Who makes it all the way? Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT

Factors Associated With Physical Activity During Hospitalization for Hematopoietic Cell Transplantation and After Discharge: A Pilot Study

BACKGROUND

The importance of physical activity to support health has been widely demonstrated. Hematopoietic cell transplantation (HCT) requires lengthy hospitalizations resulting in substantial decreases in physical activity. Understanding the factors associated with physical activity during hospitalization and immediately following hospital discharge is vital to support the transition from hospital to home.

OBJECTIVE

To examine the associations among personal factors (exercise self-efficacy, physical and mental health, and symptom severity and interference) and physical activity immediately following HCT.

METHODS

In this prospective observational pilot study, accelerometers measured physical activity during hospitalization on HCT days 0 to 4 (T1) and days 5 to 9 (T2), and in the first 7 days after hospital discharge (T3). Personal factors were assessed at T1, T2, and T3. Physical activity and personal factors were evaluated for change over time (Friedman test) and associations (Spearman correlations).

RESULTS

Participants' (n = 26, 57% male; median age, 55 years [40-65.3]) accelerometer data revealed light and moderate to vigorous physical activity, and median steps decreased significantly as symptoms severity and interference increased from T1 to T2. Exercise self-efficacy was moderate to high from T1 to T3 and was correlated with increased steps at T2 (r = 0.57, P = .05) and increased light physical activity (r = 0.55, P = .05) and steps (r = 0.61, P = .01) at T3.

CONCLUSIONS

This pilot study provides preliminary evidence of the relationships between physical activity and symptoms, symptom severity, and exercise self-efficacy.

IMPLICATIONS FOR PRACTICE

Maintaining high levels of physical activity during hospitalization for HCT may not be possible. Nurses can help patients set realistic expectations for physical activity during hospitalization and immediately after hospital discharge.

Developing and testing the feasibility of a theory-based brief counseling intervention to promote physical activity in breast cancer survivors enrolled in the PAC-WOMAN trial

BACKGROUND

Despite the benefits of physical activity (PA), cancer survivors report engagement barriers, and existing interventions often lack comprehensive solutions. Theory-based interventions using evidence-based behavior change techniques (BCTs) have been shown to be effective in promoting PA for breast cancer survivors, although their feasibility and acceptability lack evidence. The PAC-WOMAN trial is a three-arm randomized controlled trial aimed at promoting short- and long-term PA and improving the quality of life of breast cancer survivors. This study describes the development of a brief counseling theory-based motivational intervention from the PAC-WOMAN trial, assessing its feasibility and acceptability.

METHODS

A broad search of theory-based interventions for people with chronic diseases was conducted. Key strategies from each intervention helped shape the main components and BCTs used in the eight bimonthly sessions of the PAC-WOMAN brief counseling intervention, which was based on self-determination theory principles and aimed at empowering participants to develop self-regulation resources for PA through basic psychological needs satisfaction. A toolkit and manuals for intervention facilitators and participants were developed. A feasibility study was conducted to monitor implementation fidelity, acceptability, adherence, and participants' experiences (via a focus group).

RESULTS

Twelve women (mean age 55.9 ± 6.7 years) participated. Implementation monitoring indicated that the intervention was feasible. The attrition rate was 25%. Focus-group discussion suggested that weekly sessions would increase attendance, highlighted the helpfulness of self-monitoring and the importance of role models for PA, and identified the session on safely exercising at home as key in improving PA levels.

CONCLUSIONS

This research aims to enhance systematic reporting in intervention development by detailing the specific BCTs used, translating them into implementation strategies, providing comprehensive resources for facilitators/participants, and supporting the implementation, dissemination, and adoption of a theory-based intervention informed by previous research. Feasibility testing suggests that the intervention was well accepted by participants and feasible, although it could benefit from adjustments in format to increase compliance.

TRIAL REGISTRATION

NCT05860621, registered 20 April 2023 - retrospectively registered, https://clinicaltrials.gov/study/NCT05860621 . Registered 21 April 2023 - retrospectively registered, https://doi.org/10.17605/OSF.IO/ZAQ9N . UMIN000050945, registered 27 April 2023 - retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058070 .

The views and experiences of people with myeloma referred for autologous stem cell transplantation, who declined to participate in a physiotherapist-led exercise trial: a qualitative study

BACKGROUND

Recruitment rates to rehabilitation trials are variable among cancer survivors, and deeper investigation into the causes for declining participation is needed. The aim of this study was to qualitatively explore the experiences of people with myeloma referred for autologous stem cell transplant who were approached to take part in a physiotherapist-led exercise trial but declined.

