1. Bennett, Christina MS

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SAN DIEGO-In a recent study, the majority of cancer patients reported decreasing their level of physical activity since being diagnosed with cancer. Also, barriers to physical activity were physical factors, such as fatigue and pain, and psychological factors, such as difficulty getting motivated and staying disciplined (Abstract 162). Results were reported at the 2017 Cancer Survivorship Symposium.

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"While there's previous research that shows physical activity is a great prevention from cancer, [there's] new emerging data showing that moderate forms of physical activity can potentially improve quality of life and cancer outcomes among cancer patients," said Sally A. D. Romero, PhD, a postdoctoral research fellow at Memorial Sloan Kettering Cancer Center, New York City, during a press conference in which she presented the study findings.


The ASCO clinical practice guidelines recommend physicians advise their patients who have completed cancer treatment to engage in moderate physical activity, which is 150 minutes of aerobic exercise, such as brisk walking or swimming, per week. Several studies, including randomized trials, meta-analyses, and systematic reviews, have shown that moderate physical activity can reduce cancer-related fatigue among cancer patients after treatment.


Despite the benefits, physical activity is a challenge for most cancer survivors.


Survivor Perspective

Desiree A.H. Walker, a two-time breast cancer "victor" diagnosed for the first time with breast cancer nearly 16 years ago, told Oncology Times that, before her diagnosis, she exercised at least 5 days a week. Throughout her treatment, her oncologist asked about her physical activity and encouraged her to stay active. However, she said she did decrease her physical activity during treatment.


"While you're going through active treatment, you're just trying to get through each day, and sometimes you're just trying to get through an hour, so being disciplined about trying to get in 15 [or] 30 minutes-or whatever amount of time-definitely is a challenge," Walker said.


She said that she "definitely became exhausted" halfway through radiation therapy, and that "it was the type of fatigue that I had never experienced before, and that basically stopped me from working out and doing anything other than trying to go to work."


Walker said that fatigue, vertigo, and surgical complications and collateral damage made it difficult for her to stay physically active. Eventually, she returned to exercising, but her return was more difficult after her second cancer diagnosis.


The study asks a "very important question" that aims to determine "what is it that allows some people to remain active throughout and after their treatment," noted Lorenzo Cohen, PhD, Professor in the Department of Palliative, Rehabilitation, and Integrative Medicine in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, Houston. "We know that physical activity is a strong predictor of response to treatment as well as survival after diagnosis of cancer."


However, Cohen offered a note of caution regarding the relationship between physical activity and prognosis. He said "there's overwhelming data from epidemiological observational studies from multiple countries [and for] multiple cancers" supporting the link between physical activity and prognosis, but these studies show only an association, and "association does not determine causation."


At this point, what can be communicated to patients is that staying physically active can improve quality of life.


Oncologists' Support

For this cross-sectional study, a one-time survey was conducted with 662 participants. Participants were asked whether they had increased, decreased, or maintained their level of physical activity since their cancer diagnosis but were not asked specifically about their physical activity level before treatment. Participants also were asked to agree or disagree with the listed known barriers to remaining physically active.


Researchers found that patients who had metastatic disease or received chemotherapy were more likely to decrease levels of physical activity. Those with metastatic disease had a 1.6 higher odds of decreasing their level of physical activity than those who did not have a metastatic disease. Those who received chemotherapy had a 3.5 higher odds of decreasing their level of physical activity than those who did not receive chemotherapy. No significant associations between a patient's age, sex, or body mass index and their physical activity levels were found.


Specifically, 78 percent of patients reported fatigue as a barrier to staying physically active, 71 percent reported pain, 67 percent reported difficulty getting motivated, and 65 percent reported difficulty remaining disciplined.


"These are things that are easy to work with our patients to help them overcome these physical and psychological barriers," Romero said. She suggested patients talk with their cancer care teams and vice versa.


These conversations "need to happen" between the clinician and the patient, Romero told Oncology Times. "I think that's the most important part for physicians to understand is that they play a role in this as well in helping to keep their patients maintaining their level of physical activity throughout the cancer continuum."


However, currently, most clinicians are probably not discussing physical activity with their patients, according to Cohen. He agreed that physical activity needs to be discussed with patients and one way to motivate patients is by educating them.


He explained that it's not enough to just tell patients to be physically active-patients need to understand why doing so is important. "Now just saying that, that's the first step. Providing the support to the patient to enact it is really something that's incumbent upon the medical center, and hopefully in the future, we'll start doing that more."


"[This study] also highlights the need for physicians to not just recommend exercise but to ask the next questions of our patients," said Merry-Jennifer Markham, MD, ASCO expert, during the press conference. "Namely, what is keeping you from exercising and how can we help you overcome those barriers?"


Christina Bennett is a contributing writer.