Exercise as a supportive care strategy in men with prostate cancer receiving androgen deprivation therapy at a regional cancer centre: a survey of patients and clinicians

A Patient-Specific, Goal-Oriented Exercise Algorithm for Men Receiving Androgen Deprivation Therapy

For men receiving androgen deprivation therapy for prostate cancer, exercise is essential to preserve lean muscle mass, body mass, and bone density, which may be lost as a side effect of treatment. This quality improvement pr.

Promoting Physical Activity to Cancer Survivors in Practice: Challenges and Solutions for Implementation

Objectives: This study explored the challenges and solutions to the effective promotion of physical activity (PA) to cancer survivors in practice in Ireland amongst a variety of stakeholders, including healthcare professionals (HCPs), policy makers, community providers of cancer care, and academics. Methods: Focus groups (n = 5) were conducted with participants (n = 40), including oncologists, oncology nurses, physiotherapists, cancer support centre managers, academics, consumers, cancer policy representatives, exercise specialists, community providers of exercise programmes, and a chartered psychologist. The data were analysed using reflexive thematic analysis. Results: Four primary themes were identified: (i) embedding PA into the cancer pathway (including the sub-themes of 'singing from the same hymn sheet', 'PA as an essential element of treatment', and 'intervention opportunities and models of care'); (ii) education and training; (iii) access to appropriate PA interventions; and (iv) tailored programmes. Conclusions: The importance of embedding PA into the cancer pathway such that PA is viewed by clinicians and patients as a key part of their treatment was emphasised. Opportunities for PA intervention within existing practice were highlighted, such as the chemotherapy education sessions run by Daffodil nurses. Findings pointed to a need for education and training for HCPs that include how to coach and counsel cancer patients concerning PA in clinic. Finally, a major barrier to PA promotion was limited access to appropriate PA interventions.

Barriers and enablers to exercise prehabilitation before breast cancer surgery in an Australian regional health service: patient and clinician perspective

PURPOSE

To identify barriers and enablers of an exercise-based prehabilitation service for surgical patients with breast cancer and medical professionals in a regional healthcare setting.

METHODS

A cross-sectional survey was distributed to patients with breast cancer and medical professionals from regional populations. Surveys included closed and open-ended responses. A chi-square goodness of fit test with a Fisher's exact correction was used for quantitative analysis of the frequencies of barriers and enablers within groups. Content analysis was used for open-ended responses.

RESULTS

Twenty-five patients and 14 clinicians participated. Patients identified psychological barriers as the lowest concern to exercise prehabilitation (χ2(9, n = 23) = 21.78, p = .011). No other patient barriers were statistically significant. Fifty-nine percent of patients expressed interest in participation in exercise prehabilitation, with 40% citing personal fitness benefits as the leading enabler. Clinicians identified time constraints as a barrier (χ2(2, n = 13) = 8.00, p < .05), with challenges integrating prehabilitation into pre-surgery timelines. Clinicians indicated electronic referral methods and information would be enablers for prehabilitation.

CONCLUSION

The study underpins the need for integrating exercise professionals into preoperative teams to address exercise prehabilitation within limited time frames. Patients do not describe psychological barriers and instead report motivation to improve fitness as an enabler of prehabilitation. Clinicians report time constraints in pre-operative appointments as a barrier to prehabilitation. Implementing electronic referral methods alongside traditional approaches may enhance prehabilitation delivery for patients receiving breast cancer surgery. Future research should leverage these findings for prehabilitation referral and program design.

Patient and Health Care Professional Perspectives on Barriers to and Facilitators of Healthy Eating and Exercise Among Patients With Cancer at a Safety-Net Oncology Clinic: A Qualitative Exploration

PURPOSE

Previous studies have described barriers to and facilitators of healthy eating and being physically active among patients with cancer, but few have done so in a safety-net community oncology setting.

MATERIALS AND METHODS

To understand multiple perspectives on the factors that influence diet and exercise in patients with cancer treated in safety-net settings, we conducted semistructured interviews between June and November 2021 with patients and oncology clinic medical professionals at a safety-net hospital in Houston, TX.

