinna Meyer-Schwickerath
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany ,Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Maximilian Köppel
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany ,Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Rea Kühl
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Janina Bujan Rivera
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany ,Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Angeliki Tsiouris
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Gerhard Huber
- Institute of Sports and Sports Sciences, University of Heidelberg, Heidelberg, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
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13
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Shimizu Y, Tsuji K, Ochi E, Okubo R, Kuchiba A, Shimazu T, Tatematsu N, Sakurai N, Iwata H, Matsuoka YJ. Oncology care providers' awareness and practice related to physical activity promotion for breast cancer survivors and barriers and facilitators to such promotion: a nationwide cross-sectional web-based survey. Support Care Cancer 2021; 30:3105-3118. [PMID: 34853914 PMCID: PMC8857119 DOI: 10.1007/s00520-021-06706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
Purpose A known barrier to getting breast cancer survivors (BCSs) to engage in habitual exercise is a lack of information on recommended physical activity levels provided to them by oncology care providers (OCPs). However, the actual situation in Japan remains unclear. This study sought to clarify OCPs’ awareness and practice related to Japan’s physical activity recommendation for BCSs and to ascertain barriers to routine information provision. Methods We conducted a web-based survey involving members of the Japanese Breast Cancer Society (JBCS) and the Japanese Association of Cancer Rehabilitation between Dec. 2018 and Feb. 2019. Results Of 10,830 members, 1,029 (9.5%) responded. Only 19.1% were aware of the details of the JBCS physical activity recommendation, and only 21.2% routinely provided physical activity information to BCSs. Factors related to being aware of the recommendation details were 1) availability of the guidelines, 2) experience reading relevant parts of the guidelines, and 3) involvement in multidisciplinary team case meetings. Barriers to routine information provision were 1) absence of perceived work responsibility, 2) underestimation of survivors’ needs, 3) lack of resources, 4) lack of self-efficacy about the recommendation, and 5) poor knowledge of the recommendation. Conclusions Only one fifth of the OCPs routinely provided physical activity information. Barriers to provision were poor awareness, self-efficacy, and attitudes and unavailable resources. The physical activity recommendation needs to be disseminated to all OCPs and an information delivery system needs to be established for BCSs to receive appropriate information and support to promote their engagement in habitual physical activity. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06706-8.
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Affiliation(s)
- Yoichi Shimizu
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Katsunori Tsuji
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Eisuke Ochi
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Faculty of Bioscience and Applied Chemistry, Hosei University, Tokyo, Japan
| | - Ryo Okubo
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Aya Kuchiba
- Division of Biostatistical Research, Center for Public Health Sciences/Biostatistics Division, Center for Research Administration and Support, National Cancer Center Japan, Tokyo, Japan.,Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Noriatsu Tatematsu
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | | | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Lifestyle Medicine, Cooperative Graduate Program, The Jikei University Graduate School of Medicine, Tokyo, Japan.
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14
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Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review. J Cancer Surviv 2021; 16:865-881. [PMID: 34510366 PMCID: PMC9300485 DOI: 10.1007/s11764-021-01080-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022]
Abstract
Purpose While calls have been made for exercise to become standard practice in oncology, barriers to implementation in real-world settings are not well described. This systematic scoping review aimed to comprehensively describe barriers impeding integration of exercise into routine oncology care within healthcare systems. Methods A systematic literature search was conducted across six electronic databases (since 2010) to identify barriers to implementing exercise into real-world settings. An ecological framework was used to classify barriers according to their respective level within the healthcare system. Results A total of 1,376 results were retrieved; 50 articles describing implementation barriers in real-world exercise oncology settings were reviewed. Two hundred and forty-three barriers were identified across all levels of the healthcare system. Nearly 40% of barriers existed at the organizational level (n = 93). Lack of structures to support exercise integration and absence of staff/resources to facilitate its delivery were the most common issues reported. Despite the frequency of barriers at the organizational level, organizational stakeholders were largely absent from the research. Conclusions Implementing exercise into routine cancer care is hindered by a web of interrelated barriers across all levels of the healthcare system. Organizational barriers are central to most issues. Future work should take an interdisciplinary approach to explore best practices for overcoming implementation barriers, with organizations as a central focus. Implications for Cancer Survivors This blueprint of implementation barriers highlights critical issues that need to be overcome to ensure people with cancer have access to the therapeutic benefits of exercise during treatment and beyond. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01080-0.