METHODS

Participants were asked to participate in this qualitative study after declining to participate in a trial conducted at a UK tertiary cancer center. Semi-structured interviews were conducted. Data was analyzed inductively using reflexive thematic analysis.

RESULTS

Interviews from 18 myeloma patients (56% male, mean age 62 years) were analyzed. Four themes were identified: 1) Traveling to the specialist center is challenging, not just logistically; 2) Individualized approach valued but recall of research information variable; 3) Being less active has profound impact yet ameliorative support is lacking; and 4) Common side-effects of treatment are expected and endured but personal impact underestimated and unaddressed.

CONCLUSION

A number of barriers to participation were identified. Travel, a commonly cited reason for declining research participation, is more than a logistical issue for cancer survivors experiencing side-effects and the time burden of clinical appointments. Expectation or knowledge of the typical side-effects from myeloma and its treatment may lead to under-reporting of concerns to care providers, despite their impact upon daily activities and quality of life. Approaches used for research recruitment should consider the timing and consequences of ongoing cancer treatment to reduce potential barriers to participation.

Exploring sedentary behavior during neo- or adjuvant treatment in patients with cancer: A phenomenological study

PURPOSE

Increased sedentary behavior during cancer treatment is common, which may have negative long-term health effects. Understanding patients' experience of sedentary behavior during neo- or adjuvant cancer treatment may be crucial in developing effective support for patients to reduce sedentary behavior. Therefore, the present study aimed to explore sedentary behavior in patients undergoing neo- or adjuvant cancer treatment.

METHODS

Eleven interviews were conducted with patients undergoing treatment for breast, prostate, and colorectal cancer. Participants were recruited from a university hospital in Sweden. Interviews were analyzed phenomenologically, and the results were presented as descriptions of the phenomenon sedentary behavior.

RESULTS

The overarching theme of sedentary behavior during cancer treatment was that sedentary behavior is experienced through being physically active or not. Furthermore, experiences of sedentary behavior increased with side effects and varied depending on the type and phase of cancer treatment, meaning that sedentary behavior is an adjustment to side effects. Additionally, sedentary behavior was influenced by life circumstances and social interaction, such as work status and having social support. Finally, sedentary behavior is influenced by strategies and motivations, such as the perceived benefits of physical activity and self-image.

CONCLUSIONS

Sedentary behavior is difficult for patients to discern, which is why health care personnel may need to help patients by increasing awareness of the negative impact of sedentary behavior in a way that does not stigmatize patients. Furthermore, developing support that targets periods with more side effects and helping patients reduce sedentary behavior throughout changing life circumstances may be helpful.

Dropout from exercise trials among cancer survivors-An individual patient data meta-analysis from the POLARIS study

INTRODUCTION

The number of randomized controlled trials (RCTs) investigating the effects of exercise among cancer survivors has increased in recent years; however, participants dropping out of the trials are rarely described. The objective of the present study was to assess which combinations of participant and exercise program characteristics were associated with dropout from the exercise arms of RCTs among cancer survivors.

METHODS

This study used data collected in the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) study, an international database of RCTs investigating the effects of exercise among cancer survivors. Thirty-four exercise trials, with a total of 2467 patients without metastatic disease randomized to an exercise arm were included. Harmonized studies included a pre and a posttest, and participants were classified as dropouts when missing all assessments at the post-intervention test. Subgroups were identified with a conditional inference tree.

RESULTS

Overall, 9.6% of the participants dropped out. Five subgroups were identified in the conditional inference tree based on four significant associations with dropout. Most dropout was observed for participants with BMI >28.4 kg/m2 , performing supervised resistance or unsupervised mixed exercise (19.8% dropout) or had low-medium education and performed aerobic or supervised mixed exercise (13.5%). The lowest dropout was found for participants with BMI >28.4 kg/m2 and high education performing aerobic or supervised mixed exercise (5.1%), and participants with BMI ≤28.4 kg/m2 exercising during (5.2%) or post (9.5%) treatment.

CONCLUSIONS

There are several systematic differences between cancer survivors completing and dropping out from exercise trials, possibly affecting the external validity of exercise effects.

