Exercise Programming and Counseling Preferences of Breast Cancer Survivors During or After Radiation Therapy

"It has to be more than exercise": exploring multiple perspectives to community-based exercise program design for persons with breast cancer

PURPOSE

Connecting persons with cancer to exercise resources and/or supports requires a diverse team of professionals. As such, there is merit to engaging multiple individuals or "partners" along the cancer pathway to explore the relevant features of community-based exercise program (CBEP) design. The purpose of this study was to explore multi-partner perspectives to CBEP design for persons diagnosed with breast cancer (PWBC) to inform the implementation of a CBEP in a local setting.

METHODS

PWBC, health care professionals and qualified exercise professionals participated in one of four 60-min focus group discussions. Rich dialogue about preferred program environments, program delivery teams, and core program practices was encouraged using a semi-structured discussion guide. Focus groups were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Five main themes were identified based on focus group discussions, each pointing to an important feature of CBEP design for PWBC. Themes included the desire for CBEPs to incorporate elements designed to improve cancer literacy, provide opportunities to participate with peers, foster self-efficacy, prioritize program accessibility, and meaningfully integrate CBEPs within a network of supportive cancer care.

CONCLUSION

The collective effect of fostering such elements in CBEPs may serve to increase the uptake and maintenance of exercise among PWBC; ultimately enhancing their overall well-being and quality of life.

Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review

PURPOSE

Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period.

METHODS

We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information.

RESULTS

Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care.

CONCLUSIONS

Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.

Attitudes and Beliefs of Older Female Breast Cancer Survivors and Providers About Exercise in Cancer Care

OBJECTIVES

To understand breast cancer survivors' and providers' attitudes and beliefs regarding exercise counseling and structured exercise programs within cancer care.

SAMPLE & SETTING

61 female breast cancer survivors and 11 breast cancer providers from a university cancer center in the Pacific Northwest.

METHODS & VARIABLES

Survivors completed anonymous self-report surveys, and providers participated in semistructured interviews. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed using qualitative content analysis.

RESULTS

Breast cancer survivors and providers believed that including exercise counseling within cancer care was important. More than half of the survivors reported that they would attend structured exercise classes; a majority of providers thought cancer centers should offer exercise programs.

IMPLICATIONS FOR NURSING

Nurses could facilitate exercise counseling within cancer care and advocate for clinic-based exercise programs.

Physical activity preferences before and after participation in a 6-month physical activity intervention among women with metastatic breast cancer

OBJECTIVE

This secondary analysis of the ABLE Trial (ClinicalTrials.gov NCT03148886) aimed to assess physical activity preferences before and after a 6-month physical activity intervention for women recently diagnosed with metastatic breast cancer and to investigate demographic and clinical correlates of these preferences.

METHODS

Forty-nine patients participated in the ABLE Trial, a single-arm, unsupervised 6-month physical activity intervention with activity trackers. At baseline and 6 months, physical activity preferences, physical activity level, clinical variables, demographics and social vulnerability were assessed.

RESULTS

At baseline, 49 participants were included, among whom 85% were interested in receiving physical activity counselling and 89% were interested in following a physical activity programme designed for metastatic breast cancer. At the end of the study, more participants preferred practising in a community fitness centre (66%) rather than at home (19% vs. 44% at baseline, p = .03). A higher social vulnerability score and not being treated by chemotherapy at baseline were significantly associated with lower desire to receive physical activity counselling (p = .01 and p = .04 respectively).

CONCLUSIONS

This study will help design future studies within patients with metastatic breast cancer in accordance with their preferences. Designing tailored physical activity interventions according to the participant's preferences may be one key to success for adherence.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS

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

Breast cancer survivors' preferences for technology-supported exercise interventions

PURPOSE

The purpose of this study was to explore breast cancer survivors' interest in and preferences for technology-supported exercise interventions.

METHODS

Post-treatment survivors [n = 279; M _age = 60.7 (SD = 9.7)] completed a battery of online questionnaires in August 2015. Descriptive statistics were calculated for all data. Logistic regression analyses were conducted to examine relationships between survivors' interest in a technology-supported exercise interventions and demographic, disease, and behavioral factors. These same factors were examined in relation to perceived effectiveness of such interventions using multiple regression analyses.

