Exercise counselling and referral in cancer care: an international scoping survey of health care practitioners' knowledge, practices, barriers, and facilitators

Cancer and physical activity: facilitating counseling

Recent studies suggest that only 27.6% of cancer survivors meet PA guidelines. This could partially be attributed to the limited knowledge reported by healthcare professionals (HCP) regarding the appropriate timing, methodology, and suitability of referring cancer survivors to exercise programs or professionals. In this commentary, we aim to acknowledge the challenges that HCP may face in prescribing exercise and propose potential solutions to facilitate their efforts in this regard.

Nutrition and Exercise Knowledge, Attitude, and Practice: A Scoping Review of Assessment Questionnaires in Cancer Survivorship

Cancer survivors are encouraged to maintain a healthy diet and engage in regular exercise to improve overall physical and psychosocial health, and to reduce the likelihood of cancer recurrence and related mortality. Consequently, nutrition and exercise (the structured component of physical activity) knowledge, attitude, and practice (NE-KAP) are frequently evaluated in research studies involving cancer survivors and are associated with various health outcomes. The aims of this scoping review were to (1) systematically map the types of NE-KAP assessment questionnaires used in cancer survivorship research (i.e., trend or use over the past five years), (2) provide a directory of questionnaires, and (3) identify the most frequently reported health outcomes that have been associated with them. A systematic search was conducted across four databases-Medline, Emcare, CINAHL, and Scopus-from 1 January 2019 to 9 May 2024, for studies addressing one or more aspects of NE-KAP (e.g., food frequency questionnaire for nutrition practice, attitude towards exercise scale for exercise attitude). Eligible studies were extracted, assessed, and reviewed by two independent authors, and data were summarized descriptively. Of the initial 5452 records screened, 1122 articles were screened for full text, and 852 were deemed eligible, with 262 studies included. There was an overall increasing trend in NE-KAP research in cancer survivorship research from 2019 to 2023. Of the 200 unique questionnaires aligning with at least one NE-KAP domain, 45 were untitled and created/adapted specifically for their respective studies, with limited information about their psychometric properties. Out of the 262 included studies, the most utilized questionnaires were those measuring nutrition or physical activity practices, such as study-specific food frequency questionnaires (n = 26, 10%) and the Godin-Shephard Leisure-Time Physical Activity questionnaire (n = 52, 20%). Out of studies that had reported health outcomes (nutrition, n = 23; exercise, n = 40), health-related quality of life was most commonly associated with nutrition (n = 12, 53%) and exercise (n = 9, 23%), and from cross-sectional studies (nutrition, n = 13; exercise, n = 23). An emphasis was placed on assessing nutrition and exercise practices, with limited attention towards the knowledge and attitude domains. Psychometric evaluation of questionnaires was also lacking.

Key components for a weight management intervention for breast cancer patients - Results from a focus group study

OBJECTIVES

While weight gain after cancer diagnosis is associated with higher tumor recurrence rates, morbidity, and poorer overall survival, appropriate weight management programs are insufficiently available. This study aimed to identify the key features for a multimodal weight management intervention from patients' and healthcare professionals' (HCP) perspectives.

METHODS

Patients treated for breast cancer at the Netherlands Cancer Institute were invited to participate in one of two online focus groups; HCPs were recruited via LinkedIn and participated in a single online focus group. All three 90-minute focus groups were moderated using a semi-structured interview guide. Recordings were transcribed and coded using thematic content analysis.

RESULTS

Nine patients and seven HCPs participated. Themes applicable for patients were: 1) Absence of information; 2) Combining weight management with daily activities and responsibilities; 3) Physical and psychological side-effects; 4): Integrating weight management in treatment continuum. For HCPs, themes were: 1) Health education; 2) Integrating weight management in treatment continuum; 3) Role of healthcare insurance companies.

CONCLUSION

Multimodal lifestyle interventions designed to prevent and reduce weight gain in breast cancer patients are needed. Awareness should be raised for HCPs and patients.

PRACTICE IMPLICATIONS

For equal accessibility, cost-effective lifestyle interventions are ideally covered by healthcare insurance companies.