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15
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Nicol JL, Hill MM, Burton NW, Skinner TL. Promoting exercise for patients with multiple myeloma: attitudes and practices of clinical haematologists. J Cancer Surviv 2021; 16:688-695. [PMID: 34114194 DOI: 10.1007/s11764-021-01062-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the attitudes and practices of clinical haematologists towards promoting physical activity (PA) and exercise for patients with multiple myeloma (MM). METHODS Using a quantitative cross-sectional survey, clinical haematologists reported on the perceived benefits and acceptability of PA and exercise and frequency, confidence and barriers to providing exercise advice. RESULTS Clinical haematologists (n=34; 68% response rate), who cumulatively treated ~340 patients with MM each week, completed the survey. Almost all (97%) agreed that PA was important, with benefits for quality of life, activities of daily living, mental health and fatigue. Whilst 88% discussed PA at least occasionally with their patients, approximately two-thirds were not confident advising specific exercises (68%) or identifying PA resources (62%). Despite this, 44% never referred patients to exercise professionals, with 18% only doing so if the patient asked. Over half did not recommend exercise when patients had spine fractures or were physically unwell. No differences were observed in individual factors (age, gender, practice type and own PA participation) and promotion of PA. CONCLUSIONS Clinical haematologists perceive PA as important, but lack confidence on what exercise/s to recommend and if exercise is appropriate for specific disease complications. They tend to not refer patients to exercise professionals. IMPLICATIONS FOR CANCER SURVIVORS Patients with MM often suffer from symptoms and toxicities that may be alleviated through PA. However, PA participation rates are low. Support for clinical haematologists for when and how to discuss exercise, and clearer referral pathways to exercise professionals may improve PA uptake and hence ensure access to optimal care, thereby improving patient outcomes.
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Affiliation(s)
- Jennifer L Nicol
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Michelle M Hill
- Precision and Systems Biomedicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Lv F, Zhang Y, Min S, Li P, Peng L, Ren L, Yu J, Wang B, Shen Y, Tong S, Jin J, Luo X, Chen J, Chen Y, Li Y, Chen J, Zeng X, Luo F, Xiong Q, Zou L, Guo Y, Cao J, Chen Q, Wu B, Chen G, Liu X, Xie B. Perioperative Exercise Intention and Influencing Factors: A Multi-Centered Cross-Sectional Study. Front Public Health 2021; 9:653055. [PMID: 34095058 PMCID: PMC8172588 DOI: 10.3389/fpubh.2021.653055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to evaluate the level and factors affecting the perioperative exercise intention in China. Design: This study was a cross-sectional survey in Southwest China. Methods: Four hundred and ninety nine participants were randomly sampled in eight medical centers from November 23, 2020 to November 27, 2020. The survey included sociodemographic information and a 24-item modified questionnaire, which aimed to evaluate the attitude toward daily exercise, perception of perioperative exercise, social support and the perioperative exercise intention. A multivariable linear regression model was used to evaluate the effect of different items on the patients' intention for perioperative exercise. Results: A total of 523 responses (95.09%) were collected and 499 (95.41%) were analyzed. The level of exercise intention of the patients during the perioperative period was: 14.83% planned to exercise every day in the hospital, 21.04% planned to exercise every other day, and 35.87% planned to exercise every week. Intensity of daily exercise (P = 0.016), positive attitude of daily exercise (P < 0.001), positive attitude of perioperative exercise (P < 0.001) and social support (P < 0.001) were positively associated with the intention for perioperative exercise. Female (P = 0.012), non-tertiary center (P = 0.011), and preoperative anxiety (P = 0.023) was negatively associated with it. Conclusions: The intention for perioperative exercise was low in Southwest China. The authors aimed to relieve preoperative anxiety, promote the education of perioperative exercise, design perioperative exercise programs, and provide more social support from medical staff and family for inpatients undergoing elective surgery.
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Affiliation(s)
- Feng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxi Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lihua Peng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ren
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiwei Shen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shanshan Tong
- Department of Anesthesiology, Jiangjin Centre Hospital, Chongqing, China
| | - Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Luo
- Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingrui Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Li
- Department of Anesthesiology, The People's Hospital of Liangping District of Chongqing, Chongqing, China
| | - Jin Chen
- Department of Anesthesiology, The People's Hospital of Liangping District of Chongqing, Chongqing, China
| | - Xing Zeng
- Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Fuquan Luo
- Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Qiuju Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Guo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Cao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Chen
- Department of Anesthesiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Xiaoli Liu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing, China
| | - Boli Xie
- Department of Anesthesiology, Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bade BC, Gan G, Li F, Lu L, Tanoue L, Silvestri GA, Irwin ML. "Randomized trial of physical activity on quality of life and lung cancer biomarkers in patients with advanced stage lung cancer: a pilot study". BMC Cancer 2021; 21:352. [PMID: 33794808 PMCID: PMC8015735 DOI: 10.1186/s12885-021-08084-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung cancer survivors need more options to improve quality of life (QoL). It is unclear to what extent patients with advanced stage disease are willing to participate in home-based physical activity (PA) and if these interventions improve QoL. The goal of our study was to determine interest in participating in our 3-month home-based walking regimen in patients with advanced stage lung cancer. We used a randomized design to evaluate for potential benefit in PA and patient-reported outcomes. METHODS We performed an open-label, 1:1 randomized trial in 40 patients with stage III/IV non-small cell lung cancer (NSCLC) evaluating enrollment rate, PA, QoL, dyspnea, depression, and biomarkers. Compared to usual care (UC), the intervention group (IG) received an accelerometer, in-person teaching session, and gain-framed text messages for 12 weeks. RESULTS We enrolled 56% (40/71) of eligible patients. Participants were on average 65 years and enrolled 1.9 years from diagnosis. Most patients were women (75%), and receiving treatment (85%) for stage IV (73%) adenocarcinoma (83%). A minority of patients were employed part-time or full time (38%). Both groups reported low baseline PA (IG mean 37 (Standard deviation (SD) 46) vs UC 59 (SD 56) minutes/week; p = 0.25). The IG increased PA more than UC (mean change IG + 123 (SD 212) vs UC + 35 (SD 103) minutes/week; p = 0.051)). Step count in the IG was not statistically different between baseline (4707 step/day), week 6 (5605; p = 0.16), and week 12 (4606 steps/day; p = 0.87). The intervention improved EORTC role functioning domain (17 points; p = 0.022) with borderline improvement in dyspnea (- 13 points; p = 0.051) compared to UC. In patients with two blood samples (25%), we observed a significant increase in soluble PD-1 (219.8 (SD 54.5) pg/mL; p < 0.001). CONCLUSIONS Our pilot trial using a 3-month, home-based, mobile health intervention enrolled over half of eligible patients with stage III and IV NSCLC. The intervention increased PA, and may improve several aspects of QoL. We also identified potential biomarker changes relevant to lung cancer biology. Future research should use a larger sample to examine the effect of exercise on cancer biomarkers, which may mediate the association between PA and QoL. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov ( NCT03352245 ).