RESULTS

About half (53.4%) of survivors self-reported meeting public health recommendations for physical activity. Fewer than half reported using an exercise or diet mobile app (41.2%) or owning an activity tracker (40.5%). The majority were interested in receiving remotely delivered exercise counseling (84.6%), participating in a remotely delivered exercise intervention (79.5%), and using an exercise app or website (68%). Survivors reported that the most helpful technology-supported intervention components would be an activity tracker (89.5%), personalized feedback (81.2%), and feedback on how exercise is influencing mood, fatigue, etc. (73.6%). Components rated as least helpful were social networking integration (31.2%), group competitions (33.9%), and ability to see others' progress (35.1%).

CONCLUSIONS

Preferences for technology-supported exercise interventions varied among breast cancer survivors. Nonetheless, data indicate that technology-supported interventions may be feasible and acceptable. Engaging stakeholders may be important in developing and testing potential intervention components.

Breast and Colon Cancer Survivors' Expectations About Physical Activity for Improving Survival

PURPOSE/OBJECTIVES

To compare physical activity outcome expectations related to cancer survival with traditional physical activity outcome expectations in breast and colon cancer survivors
.

DESIGN

Cross-sectional survey
.

SETTING

Canada and the United States.

SAMPLE

146 participants
.

METHODS

Self-reported survey instruments and height and weight measurement. The online survey was completed once by each participant
.

MAIN RESEARCH VARIABLES

Godin Leisure-Time Exercise Questionnaire, Multidimensional Outcome Expectations for Exercise Scale (MOEES), and an item assessing physical activity outcome expectations related to cancer survival.

FINDINGS

Paired sample t tests indicated that the mean score for the physical subscale of the MOEES was significantly higher than the mean score on the physical activity outcome expectations related to cancer survival variable (p < 0.001). Multiple regression analyses indicated that physical activity outcome expectations related to cancer survival explained 4.8% of the variance in physical activity (p = 0.011)
.

CONCLUSIONS

Findings from the current study suggest that, among breast and colon cancer survivors, outcome expectations related to cancer survival may influence physical activity levels and may not be as realized as traditional outcome expectations
.

IMPLICATIONS FOR NURSING

Oncology nurses should familiarize themselves with the guidelines and benefits of physical activity for survivors so they can provide guidance and support to patients.

Newly diagnosed lung cancer patients' preferences for and beliefs about physical activity prior to chemotherapy

Physical activity has been found to have a number of benefits for lung cancer patients yet very little information is available concerning physical activity beliefs and preferences for this population. The purpose of the study was to explore physical activity programming and counseling preferences and beliefs about physical activity in newly diagnosed lung cancer patients scheduled to receive chemotherapy. A total of 43 new diagnosed lung cancer patients completed a researcher-administered survey prior to commencing chemotherapy. Results indicated that only 7 participants (17%) reported meeting public health recommendations for physical activity yet the majority of participants (n = 28) indicated interest or possible interest in physical activity counseling. Many participants also indicated interest or possible interest in an exercise program (n = 29) for lung cancer survivors, preferring it to start during chemotherapy (n = 20), for it to be home based (n = 21), and moderate in intensity (n = 22). The most common behavioral belief (advantage) of physical activity was to build/maintain strength (n = 26) and the most common control belief (barrier) was fatigue (n = 11). These data suggest that physical activity counseling and programming may be well received by newly diagnosed lung cancer patients. Information about physical activity and programming preferences and beliefs from this study may be useful for the design of optimal physical activity interventions for lung cancer patients.

Exercise preferences, levels and quality of life in lung cancer survivors

PURPOSE

Lung cancer poses multiple challenges to adopting an exercise (EX) program, and the ideal timing of an EX program to improve quality of life (QoL) is unknown. This study explored the EX counselling and programming preferences of lung cancer survivors and examined the association of EX before diagnosis, during treatment and after treatment on QoL.

METHODS

Cross-sectional, retrospective survey design in a sample of lung cancer survivors. EX preferences were compared between patients who had received radical chest radiation or lung surgery versus those who had not. EX was measured by self-report using the Godin Leisure Time Exercise Questionnaire (GLTEQ). Separate linear regression models, controlling for significant covariates, examined the association of EX at each time point with scores on QoL measures and subscales.