What patients with cancer require from their clinicians to enable uptake of exercise as part of cancer care: A mixed methods study

PURPOSE

Despite robust evidence and a series of evidence-based guidelines stating the benefits of exercise for cancer patients, uptake remains low. This study aimed to explore and describe what patients with cancer require from their clinicians to enable uptake of exercise as part of cancer care.

METHODS

Concurrent mixed methods design. Participants included adult cancer patients. Online questionnaires and semi-structured telephone interviews explored patient preferences for receiving information about the role of exercise in cancer care. Quantitative data were analysed using standard descriptive statistics and an interpretive descriptive approach was used to inform qualitative analysis.

RESULTS

Participants included 456 cancer patients. A randomly selected sub-set of 30 patients completed an interview. Many participants (n = 280/61.6%) reported discussion with clinicians as the way they mostly preferred to receive exercise information. Receiving exercise information shortly after being diagnosed and before starting treatment (n = 186/41.1% and n = 90/19.9%) were the timepoints mostly preferred for being informed about exercise. Information that was personalised and described exercise as being important to their cancer care was reported to be more likely to influence exercise behaviour. Clinician actions/provision of resources ranked as most helpful were: referral to cancer-specific exercise specialist (n = 330/76.6%) or program (n = 310/71.8%), and written exercise recommendations from a doctor/nurse (n = 234/54.3%). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer patients would be more likely to consider exercise as part of their cancer care if their clinicians initiated an informed conversation about exercise, introduced early in the care continuum, using personalised and cancer-specific messaging, that was supported by referral to cancer-specific exercise services.

Exploring Healthcare Provider Experiences with the EXCEL Exercise Referral Pathway for Individuals Living with and Beyond Cancer

Exercise is an evidence-based strategy shown to reduce the negative side effects associated with cancer treatment for individuals living with and beyond cancer (LWBC). Healthcare providers (HCPs) play a critical role in promoting exercise for these individuals. Notwithstanding, several barriers hinder HCPs' ability to discuss and support exercise in clinical practice. EXCEL is an exercise intervention designed to address health disparities in access to exercise oncology resources for rural/remote individuals LWBC, including a referral pathway for HCPs to use. The purpose of this study was to evaluate HCP experiences using the EXCEL exercise referral pathway. We employed an interpretive description methodology, using semi-structured interviews to assess HCP experiences with EXCEL. Overall, HCPs felt empowered to refer to exercise when they were supported in doing so. The findings highlighted (1) a need for a better understanding of the role of exercise professionals and their integration into cancer care; (2) the need for efficient referral systems including embedding referrals into existing health care electronic record systems; and (3) sharing patient feedback with exercise oncology programs back to the HCPs to drive continued referrals.

Healthcare provider perspectives on a clinical decision tool to support individualized exercise prescriptions and discussions for breast cancer survivors

PURPOSE

We evaluated healthcare providers' current knowledge, practices, and perspectives on a novel clinical decision tool (beta-version) to facilitate individualized exercise prescriptions and discussions in clinical settings.

METHODS

We recruited healthcare providers who had treated or provided care to breast cancer survivors aged ≥ 35-years in the past 12 months. The participants were presented with a tool to provide individualized exercise recommendations considering women's individual, clinical, and contextual characteristics. Validated and reliable pre-existing instruments were used to survey providers' current knowledge, practices regarding exercise discussions, and perspectives on the beta-version (paper-draft) of the novel tool.

RESULTS

The sample consisted of complete survey responses from 177 healthcare providers including breast oncologists (27.7%), primary care physicians (10.7%), exercise specialists (19.8%), occupational/physical therapists (18.1%), advanced care providers, nurses, navigators, and social workers (23.7%). Median years of experience was 8-years (range: 5-13). Overall, 62.1% (n = 110) reported that they were knowledgeable about counseling survivors based on exercise guidelines. Among breast oncologists and primary care physicians (n = 68), only 39.7% reported that they were knowledgeable about identifying patients for exercise referals. The majority agreed that they would find the tool offering individualized information useful (n = 148, 83.6%), and would use it regularly to inform practice (82.5%). 'Exercise Readiness', 'Exercise Resources at Home', and 'Quality-of-Life' were the highest rated items for inclusion in the tool for exercise prescriptions. Provider perspectives were incorporated into the beta-version of the tool.