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Affiliation(s)
- Brett C Bade
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, P.O. Box 208057 300 Cedar Street TAC - 441 South, New Haven, CT, 06520-8057, USA.
| | - Geliang Gan
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, USA
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, USA
| | - Lynn Tanoue
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, P.O. Box 208057 300 Cedar Street TAC - 441 South, New Haven, CT, 06520-8057, USA
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Medical University of South Carolina, New Haven, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, USA
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18
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Tsiouris A, Ungar N, Gabrian M, Haussmann A, Steindorf K, Wiskemann J, Sieverding M. What is the Image of the "Typical Cancer Patient"? The View of Physicians. Am J Mens Health 2021; 15:1557988320988480. [PMID: 33666112 PMCID: PMC7940746 DOI: 10.1177/1557988320988480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Former research has identified stigmatizing attitudes toward cancer patients in the general population. Little is known about (implicit) attitudes of physicians toward cancer patients. By using the prototype approach, the study investigated German physicians’ prototypical perceptions of cancer patients. Five hundred nineteen physicians (mean age: 46 years, 47% female) who regularly treat cancer patients participated in the questionnaire study. Participants were asked to state three prototype attributes that describe the “typical cancer patient.” Open format answers were coded on the dimensions favorability (coded with unfavorable, favorable, or neutral) and gender-stereotypicality (coded with masculine stereotypical, feminine stereotypical, or gender-neutral). Of all prototype attributes (N = 1,589), 69.9% were coded as unfavorable and 14.3% as favorable, the remaining attributes were neutral (15.9%). Analysis of gender-stereotypicality revealed that nearly half of the attributes (49.5%) were compatible with the feminine, whereas only 6.5% were compatible with the masculine stereotype. The remaining attributes (44.0%) were gender-neutral. There were no significant associations between prototype favorability or gender-stereotypicality and demographic/professional characteristics of physicians. The prototype approach was successful to identify (implicit) attitudes toward cancer patients and might be more sensitive than social distance scales when investigating stigmatizing attitudes. Physicians described the “typical cancer patient” with predominantly unfavorable and feminine attributes, while favorable attributes were underrepresented and positive masculine attributes were barely mentioned. The finding that the “typical cancer patient” lacks (positive) masculine attributes should be followed up in further research.
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Affiliation(s)
- Angeliki Tsiouris
- Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany.,Institute of Sport and Sport Science, Heidelberg University, Heidelberg, Germany
| | - Nadine Ungar
- Gender Studies and Health Psychology, Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Martina Gabrian
- Gender Studies and Health Psychology, Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim Wiskemann
- Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Monika Sieverding
- Gender Studies and Health Psychology, Institute of Psychology, Heidelberg University, Heidelberg, Germany
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19
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Nadler MB, Rose AAN, Prince R, Eng L, Lott A, Grant RC, Jones JM, Enright K. Increasing Referrals of Patients With Gastrointestinal Cancer to a Cancer Rehabilitation Program: A Quality Improvement Initiative. JCO Oncol Pract 2020; 17:e593-e602. [PMID: 33290162 DOI: 10.1200/op.20.00432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND People with cancer are at risk for initial, late, and long-term effects of cancer and its treatments. Cancer rehabilitation (CR) focuses on prevention/treatment of these sequelae and optimization of physical, social, and vocational functioning. Our center has a multidisciplinary impairment-driven outpatient CR program, but referrals of patients with GI cancer were low. AIMS We aimed (for 2019, relative to 2018) (1) to increase CR referrals of patients with GI cancer by 50% and (2) to increase the proportion of referrals coming from oncologists. Balancing measures included inappropriate referrals and cancellations. METHODS A rapid cycle improvement approach was used to optimize GI referrals to the CR program. Barriers to CR referral were identified through a literature review and informal interviews of GI clinicians. Barriers included (a) knowledge of CR program existence, (b) awareness of the referral process, (c) time, and (d) lack of CR program exposure. The team used Plan-Do-Study-Act (PDSA) cycles every 2 months from January to December 2019 to address barriers. A p-chart was used to analyze the results. RESULTS PDSA cycles included CR program advertisement, a presentation to GI staff, nurse-led patient identification, patient-facing posters, and clinician thank-you emails. The p-chart showed a 100% relative increase in referral numbers and an improvement in the percentage of patients referred by oncologists from 51% to 75%. There was no significant change in inappropriate referrals or cancellations. CONCLUSION Through PDSA cycles, we improved the total number of patients with GI cancer and percentage referred by an oncologist to a CR program. Future work will assess sustainability.