RESULTS

Participants (N = 66, M age 66.4 ± 9.1) were between 4 months and 11.5 years after lung cancer diagnosis (M = 31.7 ± 22.9 months). Patients who had lung surgery were more likely to prefer to start an EX program during adjuvant treatment than those who did not have surgery (t(33) = 2.43, p = .025). Compared to prediagnosis EX (M = 36.7 ± 56.0 MET h/week), EX levels declined significantly during (M = 12.4 ± 25.0 MET h/week) and after (M = 12.3 ± 17.4 MET h/week) treatment (p < .05). After controlling for disease stage and income, regression models were not significant, but EX after treatment was a significant individual predictor of fatigue (β = .049, p = .006) and QoL measured by the Chronic Respiratory Disease Questionnaire (β = .163, p = .025).

CONCLUSIONS

Lung cancer patient preferences indicate that EX program timing should take into account whether the patient has undergone surgery. Lung cancer survivors' EX levels declined after diagnosis and engaging in EX after treatment may improve fatigue and QoL.

Resources for physical activity in cancer centers in the United States

Physical activity (PA) has many benefits for cancer survivors. However, the available PA resources for survivors at cancer centers throughout the United States are undocumented. The current study surveyed major cancer centers concerning the availability and types (e.g., facilities, programs, counseling, information resources) of PA resources available. Of supportive care services, PA resources were the least commonly reported. Significant correlations were found among availability of PA resources and other supportive care services. Although many cancer centers reported offering PA programming, formal and informal PA guidance and support seem to fall on oncology nurses and other clinicians. Oncology nurses should be reminded that they may be one of the only sources of PA guidance available to survivors at cancer centers.

Response to a mobile health decision-support system for screening and management of tobacco use

PURPOSE/OBJECTIVES

To describe the predictors of nurse actions in response to a mobile health decision-support system (mHealth DSS) for guideline-based screening and management of tobacco use.

DESIGN

Observational design focused on an experimental arm of a randomized, controlled trial.

SETTING

Acute and ambulatory care settings in the New York City metropolitan area.

SAMPLE

14,115 patient encounters in which 185 RNs enrolled in advanced practice nurse (APN) training were prompted by an mHealth DSS to screen for tobacco use and select guideline-based treatment recommendations.

METHODS

Data were entered and stored during nurse documentation in the mHealth DSS and subsequently stored in the study database where they were retrieved for analysis using descriptive statistics and logistic regressions.

MAIN RESEARCH VARIABLES

Predictor variables included patient gender, patient race or ethnicity, patient payer source, APN specialty, and predominant payer source in clinical site. Dependent variables included the number of patient encounters in which the nurse screened for tobacco use, provided smoking cessation teaching and counseling, or referred patients for smoking cessation for patients who indicated a willingness to quit.

FINDINGS

Screening was more likely to occur in encounters where patients were female, African American, and received care from a nurse in the adult nurse practitioner specialty or in a clinical site in which the predominant payer source was Medicare, Medicaid, or State Children's Health Insurance Program. In encounters where the patient payer source was other, nurses were less likely to provide tobacco cessation teaching and counseling.

CONCLUSIONS

mHealth DSS has the potential to affect nurse provision of guideline-based care. However, patient, nurse, and setting factors influence nurse actions in response to an mHealth DSS for tobacco cessation.

IMPLICATIONS FOR NURSING

The combination of a reminder to screen and integration of guideline-based recommendations into the mHealth DSS may reduce racial or ethnic disparities to screening, as well as clinician barriers related to time, training, and familiarity with resources.