CONCLUSION

A clinical decision tool considering individual, clinical, and contextual characteristics may support exercise prescriptions and discussions in clinical settings.

IMPLICATIONS FOR CANCER SURVIVORS

An evidence-based tool for exercise prescriptions may increase healthcare provider confidence to discuss, educate, encourage, and provide exercise referrals for breast cancer survivors.

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.

Willingness to pay for exercise oncology services: a mixed methods study

PURPOSE

To evaluate cancer patients' willingness to pay for exercise services and oncology health professionals' perception of patients' willingness to pay.

METHODS

A mixed-methods design was used. Online questionnaires and semi-structured interviews were administered to people with any type of cancer and oncology health professionals delivering clinical care. Questionnaires assessed patients' willingness to pay for one consultation with a cancer-trained exercise specialist (i.e. exercise physiologist/physiotherapist) and regular group exercise sessions supervised by cancer-trained exercise specialists. Interviews probed factors associated with the out-of-pocket cost of adopting exercise guidelines. Data were analysed using standard descriptive statistics and an interpretive descriptive approach to qualitative analysis.

RESULTS

Participants included 450 cancer patients and 300 oncology health professionals. A randomly selected sub-set of 30 patients and 31 health professionals completed interviews. The majority of patients surveyed would pay for an exercise consultation (94%) and regular group exercise sessions (58.4% extremely likely; 24.7% moderately likely; standard 7-point Likert scale response options). A greater proportion of patients who were employed (97.2% p = 0.030), below average general health (97.0% p = 0.031), were female (96.1% p = 0.013), and insufficiently active (95.3% p = 0.048) were willing to pay for exercise services. Oncology health professionals perceived fewer patients would be willing to pay for exercise services (p < 0.001; consultation = 7.0% extremely likely, 32.7% moderately likely; regular supervised sessions = 5.3% extremely likely; 32.0% moderately likely).

CONCLUSIONS

When briefly informed of the benefits and costs of exercise, the majority of patients in this study would pay for cancer-specific exercise services. There is an opportunity to align perceptions of willingness to pay among patients and health professionals involved in their care to help facilitate the uptake of exercise guidelines.

Healthcare professionals' promotion of physical activity to people living with and beyond head and neck cancer: a cross-sectional survey

PURPOSE

Physical activity (PA) can improve health-related outcomes for head and neck cancer (HaNC) patients, and PA guidance from healthcare professionals' can increase patients' PA levels. However, less than 9% of HaNC patients are physically active. This study explored healthcare professionals' promotion of PA across the National Health Service (NHS) in North West England and North Wales, to HaNC patients.

METHODS

A cross-sectional online survey exploring healthcare professionals' promotion of PA in HaNC. The International Physical Activity Questionnaire-Short Form was used to estimate healthcare professionals' PA levels. Quantitative data were analyzed using descriptive or inferential statistics and qualitative data were analyzed using reflexive thematic analysis. Data were synthesized drawing on the capability-opportunity-motivation-behavior model and theoretical domains framework.

RESULTS

Eighty-one professionals participated. Fifty-three percent self-reported high levels of PA. Seventy-five percent considered PA promotion as part of their role; however, only 39% discussed PA with their patients (reflective motivation and social/professional role and identity). Only 38% felt confident initiating PA discussions and 76% reported needing further training. Training on the benefits of PA for HaNC patients and how to encourage health-related behavior change were identified as beneficial (psychological capability and knowledge).

CONCLUSION

Healthcare professionals are influential in enabling patients to adopt health-related behavior change; however, PA promotion was not routine practice for professionals involved in the care of HaNC patients. Training should be provided to professionals on PA promotion, with a focus on behavior change techniques. Future research should explore how behavior change techniques can be implemented into clinical practice to improve health-related outcomes in HaNC.

Lifestyle Advice to Patients with Bladder Cancer: A National Survey of Dutch Urologists

BACKGROUND

Not much is known about the extent to which urologists discuss lifestyle with patients with bladder cancer (BC), despite patients considering urologists as an important source of information and motivation.

OBJECTIVE

To determine how often lifestyle is asked about, advised on, and referred for by Dutch urologists to patients with BC, as well as to evaluate urologists' perceptions and barriers.