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Affiliation(s)
- Michelle B Nadler
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada
| | - April A N Rose
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada
| | - Rebecca Prince
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada
| | - Lawson Eng
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada
| | - Anthony Lott
- University of Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert C Grant
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada
| | - Jennifer M Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Katherine Enright
- University of Toronto, ON, Canada.,Carlo Fidani Regional Cancer Centre, Trillium Health Partners-Credit Valley Hospital, Mississauga, ON, Canada
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20
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Alderman G, Keegan R, Semple S, Toohey K. Physical activity for people living with cancer: Knowledge, attitudes, and practices of general practitioners in Australia. PLoS One 2020; 15:e0241668. [PMID: 33166304 PMCID: PMC7652282 DOI: 10.1371/journal.pone.0241668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background Healthcare professionals’ (Oncologists, doctors, and nurses) physical activity (PA) recommendations impact patients living with cancer PA levels. General practitioners (GPs) monitor the overall health of patients living with cancer throughout their treatment journey. This is the first study to explore GP’s knowledge, attitudes and practices of PA for patients living with cancer. Methods GPs who see patients living with cancer regularly (n = 111) completed a survey based on The Theory of Planned Behaviour (TPB). Participants (GP’s) reported knowledge, attitudes, perceived behaviour control and subjective norms of PA within the cancer population. GP recommendation and referral rates of PA were reported. Principal component analysis was conducted to establish a set of survey items aligned to TPB constructs (attitude, subjective norms, perceived control), and multiple regression analyses characterised associations between these predictor variables and (a) recommendation; and (b) referral–of PA to cancer patients. Results GPs (n = 111) recommended PA to 41–60% of their patients and referred 1–20% to PA programs. Multiple regression models significantly predicted the percent of patients recommended PA, p < .0005 adj. R2 = 0.40 and referred PA, p < .0005, adj. R2 = 0.21. GP attitudes and perceived behavioural control and GP’s own activity levels were significant predictors of whether patients were recommended and referred for PA, p<0.05. Conclusion GPs reported positive attitudes and perceptions towards promoting PA for their patients living with cancer. Despite having a positive correlation between PA recommendations and referral rates, a gap was evident between GP’s PA beliefs and their individual referral practices. More GP’s willing to promote and refer their patients for PA, would improve the physical and mental health outcomes of the cancer population.
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Affiliation(s)
- Georgina Alderman
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
| | - Richard Keegan
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Stuart Semple
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Kellie Toohey
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
- Health Research Institute, University of Canberra, Canberra, Australia
- * E-mail:
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21
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Alderman G, Semple S, Cesnik R, Toohey K. Health Care Professionals’ Knowledge and Attitudes Toward Physical Activity in Cancer Patients: A Systematic Review. Semin Oncol Nurs 2020; 36:151070. [DOI: 10.1016/j.soncn.2020.151070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Autonomy is not but competence and relatedness are associated with physical activity among colorectal cancer survivors. Support Care Cancer 2020; 29:1653-1661. [PMID: 32761518 DOI: 10.1007/s00520-020-05661-0] [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: 12/24/2019] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The main objective of this study was to use the framework of the self-determination theory, incorporating both internal and external sources of motivation, to identify factors influencing physical activity among colorectal cancer survivors (CRC-S) in Korea. METHOD In total, 242 patients at a university-affiliated hospital in Seoul, Korea, responded to a descriptive survey, which comprised questionnaire sets including the Global Physical Activity Questionnaire and the Patient Health Questionnaire. Motivation was then assessed on three scales: the Treatment Self-Regulation (autonomy), Perceived Competence (competence), and the multidimensional Scale of Perceived Social Support (relatedness). Logistic regression analysis was then used to identify factors associated with physical activity. RESULT The mean physical activity score was 16.07 metabolic equivalent hours per week, and only 23.3% of patients had an appropriate level of exercise. In the logistic regression analysis, physical activity was associated with competence (odds ratio (OR) = 1.36, 95% confidence interval (CI): 1.06-1.74), relatedness (OR = 1.11, 95% CI: 1.04-1.18), depression (OR = 0.84, 95% CI: 0.75-0.94), and stage I or II disease (OR = 3.33, 95% CI: 1.28-1.86). This study indicated that competence, relatedness, depression, and the disease stage contributed to physical activity among these subjects while autonomy did not. CONCLUSION Future interventions to achieve the recommended levels of physical activity among CRC-S could benefit from taking into account the disease stage as well as psychosocial factors including motivation and depression.
