Finding Common Ground: Improving Cancer Outcomes Through Exercise

Exercise improves wellness and it also has the potential to improve outcomes in patients undergoing cancer treatment. However, there is disagreement between patients and oncologists around dissemination and implementation of exercise plans.

A growing research base has emphasized the importance of physical activity in managing patient symptoms and reducing the risk of recurrence in patients with cancer. The challenge is with ensuring that patients stick with their exercise routine, considering the emotional and physical toll that cancer treatment can have on patients. Deciding who should lead the design and implementation of these exercise routines is vital.

With this in mind, researchers from the Gundersen Health System and Gundersen Lutheran Medical Foundation held focus groups and interviews with 20 patients with cancer and 9 oncologists. The sessions were audio recorded after receiving informed consent from the participants. Ten patients participated in 2 focus group sessions, which had the same moderator and an observer who was a researcher with a background in education. The observer also conducted one-on-one interviews with 10 other patients. Provider focus groups were conducted during a routine provider meeting; the session had a similar structure of a moderator and an observer.

Patient demographic and clinical information was drawn from patient charts, and specific details on the provider-initiated conversation around exercise was excised from a review of 12 patient electronic health records. The mean patient age was 64 years (±7.8), with an equal gender representation. Participants represented 11 different cancers.

The study found that none of the patients recalled having a conversation about physical activity with their oncologist during treatment. A majority (95%) of patients felt exercise is important during cancer treatment, and a significant number (80%) preferred a home-based exercise program. However, half of the patients considered fatigue associated with their treatment as a barrier to maintaining a regular exercise routine.

Providers concurred with patients on the importance of an exercise routine for patients, but not universally for all. Oncologists identified time constraints associated with a clinic visit and their limited expertise about physical activity as major barriers to making exercise recommendations to their patients.

The authors note a discrepancy in the patient versus the physician approach: “patients want to hear this information from physicians; however, physicians are reluctant to consistently include physical activity discussions for a number of reasons,” they write. The authors believe the following recommendations could help bridge the existing gap:

• A collaboration with physical therapy, exercise physiology, or other subspecialty to provide guidelines for exercise
• Integrating a physical activity specialist in the oncology clinic visit

Reference

Smaradottir A, Smith AL, Borgert AJ, Oettel KR. Are we on the same page? Patient and provider perceptions about exercise in cancer care: a focus group study. J Natl Compr Canc Netw. 2017;15(5):588-594.