Supportive Care in Cancer

, Volume 21, Issue 12, pp 3345–3353 | Cite as

Patients' perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise

  • Shaunna M. Burke
  • Jennifer Brunet
  • Catherine M. Sabiston
  • Sandy Jack
  • Michael P. W. Grocott
  • Malcolm A. West
Original Article



The purpose of this longitudinal study was to explore advanced rectal cancer patients' perceptions of quality of life (QoL) during participation in a pre-surgery structured exercise program.


Patients (n = 10) participated in repeated semi-structured in-depth interviews which covered four broad QoL domains (i.e., physical, psychological, social, and spiritual well-being). Patients' personal accounts of QoL were explored prior to (0 weeks), midway (3 weeks), and at completion (6 weeks) of the program. Data were analyzed using strategies grounded in a phenomenological approach.


Participation in the program facilitated positive changes in QoL over time by (1) fostering a greater sense of vitality, (2) cultivating a positive attitude, (3) enhancing social connections, and (4) fostering a strong sense of purpose in life for these patients.


Based on these data, preoperative exercise programs can be effective in promoting QoL among patients diagnosed and treated for locally advanced rectal cancer during a particularly difficult time in the cancer trajectory. Additional research is needed to develop and evaluate implementation strategies to facilitate the delivery of preoperative exercise programs as part of routine care in this population.


Advanced cancer Preoperative exercise Quality of life Qualitative 



The authors would like to express their gratitude to Lisa Loughney for supervising the exercise training of all patients, Ben Bolland for conducting the interviews, and all of the patients for sharing their experiences with us.

Conflict of interest

The authors report no declarations of interest. They have full control of all primary data and agree to allow the journal to review their data if requested.