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Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4358. [PMID: 32570715 PMCID: PMC7345303 DOI: 10.3390/ijerph17124358] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
Physical activity (PA) is a cost-effective and non-pharmacological foundation for the prevention and management of chronic and complex diseases. Healthcare professionals could be viable conduits for PA promotion. However, the evidence regarding the effectiveness and benefits of the current forms of PA promotion are inconclusive. Healthcare professionals' perceptions on key determinants impact on the optimum promotion of PA were explored in this review. Thirty-four (34) studies were identified after systematically searching seven databases for peer-reviewed articles published within the last decade. PA advice or counselling was the most recorded form of PA promotion, limited counselling time was the most reported obstacle while providing incentives was viewed as a key facilitator. There is widespread consensus among healthcare professionals (HCPs) on some aspects of PA promotion. Utilisation of all PA promotional pathways to their full potential could be an essential turning point towards the optimal success of PA promotional goals. Hence, strategies are required to broaden chronic disease treatment methods to include preventive and integrative PA promotion approaches particularly, between frontline HCPs (e.g., GPs) and PA specialists (e.g., EPs). Future studies could explore the functionality of GP to EP referral pathways to determining what currently works and areas requiring further development.
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Affiliation(s)
- Francis A. Albert
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
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Rodrigues B, Ribeiro C, Encantado J, Palmeira AL. Perceções e comportamentos dos médicos oncologistas relativos à promoção de atividade física. PSYCHOLOGY, COMMUNITY & HEALTH 2020. [DOI: 10.5964/pch.v8i1.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objetivo
Descrever e explorar determinantes da promoção de Atividade Física (AF) por parte dos oncologistas, analisar a perceção de capacidade, oportunidade e motivação dos médicos quanto à promoção de AF, e analisar as preocupações relacionadas com a prática de exercício físico dos doentes oncológicos.
Método
Um total de 76 oncologistas preencheram um questionário constituído por demografia, questões sobre a promoção da AF ligadas às perceções de capacidade, oportunidade, motivação, comportamento, e necessidades. Foram realizadas análises de correlação de Pearson e Spearman, regressão linear múltipla, teste-t paramétrico e não paramétrico.
Resultados
Foram detetadas perceções de capacidade e oportunidade baixas e uma motivação elevada. A grande maioria promove atividade física, mas não promove exercício físico estruturado, contudo, reconhecem a sua importância. A capacidade é a variável mais preponderante no comportamento, mas as restantes variáveis estão associadas ao mesmo. É reportada uma necessidade de melhoria de condições para a promoção de AF.
Conclusão
Os resultados devem ser analisados com cautela devido à amostra reduzida, no entanto, sugerem que os médicos valorizam a prática de AF dos seus doentes mas não se sentem capazes para promovê-la, o que legitima a presença de fisiologistas do exercício nos serviços de saúde. A presença do fisiologista do exercício pode ser um fator desencadeador da promoção de AF e exercício físico.
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Hardcastle SJ, Galliott M, Lynch BM, Nguyen NH, Cohen PA, Mohan GR, Johansen NJ, Saunders C. 'If I Had Someone Looking Over My Shoulder…': Exploration of Advice Received and Factors Influencing Physical Activity Among Non-metropolitan Cancer Survivors. Int J Behav Med 2019; 26:551-561. [PMID: 31364038 DOI: 10.1007/s12529-019-09808-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are significant geographic inequalities in cancer survival with poorer survival rates in non-metropolitan areas compared to major cities. Physical activity (PA) can reduce cancer recurrence and prevent cardiovascular disease. However, few survivors participate in sufficient PA and the prevalence of inactivity is significantly higher in non-metropolitan survivors. The study investigated non-metropolitan survivors' recollections regarding PA advice received following cessation of active treatment, their knowledge of PA guidelines, and the factors that impact on PA behaviour change. METHOD Sixteen individuals (14 women and 2 men) with breast (n = 8), endometrial (n = 4) or colorectal cancer (n = 4), with a mean age of 60 years (SD = 12) completed semi-structured interviews as part of a larger study to examine the acceptability and utility of wearable trackers to increase PA. Interviews explored survivors' recollections regarding the advice they received concerning PA following active treatment, knowledge of PA guidelines for cancer survivors and the influences on PA behaviour change. Interview transcripts were analysed using thematic analysis. RESULTS Four main themes emerged: (i) insufficient knowledge of guidelines, (ii) support from the treating oncology team, (iii) external accountability, and (iv) barriers to PA. CONCLUSIONS Survivors' knowledge of PA guidelines was limited and they did not often recall their oncologists making specific recommendations concerning PA. Survivors' referred to the desire for accountability and monitoring in order to successfully change PA. Lack of motivation was the main barrier to PA participation. Other barriers included age, health status, and lack of facilities or exercise programs.