RESULTS

Thirty-one patients with cancer were interviewed, including 11 patients on active treatment and 20 survivors, as well as 21 care health care professionals. Most patients thought that they had a healthy diet but did not exercise enough, mainly because of cancer-related symptoms. The majority stated that they would like to participate in healthy living programs and follow their doctor's recommendations although only half noted receiving any recommendations from their provider. Health care professionals perceived patients' barriers to healthy diet and exercise as lack of knowledge, low access to resources, and low motivation, potentially impacting adherence to lifestyle recommendations.

CONCLUSION

Patients with cancer in a safety-net oncology clinic were motivated to participate in healthy living activities. However, health care professionals believed that patients faced barriers with the potential to impact adherence to health care professional recommendations. Further research is needed to better understand and optimize lifestyle counseling in a safety-net oncology setting and explore potential referral pathways to healthy living programs for patients.

[Prostate Cancer: Side-Effect Management for Androgen Deprivation Therapy]

Drug-based hormonal ablation is an essential component of therapy in hormone-sensitive advanced prostate cancer and as a backbone in castration resistance. LHRH agonists are among the most widely used medicinal products. Since these are usually given for life, therapy management is very important. Common side-effects typical of the substance class, such as weight gain, cardiovascular problems, hot flushes, erectile dysfunction or osteoporosis, can significantly reduce patients' quality of life and increase morbidity and mortality. This endangers adherence and, hence, treatment success. This paper provides an overview of how to deal with side-effects during LHRH therapy based on current data and practical experience.

Barriers, facilitators, perceptions and preferences influencing physical activity participation, and the similarities and differences between cancer types and treatment stages - A systematic rapid review

The aim of this systematic rapid review was to explore barriers, facilitators, perceptions and preferences of physical activity for people diagnosed with cancer, by cancer type and treatment stage. The search strategy, implemented through four databases, included terms relating to cancer, physical activity, barriers, facilitators, perceptions and preferences, and relevant study designs. Studies reporting the outcomes of interests for adults diagnosed with cancer and living in Western countries were included and grouped according to the Social-Ecological Model and the Health Belief Model, and pragmatically. A total of 118 studies, involving 15 cancers were included. Outcomes were most commonly explored within samples involving mixed cancers (32 studies) and breast cancer (31 studies), and at the post-treatment phase (52 studies). Across all cancers and during- and post-treatment, treatment- and disease-related side-effects were the most commonly identified barrier, social support and guidance was the most commonly identified facilitator, and promoting health and recovery was the most commonly identified perception of benefit of physical activity. Notable differences were identified in barriers, facilitators and perceptions across cancer types and treatment stages, with specific examples including: comorbidities were inconsistently reported as a barrier across cancers; time pressure was more commonly reported as a barrier post-treatment; and women with breast cancer reported inaccessibility of appropriate services more commonly during-treatment than post-treatment. Preference findings varied widely across cancer types and treatment phases. These findings can be used to aid efforts to improve physical activity levels post-cancer by providing healthcare professionals with information to facilitate individualised advice and services.

Factors related to promotion of physical activity in clinical oncology practice: A scoping review

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.

Exercise Cardio-Oncology: Exercise as a Potential Therapeutic Modality in the Management of Anthracycline-Induced Cardiotoxicity

Anthracyclines are one of the most effective chemotherapy agents and have revolutionized cancer therapy. However, anthracyclines can induce cardiac injuries through ‘multiple-hits', a series of cardiovascular insults coupled with lifestyle risk factors, which increase the risk of developing short- and long-term cardiac dysfunction and cardiovascular disease that potentially lead to premature mortality following cancer remission. Therefore, the management of anthracycline-induced cardiotoxicity is a serious unmet clinical need. Exercise therapy, as a non-pharmacological intervention, stimulates numerous biochemical and physiologic adaptations, including cardioprotective effects, through the cardiovascular system and cardiac muscles, where exercise has been proposed to be an effective clinical approach that can protect or reverse the cardiotoxicity from anthracyclines. Many preclinical and clinical trials demonstrate the potential impacts of exercise on cardiotoxicity; however, the underlying mechanisms as well as how to implement exercise in clinical settings to improve or protect against long-term cardiovascular disease outcomes are not clearly defined. In this review, we summarize the current evidence in the field of “exercise cardio-oncology” and emphasize the utilization of exercise to prevent and manage anthracycline-induced cardiotoxicities across high-risk and vulnerable populations diagnosed with cancer.