METHODS

An anonymous online survey was sent to Dutch urologists. The survey included questions on demographics, awareness of guidelines, clinical practice (asking about, advising on, and referring for lifestyle), perceptions, and barriers with regard to smoking, body weight, physical activity, diet, alcohol consumption, and fluid intake.

RESULTS

Most of the 49 respondents were male, affiliated with a non-academic hospital, and had over 10 years of experience. Smoking appeared to be the only lifestyle factor that patients are advised on, with 90% of urologists advising > 75% of their patients. Advice on other lifestyle factors was far less common, with 63-92% of urologists giving < 50% of their patients advice. Referral rates were low for all lifestyle factors. Lifestyle advice was generally perceived as (very) important. Almost all respondents reported one or more barriers in giving lifestyle advice. A lack of time and a perceived lack of patient interest and motivation were reported most.

CONCLUSIONS

Apart from advice on smoking cessation, lifestyle advice is not frequently provided by urologists to patients with BC. Although urologists perceive lifestyle as important, they report several barriers to providing lifestyle advice and referring patients.

The Physical Activity and Cancer Control (PACC) framework: update on the evidence, guidelines, and future research priorities

BACKGROUND

We proposed the Physical Activity and Cancer Control (PACC) framework in 2007 to help organise, focus, and stimulate research on physical activity in eight cancer control categories: prevention, detection, treatment preparation/coping, treatment coping/effectiveness, recovery/rehabilitation, disease prevention/health promotion, palliation, and survival.

METHODS

This perspective paper provides a high-level overview of the scientific advances in physical activity research across cancer control categories, summarises current guidelines, updates the PACC framework, identifies remaining and emerging knowledge gaps, and provides future research directions.

RESULTS

Many scientific advances have been made that are reflected in updated physical activity guidelines for six of the cancer control categories apart from detection and palliation. Nevertheless, the minimal and optimal type, dose, and timing of physical activity across cancer control categories remain unknown, especially for the understudied population subgroups defined by cancer type, age, race/ethnicity, and resource level of regions/countries.

CONCLUSION

To achieve the full benefit of physical activity in cancer control, future research should use innovative study designs that include diverse at-risk populations and understudied cancer sites. Additionally, effective behaviour change strategies are needed to increase physical activity levels across populations that use implementation science to accelerate the translation from evidence generation into practical, real-world interventions.

Intervention combinations within multimodal prehabilitation and their effect on health-related quality of life, fatigue, and adherence in the adult cancer population: an umbrella review protocol

OBJECTIVE

This umbrella review will investigate intervention combinations that are provided as multimodal prehabilitation and their effect on health-related quality of life, fatigue, and adherence in the adult cancer population.

INTRODUCTION

Cancer and treatment-related long-term and late effects are a significant source of impairment worldwide. Multimodal prehabilitation has been the subject of intense research in recent years due to its potential to improve cancer treatment and surgical outcomes. Prehabilitation has been provided in different combinations of exercise, nutrition, and psychological support, although evidence of effectiveness varies in the literature.

INCLUSION CRITERIA

The review will consider quantitative and mixed methods (segregated approach) systematic reviews investigating the effectiveness of multimodal prehabilitation compared with any other or no intervention for adults with cancer (≥18 years). Systematic reviews focusing solely on unimodal prehabilitation or rehabilitation during or after cancer treatment will be excluded.

METHODS

This review will follow the JBI methodology for umbrella reviews. The following databases will be searched from 2001 onwards: MEDLINE, Emcare, PsycINFO, and AMED (Ovid); CINAHL (EBSCOhost); PEDro; Cochrane Database of Systematic Reviews; and Epistemonikos. Backchaining and forward citation tracking will also be performed. Organizational websites will be searched for relevant gray literature. Two reviewers will perform title/abstract and full-text screening against the inclusion criteria, and disagreements will be resolved via discussion or a third reviewer. Relevant population, intervention, and outcome data will be extracted from included full-text documents, and the quality of reports will be determined using the JBI checklist for systematic reviews. The results will be presented in tabular and narrative format.

REVIEW REGISTRATION

PROSPERO CRD42024511601.