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Affiliation(s)
- Sarah J Hardcastle
- School of Psychology, Curtin University, Perth, WA, Australia. .,School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | | | - Brigid M Lynch
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Nga H Nguyen
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Paul A Cohen
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
| | | | | | - Christobel Saunders
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
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Haussmann A, Ungar N, Tsiouris A, Sieverding M, Wiskemann J, Steindorf K. The Influence of Cancer Patient Characteristics on the Recommendation of Physical Activity by Healthcare Professionals. Int J Behav Med 2019; 27:65-78. [PMID: 31823182 DOI: 10.1007/s12529-019-09833-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although physical activity (PA) is beneficial for patients with cancer, healthcare professionals (HCP) still scarcely recommend it. This study aimed to determine how HCP' sociodemographic and professional characteristics and their subjective assessments of patient characteristics are associated with their PA recommendations to patients with cancer. METHODS A cross-sectional survey (paper-pencil or online) was completed by 929 HCP (159 general practitioners, 382 specialized physicians, and 388 oncology nurses). The survey collected information on HCP' sociodemographic and professional characteristics, PA recommendation frequency, and the likelihood of 13 patient characteristics influencing PA recommendations (on a 7-point Likert scale). RESULTS Descriptive results showed that 37.6% of HCP indicated often recommending PA and 41.7% indicated routinely recommending PA. More professional experience was associated with a higher reported PA recommendation frequency among specialized physicians and oncology nurses. Patient characteristics could be assigned to three higher-level categories. Characteristics from the categories "medical side effects" and "low affinity for PA" were more frequently judged by HCP as reasons for recommending PA and characteristics belonging to "indicators of poor general health" as reasons for not recommending PA. In all professional groups, the inclusion of patient characteristics resulted in additional variance explained in the prediction of a routine PA recommendation. CONCLUSIONS HCP in this study reported that they frequently recommend PA to patients with cancer. However, HCP consider cancer patient characteristics to influence their decision whether to recommend PA. Future research and interventions should aim to enable HCP to provide adequate PA recommendations to patients with cancer having different characteristics.
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Affiliation(s)
- Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.,Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Nadine Ungar
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Angeliki Tsiouris
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz University, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Monika Sieverding
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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Patel A, Schofield G, Keogh J. Influences on health-care practitioners' promotion of physical activity to their patients with prostate cancer: a qualitative study. J Prim Health Care 2019; 10:31-38. [PMID: 30068449 DOI: 10.1071/hc17036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Physical activity is beneficial for the physical and psychological health of patients with prostate cancer (PCa). Health-care practitioners are ideally positioned to promote physical activity to their patients. AIM To identify factors that influenced health care practitioners to either promote or not promote physical activity to their patients with PCa. METHODS Individual interviews were conducted with 16 Auckland-based health-care practitioners, including specialists (oncologists and urologists), physiotherapists and complementary and alternative (acupuncturists) health-care practitioners. Data were analysed using an inductive thematic approach. RESULTS Treatment-related factors (ie counteracting side-effects of hormone suppression treatment), longer life expectancy and risk factors for other conditions appeared to influence the promotion of physical activity to patients. Time constraints of consultations and complex medical issues were barriers to the promotion of physical activity. CONCLUSIONS This study found that a variety of health-care practitioners are providing some degree of physical activity advice to their patients with PCa. Collaborative practice among health-care practitioners to verbally reinforce the benefits of physical activity, coupled with referral to experts in physical activity promotion/rehabilitation (such as physiotherapists), should be encouraged for best practice care.
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Affiliation(s)
- Asmita Patel
- School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Grant Schofield
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Justin Keogh
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Ungar N, Tsiouris A, Haussmann A, Herbolsheimer F, Wiskemann J, Steindorf K, Sieverding M. To rest or not to rest-Health care professionals' attitude toward recommending physical activity to their cancer patients. Psychooncology 2019; 28:784-791. [PMID: 30716190 DOI: 10.1002/pon.5020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE While in the past cancer patients were advised to rest, recent research revealed various beneficial effects of physical activity, including increased treatment tolerability during cancer treatment and prolonged survival, which has led to a paradigm shift in relevant guidelines. This study examined if this paradigm shift from rest to activity has been consolidated in health care professionals' (HCP') attitude. It was investigated if the two dimensions of attitude (rest and activity) are endorsed empirically within the theory of planned behavior (TPB). Differences between physicians and nurses were examined. METHODS Five hundred forty seven physicians and 398 nurses treating breast, prostate, or colorectal cancer patients completed a cross-sectional questionnaire. To assess attitude toward physical activity during cancer treatment, we developed a 15-item scale, which included original statements of HCP. TPB variables were assessed. RESULTS A factor analysis revealed the proposed distinction of attitude into two dimensions. The activity-paradigm was stronger represented in HCP' attitude compared with rest-paradigm (Mactivity-paradigm = 4.1 versus Mrest-paradigm = 2.7, p < 0.001). Additionally, the activity-paradigm had higher exploratory power in explaining intention to recommend physical activity in cancer patients. However, the rest-paradigm was able to explain intention to recommend physical activity over and above activity-paradigm (ΔR2 = 0.05). Nurses had higher scores on the rest-paradigm than physicians. CONCLUSIONS The activity-paradigm has already been consolidated in HCP' minds. However, the rest-paradigm is still present in the daily routine of oncology physicians and nurses. Addressing concerns and insecurities related to supporting cancer patients in maintaining or building up a physically active lifestyle is a very important educational task.