Kinesiophobia as a Barrier to Symptom Management Using Physical Activity When undergoing Cancer Therapy: A Preparatory Study Describing Patients' Experiences With the New Instrument Tampa-Scale for Kinesiophobia-Symptoms and Interviews

Background: Cancer care professionals need to be aware of kinesiophobia, fear of motion, in patients undergoing cancer therapy. The new instrument the Tampa-Scale Kinesiophobia Symptoms (TSK-Symptoms) aims to measure fear and avoidance of motion in relation to multiple symptoms (eg, nausea, fatigue, anxiety, pain). It is modified from the TSK, which relates solely to pain. Aim: To test the feasibility of the TSK-Symptoms, to quantify kinesiophobia in patients with cancer, to study whether kinesiophobia was associated with symptoms or physical activity, and through interviews to gain a deeper understanding of patient experiences. Methods: In this preparatory longitudinal study, patients (n = 55, mean age 68 years; 51% men; 38% had prostate cancer, 23% breast cancer) undergoing radiotherapy provided questionnaire data on kinesiophobia using the new instrument TSK-Symptoms, symptoms and physical activity twice (at baseline, T1, and 1 week later, T2). Eight patients were interviewed. Results: At T1 and T2, 4 of 54 (7%) and 8 of 55 patients (14%) reported kinesiophobia (P = .009). From T1 to T2, occurrence of nausea increased. Of the 16 nauseated patients at T2, 6 (38%) reported kinesiophobia compared to 2 (5%) of the 39 nausea-free patients (P = .005). Patients who reported kinesiophobia practiced less physical activity (median 0 days at moderate intensity at T1 (P < .001), median 2 days at moderate intensity at T2, P = .006) compared to patients free from kinesiophobia (median 4 and 5 days). Three qualitative content analysis categories described patient experiences: (1) "Struggling to stay physically active in an extraordinary situation associated with burdensome symptoms," (2) "Feeling damaged and at the same time grateful," and (3) "Needing support due to fear of motion and of worsened condition." Conclusions: This preparatory study showed that the new instrument the TSK-Symptoms was feasible for use in patients undergoing cancer therapy to quantify kinesiophobia, which was present in approximately 1 in 10 patients. Kinesiophobia was more common in patients with nausea, and patients reporting kinesiophobia practiced less physical activity. Patients highlighted a need for support. The psychometric properties of the TSK-Symptoms, completed on several languages, need to be evaluated. Cancer care professionals may quantify kinesiophobia using the TSK-Symptoms instrument and give kinesiophobic patients support.

Effects of exercise by type and duration on quality of life in patients with digestive system cancers: A systematic review and network meta-analysis

BACKGROUND

There is scant evidence regarding the effects of exercise type and duration on quality of life (QoL) in digestive system cancer (DSC) survivors. We aim to investigate the optimal type and duration of exercises to improve QoL for DSC survivors through a systematic review and network meta-analysis.

METHODS

A systematic literature search of PubMed, Embase, and Web of Science was performed. Eligibility for study inclusion was limited to studies that were randomized controlled trials involving all kinds of exercise in adult patients with DSCs, and the comparator was in standard care or other types of exercise. The primary outcome was QoL, including general health, physical health, mental health, and role function. Secondary outcomes included cancer-related symptoms such as fatigue, insomnia, depression, anxiety, and duration of hospital stay. The network meta-analyses were performed using a random-effect model.

RESULTS

The analysis included 32 eligible articles and a total of 2558 participants. Our primary outcome indicated that short-term aerobic exercise significantly enhanced general health (standardized mean differences (SMDs) = 0.66, 95% credible intervals (CrIs): 0.05 to 1.30, and also contributed to a better mental health (SMD = 0.37, 95%CrI: -0.06 to 0.81 and role function (SMD = 0.48, 95%CrI: -0.27 to 1.20). Although without significant changes, short-term resistance exercise tends to increase the physical health of patients with DSCs (SMD = 0.69, 95%CrI: -0.07 to 1.50) and effective in alleviating fatigue (SMD = -0.77, 95%CrI: -1.50 to 0.01). Short-term aerobic exercise was related to a lower score of insomnia (SMD = -1.20, 95%CrI: -2.40 to 0.06), depression (SMD = -0.51, 95%CrI: -1.50 to 0.45), and anxiety (SMD = -0.45, 95%CrI: -1.30 to 0.34). All types of exercise related to a trend of declined hospital stays (-0.87 to -5.00 days). Long-term resistance exercise, however, was negatively associated with general health (SMD = -0.33, 95%CrI: -1.70 to 1.00), physical health (SMD = -0.18, 95%CrI: -1.30 to 0.90), and role function (SMD = -1.20, 95%CrI: -2.50 to 0.11).

CONCLUSION

This study suggests that short-term aerobic exercise, with or without resistance exercise programs, enhances QoL (especially for general health) as well as relieves cancer-related symptoms for DSC survivors, while long-term resistance exercise may have negative effects, and thus should be adopted cautiously. These results provide important evidence for the management of DSCs.