Determinants of physical activity during cancer treatment: a longitudinal exploration of psycho-cognitive variables and physician counseling

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (Mage = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling.

Patient attitudes and experiences towards exercise during oncological treatment. A qualitative systematic review

PURPOSE

Exercise and physical activity (PA) during oncological treatment have many benefits. However, PA levels and adherence are often low. This systematic review of qualitative literature aims to explore the experience and the perceived barriers and facilitators to exercise and physical activity during treatment.

METHODS

A systematic search of the published literature was carried out in the Embase and Medline databases; full details for the protocol can be found in the Prospero database (CRD42022371206). Studies eligible for inclusion were qualitative and included participants that were either currently undergoing oncological treatment or had finished treatment within the last 6 months. The findings from each study were tabulated and synthesised into analytical themes.

RESULTS

Eighteen full texts from 309 studies met inclusion criteria with a total of 420 participants including both curative and palliative treatment intents. Four overarching themes were generated: (1) Facilitators; (2) Barriers; (3) Experience of PA/exercise and (4) Transforming attitudes. Sub-themes that showed perceptions of PA or exercise during treatment were positive, and seeing personal positive change was highly motivating, especially in a group class setting. Barriers included lack of support or guidance from healthcare professionals (HCPs), environmental challenges and disease burden/fear or worsening symptoms.

CONCLUSIONS

Despite having positive perceptions of exercise and PA during oncological treatment, there are significant barriers impacting participation. Lack of support from HCPs and fear of worsening symptoms were significant barriers. Future research should focus on impacting these barriers to ultimately improve PA and exercise levels in those undergoing oncological treatment.

Adopting a systems-thinking approach to optimise dietary and exercise referral practices for cancer survivors

PURPOSE

Service referrals are required for cancer survivors to access specialist dietary and exercise support. Many system-level factors influence referral practices within the healthcare system. Hence, the aim of this study was to identify system-level factors and their interconnectedness, as well as strategies for optimising dietary and exercise referral practices in Australia.

METHODS

A full-day workshop involving national multidisciplinary key stakeholders explored system-level factors impacting dietary and exercise referral practices. Facilitated group discussions using the nominal group technique identified barriers and facilitators to referral practices based on the six World Health Organisation (WHO) building blocks. The systems-thinking approach generated six cognitive maps, each representing a building block. A causal loop diagram was developed to visualise factors that influence referral practices. Additionally, each group identified their top five strategies by leveraging facilitators and addressing barriers relevant to their WHO building block.

RESULTS

Twenty-seven stakeholders participated in the workshop, including consumers (n = 2), cancer specialists (n = 4), nursing (n = 6) and allied health professionals (n = 10), and researchers, representatives of peak bodies, not-for-profit organisations, and government agencies (n = 5). Common system-level factors impacting on referral practices included funding, accessibility, knowledge and education, workforce capacity, and infrastructure. Fifteen system-level strategies were identified to improve referral practices.

CONCLUSION

This study identified system-level factors and strategies that can be applied to policy planning and practice in Australia.

Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study

PURPOSE

A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers.

METHODS

We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC).

RESULTS

Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow.

CONCLUSIONS

In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies.

Do Oncologists Recommend the "Pill" of Physical Activity in Their Practice? Answers from the Oncologist and Patients' Perspectives

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.

Exercise and the gut microbiome: implications for supportive care in cancer

PURPOSE

Growing recognition of the gut microbiome as an influential modulator of cancer treatment efficacy and toxicity has led to the emergence of clinical interventions targeting the microbiome to enhance cancer and health outcomes. The highly modifiable nature of microbiota to endogenous, exogenous, and environmental inputs enables interventions to promote resilience of the gut microbiome that have rapid effects on host health, or response to cancer treatment. While diet, probiotics, and faecal microbiota transplant are primary avenues of therapy focused on restoring or protecting gut function in people undergoing cancer treatment, the role of physical activity and exercise has scarcely been examined in this population.

METHODS

A narrative review was conducted to explore the nexus between cancer care and the gut microbiome in the context of physical activity and exercise as a widely available and clinically effective supportive care strategy used by cancer survivors.