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Affiliation(s)
- Nadine Ungar
- Institute of Psychology, Heidelberg University, Heidelberg
| | - Angeliki Tsiouris
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg
| | - Florian Herbolsheimer
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg.,Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Hospital Heidelberg, Heidelberg
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg
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Moving Cancer Care Ontario's Exercise for People with Cancer guidelines into oncology practice: using the Theoretical Domains Framework to validate a questionnaire. Support Care Cancer 2019; 27:1965-1968. [PMID: 30762143 DOI: 10.1007/s00520-019-04689-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
Evidence supporting the benefits of exercise surrounding cancer treatment has led to internationally published guidelines, with minimal uptake by oncology care providers (OCPs). There is a need to understand how to implement research evidence into practice. Our team developed a questionnaire to assess OCPs' knowledge of exercise guidelines and barriers/facilitators to exercise counseling and program referral. We validated the questionnaire using the Theoretical Domains Framework, a knowledge translation (KT) framework used to implement evidence-based guidelines into practice. In this commentary, we describe this process and the rationale for integrating a KT framework into intervention development and implementation in oncology practice. The revised questionnaire, entitled Clinicians Perspectives on Exercise in Patients with Cancer (CliPEC), is shared to facilitate the implementation process and allow for comparison across oncology practices.
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30
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Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients. Support Care Cancer 2018; 26:4087-4096. [PMID: 29934683 DOI: 10.1007/s00520-018-4279-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Although many cancer patients benefit from physical activity (PA), healthcare professionals (HCP) still do not promote it routinely. Including different groups of HCP, this study aimed to examine how structural barriers are perceived as impeding by HCP for promoting PA to cancer patients, how the perceptions of structural barriers are associated with promoting PA, and how HCP react to information resources. METHODS A total of 287 physicians in outpatient care, 242 physicians in inpatient care, and 388 oncology nurses completed our questionnaire (paper-pencil or online). Participants assessed nine different structural barriers (on a 4-point Likert Scale) and reported their PA promotion frequency. Further, they could request three different kinds of information resources about PA in oncological settings. RESULTS Across professional groups, more than 70% of HCP indicated that they promoted PA to their cancer patients often or routinely. Oncology nurses indicated that they were more impeded in promoting PA by six structural barriers than physicians (all p < .01). "Not enough time per patient" and "lack of an expert contact person" were associated with a reduced PA promotion in two professional groups (all p < .05). Information resources were requested by 69.5% of the participants: mostly physicians working in outpatient care and especially by those perceiving structural barriers. CONCLUSIONS Although a big proportion of HCP reported that they frequently promoted PA, our findings suggest that HCP still perceive structural barriers. The perception and influence of structural barriers differed between professional groups, pointing to the importance of profession specific guidance.
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Haussmann A, Gabrian M, Ungar N, Jooß S, Wiskemann J, Sieverding M, Steindorf K. What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals’ concerns, perceived patient characteristics and perceived structural factors. Eur J Cancer Care (Engl) 2018; 27:e12853. [DOI: 10.1111/ecc.12853] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer; National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ); Heidelberg Germany
- Medical Faculty; Heidelberg University; Heidelberg Germany
| | - Martina Gabrian
- Institute of Psychology; Heidelberg University; Heidelberg Germany
| | - Nadine Ungar
- Institute of Psychology; Heidelberg University; Heidelberg Germany
| | - Stefan Jooß
- Division of Medical Oncology; National Center for Tumor Diseases (NCT) Heidelberg and University Clinic; Heidelberg Germany
| | - Joachim Wiskemann
- Division of Medical Oncology; National Center for Tumor Diseases (NCT) Heidelberg and University Clinic; Heidelberg Germany
| | | | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer; National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ); Heidelberg Germany
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Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: an international survey. Support Care Cancer 2018; 26:3711-3719. [PMID: 29740694 DOI: 10.1007/s00520-018-4230-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/26/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate knowledge, attitudes, and practices of oncologists towards physical activity (PA) in cancer survivors, and the association between oncologists' own PA behavior and PA promotion. METHODS Oncologists (n = 123) completed a survey based on the Theory of Planned Behavior (TPB). Participants reported PA promotion behavior, PA involvement, attitudes, intentions, social norm, perceived behavioral control (PBC), and confidence and knowledge of exercise prescription. Structural equation modeling (SEM) evaluated these associations. RESULTS Less than half of oncologists reported regularly promoting PA to patients (46%), with 20% providing written information and 23% referrals. Only 26% were physically active. TPB SEM pathways explained 54.6% of the variance in PA promotion (comparative fit index (CFI) = 0.905, standardized root mean square residual (SRMR) = 0.040). Social norm was not only the significant pathway to intention but also a significant indirect pathway to PA promotion (p = 0.007). Confidence to promote PA, PBC, and intentions were direct significant pathways to PA promotion (p < 0.05). Exploratory SEM pathways explained 19.6% of the variance of PA behavior, which in turn explained 13.1% social norm, 10.7% attitude, 10.0% confidence to recommend, and 17.8% PA promotion behavior (CFI = 0.921, SRMR = 0.076). Instrumental attitude was a direct significant pathway to PA behavior (p = 0.001). PA behavior was a direct significant pathway to social norms, attitude, confidence to recommend, and PA promotion (p < 0.05). CONCLUSIONS Oncologists reported a modest ability to promote PA, low PA promotion rates, and limited knowledge of exercise prescription. Patient physical activity promotion may be improved through strategies that increase oncologists' PBC, confidence, and their own personal PA participation.