Exercise training as treatment in cancer cachexia

Cachexia is a wasting syndrome that may accompany a plethora of diseases, including cancer, chronic obstructive pulmonary disease, aids, and rheumatoid arthritis. It is associated with central and systemic increases of pro-inflammatory factors, and with decreased quality of life, response to pharmacological treatment, and survival. At the moment, there is no single therapy able to reverse cachexia many symptoms, which include disruption of intermediary metabolism, endocrine dysfunction, compromised hypothalamic appetite control, and impaired immune function, among other. Growing evidence, nevertheless, shows that chronic exercise, employed as a tool to counteract systemic inflammation, may represent a low-cost, safe alternative for the prevention/attenuation of cancer cachexia. Despite the well-documented capacity of chronic exercise to counteract sustained disease-related inflammation, few studies address the effect of exercise training in cancer cachexia. The aim of the present review was hence to discuss the results of cachexia treatment with endurance training. As opposed to resistance exercise, endurance exercise may be performed devoid of equipment, is well tolerated by patients, and an anti-inflammatory effect may be observed even at low-intensity. The decrease in inflammatory status induced by endurance protocols is paralleled by recovery of various metabolic pathways. The mechanisms underlying the response to the treatment are considered.

African-American breast cancer survivors' preferences for various types of physical activity interventions: a Sisters Network Inc. web-based survey

BACKGROUND

Needs assessments are essential to developing lifestyle interventions for minority populations. To our knowledge, no physical activity (PA) needs assessment studies have been conducted for African-American (AA) breast cancer survivors. The purpose of this study was to determine the PA intervention preferences of AA breast cancer survivors and determine whether these preferences differ according to medical and sociodemographic factors.

METHODS

AA breast cancer survivors (n = 475, mean age = 54 years) were recruited using ads sent via email and social media sites. Preferences for the mode of intervention delivery were assessed via web-based questionnaires. Descriptive statistics were used to characterize their interests in PA interventions, and subgroup differences were assessed.

RESULTS

About 49 % (142 out of 291) of the participants who completed the survey were obese and 54 % did not meet the recommended guidelines for PA. Most (90 %) participants reported that they could participate in PA, and many (67 %) indicated that they were interested in receiving program materials. Participants expressed the greatest interest in email (50 %)-, web (48 %)-, or mail-based (45 %) over group (39 %), and telephone (10 %). Women also expressed the greatest interest in participating in studies that promoted walking and resistance or strength training. Intervention preferences did not differ significantly (P > 0.05) across sociodemographic or medical factors.

CONCLUSION

Most AA breast cancer survivors can participate in PA, and many are interested in interventions that promoted walking and resistance training and were delivered via the email or web. The development of culturally sensitive interventions that provide activities consistent with preferences can assist AA breast cancer survivors to adopt and maintain a healthy lifestyle.

IMPLICATIONS FOR CANCER SURVIVORS

Despite evidence that AA breast cancer survivors are at increased risk for poor breast cancer-specific outcomes, they are underrepresented in clinical trials promoting positive health behaviors. In this study, we propose to assess their exercise preferences and receptivity to a culturally appropriate PA intervention developed in collaboration with the Sisters Network Inc. Health promotion programs developed in collaboration with a community-based organization may aid in the development of research tools and resources that AA breast cancer survivors are receptive to using.

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

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

Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study

BACKGROUND

Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM.

METHODS

This was a qualitative study that used a grounded theory approach. Semi-structured interviews were conducted in Victoria, Australia by telephone from December 2011-February 2012 with patients who had been treated for MM within the preceding 2-12 months. Interviews were transcribed and analysed using the constant comparison coding method to reduce the data to themes. Gender differences and differences between treatment groups were explored.

RESULTS

Twenty-four interviews were completed. The sample comprised 13 females (54%), with a mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem cell transplant (ASCT). All participants currently engaged in a range of light to moderate intensity physical activity; walking and gardening were the most common activities. Recovery from the symptoms of MM and side effects of therapy, psychological benefits, social factors and enjoyment were important benefits of physical activity. Barriers to physical activity predominately related to the symptoms of MM and side effects of therapy, including pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women participated in a more diverse range of physical activities than men and there were gender differences in preferred type of physical activity. Women were more likely to report psychological and social benefits; whereas men reported physical activity as a way to keep busy and self-motivation was a barrier. Patients treated with an ASCT more often reported affective benefits of participation in physical activity and fatigue as a barrier. Patients treated with other therapies (e.g., chemotherapy, radiotherapy) were more likely to report pain as a barrier.

CONCLUSIONS

Patients with MM experience debilitating effects of their condition and therapy, which influences their level and intensity of physical activity participation. Physical activity programs should be individualised; take into consideration gender differences and the impact of different types of therapy on physical activity; and focus on meeting the psychological, coping and recovery needs of patients.