RESULTS

Exercise can facilitate a more diverse gut microbiome and functional metabolome in humans; however, most physical activity and exercise studies have been conducted in healthy or athletic populations, primarily using aerobic exercise modalities. A scarcity of exercise and microbiome studies in cancer exists.

CONCLUSIONS

Exercise remains an attractive avenue to promote microbiome health in cancer survivors. Future research should elucidate the various influences of exercise modalities, intensities, frequencies, durations, and volumes to explore dose-response relationships between exercise and the gut microbiome among cancer survivors, as well as multifaceted approaches (such as diet and probiotics), and examine the influences of exercise on the gut microbiome and associated symptom burden prior to, during, and following cancer treatment.

Exploring the practicality and acceptability a brief exercise communication and clinician referral pathway in cancer care: a feasibility study

BACKGROUND

The majority of cancer patients and cancer care clinicians-CCCs (e.g., oncologists) believe that exercise is an important adjunct therapy that should be embedded in standard practice. Yet, CCCs do not routinely discuss exercise with their patients, nor do they regularly refer them to exercise professionals (e.g., exercise physiologists-EPs). This study evaluated the feasibility and acceptability of an evidence-based approach to improving exercise communication between CCCs and their patients, including an exercise referral pathway.

METHODS

Implementation and testing of the Exercise Communication and Referral Pathway (ECRP) occurred in Sydney, Australia. The ECRP included a brief oncology-initiated communication exchange with patients, CCC exercise referral to an EP, followed by EP-initiated telephone consultation with patients concerning tailored exercise advice. Participant perceptions concerning the feasibility and applicability of the ECPR were evaluated. Semi-structured interviews were conducted with CCCs (n = 3), cancer patients (n = 21), and an EP (n = 1). Inductive thematic analysis was undertaken.

RESULTS

Analysis generated three themes: (1) Navigating the role of CCCs in the ECRP, suggesting that oncology-initiated communication is a cue to action, however there was a lack of role clarity regarding exercise referral; (2) Implementing Patient-Orientated Care within a Standardised Pathway, highlighting the need for tailored information and advice for patients that reflects individual disease, socio-cultural, and environmental factors, and; (3) Taking Steps Towards Action, revealing the need for structural (e.g., EP initiated contact with patients) and policy changes (i.e., changes to Medicare, direct oncologist referral) to engage patients and better integrate exercise as part of standard care.

CONCLUSIONS

Findings provide important insights into improving oncology-patient exercise communication and developing an exercise referral pathway to increase engagement and patient reach. However, individual (e.g., experience, knowledge) and contextual factors (e.g., time, resources) need consideration when implementing an ECRP.

TRIAL REGISTRATION

This trial was prospectively registered with the Australian New Zealand Clinical (#ACTRN12620000358943) on March 13, 2020.

Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies

PURPOSE

Physical activity can improve health outcomes for cancer patients; however, only 30% of patients are physically active. This review explored barriers to and facilitators of physical activity promotion and participation in patients living with and beyond cancer. Secondary aims were to (1) explore similarities and differences in barriers and facilitators experienced in head and neck cancer versus other cancers, and (2) identify how many studies considered the influence of socioeconomic characteristics on physical activity behaviour.

METHODS

CINAHL Plus, MEDLINE, PsycINFO, Scopus and Cochrane (CDSR) were searched for qualitative and mixed methods evidence. Quality assessment was conducted using the Mixed Methods Appraisal Tool and a Critical Appraisal Skills Programme Tool. Thematic synthesis and frequency of reporting were conducted, and results were structured using the Capability-Opportunity-Motivation-Behaviour model and Theoretical Domains Framework.

RESULTS

Thirty qualitative and six mixed methods studies were included. Socioeconomic characteristics were not frequently assessed across the included studies. Barriers included side effects and comorbidities (physical capability; skills) and lack of knowledge (psychological capability; knowledge). Having a dry mouth or throat and choking concerns were reported in head and neck cancer, but not across other cancers. Facilitators included improving education (psychological capability; knowledge) on the benefits and safety of physical activity.

CONCLUSION

Educating patients and healthcare professionals on the benefits and safety of physical activity may facilitate promotion, uptakeand adherence. Head and neck cancer patients experienced barriers not cited across other cancers, and research exploring physical activity promotion in this patient group is required to improve physical activity engagement.