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Tsiouris A, Ungar N, Haussmann A, Sieverding M, Steindorf K, Wiskemann J. Health Care Professionals' Perception of Contraindications for Physical Activity During Cancer Treatment. Front Oncol 2018; 8:98. [PMID: 29670858 PMCID: PMC5894008 DOI: 10.3389/fonc.2018.00098] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/21/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction Suggested medical contraindications for physical activity (PA) during cancer therapy might have an influence on PA recommendation behavior of Health Care Professionals (HCP). The purpose of the present study was to examine perceptions of physicians and oncology nurses (ON) toward specific medical conditions as contraindications for PA during cancer treatment. Materials and methods A total of 539 physicians and 386 ON were enrolled in this cross-sectional survey. HCP judged 13 medical conditions as to whether they are contraindications for PA during cancer treatment. Answering format was "no contraindication"/"potentially a contraindication"/"yes, a contraindication." Results χ2 analyses revealed significant differences between general practitioners, specialized physicians, and ON in their perception of 10 medical conditions. Approximately half of the medical conditions were answered cautiously, showing high numbers on the response option potentially (36-72%). Moreover, physicians' ratings differed significantly depending on their practical experience with particular medical conditions. Those being familiar with a specific medical condition was more permissive to PA during treatment, with effect sizes (Cramer's V) ranging from 0.13 to 0.27. Conclusion Results indicate high cautiousness among HCP in judging medical conditions and their impact on PA during cancer treatment. However, group comparisons show that familiarity and clinical experience with potential contraindications facilitate a confident handling of safety issues, which at best leads to higher levels of PA recommendations during cancer treatment.
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Affiliation(s)
- Angeliki Tsiouris
- Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Nadine Ungar
- Gender Studies and Health Psychology, Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Monika Sieverding
- Gender Studies and Health Psychology, Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim Wiskemann
- Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
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Hardcastle SJ, Cohen PA. Reply to S.C. Adams et al, C. Lopez et al, and R.U. Newton et al. J Clin Oncol 2018; 36:928-930. [PMID: 29373095 DOI: 10.1200/jco.2017.76.8218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sarah J Hardcastle
- Sarah J. Hardcastle, Curtin University, Perth; and University of Western Australia, Crawley, Western Australia, Australia; and Paul A. Cohen, St John of God Hospital, Subiaco, Perth; University of Western Australia, Crawley; and University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paul A Cohen
- Sarah J. Hardcastle, Curtin University, Perth; and University of Western Australia, Crawley, Western Australia, Australia; and Paul A. Cohen, St John of God Hospital, Subiaco, Perth; University of Western Australia, Crawley; and University of Notre Dame Australia, Fremantle, Western Australia, Australia
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35
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Hardcastle SJ, Cohen PA. Effective Physical Activity Promotion to Survivors of Cancer Is Likely to Be Home Based and to Require Oncologist Participation. J Clin Oncol 2017; 35:3635-3637. [PMID: 28915086 DOI: 10.1200/jco.2017.74.6032] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sarah J Hardcastle
- Sarah J. Hardcastle, Curtin University, Perth; and University of Western Australia, Crawley, Western Australia, Australia; and Paul A. Cohen, St John of God Subiaco Hospital, Subiaco; University of Western Australia, Crawley; University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paul A Cohen
- Sarah J. Hardcastle, Curtin University, Perth; and University of Western Australia, Crawley, Western Australia, Australia; and Paul A. Cohen, St John of God Subiaco Hospital, Subiaco; University of Western Australia, Crawley; University of Notre Dame Australia, Fremantle, Western Australia, Australia
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36
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Physical activity and advanced cancer: the views of oncology and palliative care physicians in Ireland. Ir J Med Sci 2017; 187:337-342. [DOI: 10.1007/s11845-017-1677-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators. Support Care Cancer 2017; 25:2297-2304. [PMID: 28258503 DOI: 10.1007/s00520-017-3640-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the reported benefits of physical activity in alleviating the impact of cancer and its treatments, oncology care providers (OCPs) are not routinely discussing exercise with their patients, suggesting a knowledge to action gap. We sought to determine OCP's knowledge, beliefs, barriers, and facilitators to exercise discussion. METHODS A survey was administered to OCPs at the cancer center in Hamilton, Ontario. Questions comprised of demographics, knowledge and beliefs regarding exercise guidelines, and barriers and facilitators to exercise discussion. Analysis of survey responses was descriptive. Pearson's chi-squared test was used to examine select associations. RESULTS There were 120 respondents (61% response rate) representing a diversity of professions. Approximately, 80% of OCPs were not aware of any exercise guidelines in cancer and self-reported poor knowledge on when, how, and which patients to refer to exercise programs. OCPs who reported meeting Canada's Physical Activity guidelines were significantly more likely to identify correct guidelines (p = 0.023) and to report good knowledge on how to provide exercise counseling (p = 0.014). Across OCP groups, barriers to exercise discussion included poor knowledge, lack of time, and safety concerns. Most felt that educational sessions and having an exercise specialist on the clinical team would be beneficial. CONCLUSIONS OCPs have low knowledge regarding exercise counseling, but believe that discussing exercise is a multidisciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.
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