  1. 1.
    Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29PubMedCrossRefGoogle Scholar
  2. 2.
    NHS Information Centre, National bowel cancer audit (2011) annual report, November 2011Google Scholar
  3. 3.
    Landis SH, Murray T, Bolden S, Wingo PA (1999) Cancer statistics, 1999. CA Cancer J Clin 49:8–31PubMedCrossRefGoogle Scholar
  4. 4.
    Benson AIB III, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS et al (2012) Rectal cancer. J Natl Compr Canc Netw 10:1528–1564PubMedGoogle Scholar
  5. 5.
    Gérard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–4625PubMedCrossRefGoogle Scholar
  6. 6.
    Pucciarelli S, Del Bianco P, Efficace F et al (2011) Patient-reported outcomes after neoadjuvant chemoradiotherapy for rectal cancer: a multicenter prospective observational study. Ann Surg 253(1):71–77PubMedCrossRefGoogle Scholar
  7. 7.
    Janse AJ, Gemke RJ, Uiterwaal CS et al (2004) Quality of life: patients and doctors don't always agree: a meta-analysis. J Clin Epidemiol 57:653–661PubMedCrossRefGoogle Scholar
  8. 8.
    Haas BK (1999) A multidisciplinary concept analysis of quality of life. West J Nurs Res 21:728–742PubMedCrossRefGoogle Scholar
  9. 9.
    Bishop M (2005) Quality of life and psychosocial adaptation to chronic illness and acquired disability: preliminary analysis of a conceptual and theoretical synthesis. Rehabil Couns Bull 48:219–231CrossRefGoogle Scholar
  10. 10.
    Ferrell BR, Hassey-Dow K, Grant M (1995) Measurement of the QOL in cancer survivors. Qual Life Res 4:523–531PubMedCrossRefGoogle Scholar
  11. 11.
    Ferrell BR, Dow KH (1997) Quality of life among long-term cancer survivors. Oncol 11:565–571Google Scholar
  12. 12.
    Costantini M, Mencaglia E, Giulio PD et al (2000) Cancer patients as experts in defining quality of life domains. A multicentre survey by the Italian group for the evaluation of outcomes in oncology (IGEO). Qual Life Res 9:151–159PubMedCrossRefGoogle Scholar
  13. 13.
    Courneya KS, Friedenreich CM (1999) Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Beh Med 21:171–179CrossRefGoogle Scholar
  14. 14.
    Aaronson K, Fransen U, Aufdemkampe G (2005) Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol 23:3830–3842PubMedCrossRefGoogle Scholar
  15. 15.
    Monga U, Garber SL, Thornby J et al (2007) Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Arch Phys Med Rehabil 88:1416–1422PubMedCrossRefGoogle Scholar
  16. 16.
    Keogh JW, MacLeod RD (2012) Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review. J Pain Symptom Manage 431:96–110CrossRefGoogle Scholar
  17. 17.
    Mock V, Pickett M, Muscari LE et al (2001) Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract 9(3):119–127PubMedCrossRefGoogle Scholar
  18. 18.
    Minsky BD (2012) Short-course radiation versus long-course chemoradiation for rectal cancer: making progress. J Clin Oncol 30:3777–3778PubMedCrossRefGoogle Scholar
  19. 19.
    Garcia-Aguilar J, Smith DD, Avila K et al (2011) Optimal timing of surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial. Ann Surg 254:97–102PubMedCrossRefGoogle Scholar
  20. 20.
    Simunovic M, Gagliardi A, McCready D et al (2001) A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer Centres in Ontario. Can Med Assoc J 165:421–425Google Scholar
  21. 21.
    Jones LW, Peddle CJ, Eves ND et al (2007) Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 110(3):590–598PubMedCrossRefGoogle Scholar
  22. 22.
    McNeely ML, Campbell K, Ospina M et al. (2010) Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev Issue 6Google Scholar
  23. 23.
    Li C, Carli F, Lee L et al (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27(4):1072–1082PubMedCrossRefGoogle Scholar
  24. 24.
    Van Manen M (1990) Researching lived experience: human science for an action sensitive pedagogy. SUNY, New YorkGoogle Scholar
  25. 25.
    Weisman IM, Marciniuk D, Martinez FJ et al (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Resp Crit Care Med 167(2):211–277CrossRefGoogle Scholar
  26. 26.
    Sparkes A, Smith B (2009) Judging the quality of qualitative inquiry: criteriology and relativism in action. Psycho Sport Exerc 10:491–497CrossRefGoogle Scholar
  27. 27.
    Whitehead L (2004) Enhancing the quality of hermeneutic research: decision trail. J Adv Nurs 45:512–518PubMedCrossRefGoogle Scholar
  28. 28.
    Benner P (ed) (1994) Interpretive phenomenology: embodiment, caring, and ethics in health and illness. Sage, Thousand OaksGoogle Scholar
  29. 29.
    Albrecht TA, Taylor AG (2012) Physical activity in patients with advanced stage cancer: a systematic review of the literature. Clin J Oncol Nurs 16:293–300PubMedCrossRefGoogle Scholar
  30. 30.
    Courneya KS, Friedenreich CM, Sela RA, Quinney HA, Rhodes RE, Handman MT (2003) The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psycho-Oncol 12(4):357–374CrossRefGoogle Scholar
  31. 31.
    Mustian KM, Peppone LJ, Palesh OG et al (2010) Cancer-related fatigue. Oncol Rev 6(1):20–23Google Scholar
  32. 32.
    Hawthorn M (2012) Fatigue in patients with advanced cancer. Int J Pall Nurs 16(11):536–541Google Scholar
  33. 33.
    Adamsen L, Midtgaard J, Roerth M, Andersen C, Quist M, Moeller T (2004) Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy. Eur J Cancer Care 13:362–370CrossRefGoogle Scholar
  34. 34.
    Bar-Sela G, Atid L, Danos S, Gabay N, Epelbaum R (2007) Art therapy intervention improved depression with influence on fatigue level in cancer patients during chemotherapy treatment; a phase II study. Psychooncology 16:980–984PubMedCrossRefGoogle Scholar
  35. 35.
    Steele CM (1988) The psychology of self-affirmation: sustaining the integrity of the self. In: Berkowitz L (ed) Advances in experimental social psychology, vol 21. Academic, New York, pp 261–302Google Scholar
  36. 36.
    Courneya KS, Segal RJ, Gelmon K et al (2007) Six-month follow-up of patient rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiol Biomarkers Prev 16(12):2572–2578PubMedCrossRefGoogle Scholar
  37. 37.
    Sabiston CM, McDonough MH, Crocker PRE (2007) Psychosocial experiences of breast cancer survivors involved in a dragon boat program: exploring links to positive psychological growth. J Sport Exerc Psychol 29:419–438PubMedGoogle Scholar
  38. 38.
    Legault L, Al-Khindi T, Inzlicht M (2012) Preserving integrity in the face of performance threat: self-affirmation enhances neurophysiological responsiveness to errors. Psychol Science 22:1–6Google Scholar
  39. 39.
    Folkman S, Moskowitz JT, Tedlie J (2000) Positive affect and the other side of coping. Am Psychol 55:647–654PubMedCrossRefGoogle Scholar
  40. 40.
    Isen AM, Labroo AA (2003) Some ways in which positive affect facilitates decision making and judgment. In: Schneider S, Shanteau J (eds) Emerging perspectives on judgment and decision research. Cambridge, New York, pp 365–393CrossRefGoogle Scholar
  41. 41.
    Helgeson VS, Cohen S (1996) Support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychol 15:135–148PubMedCrossRefGoogle Scholar
  42. 42.
    Epplein M, Zheng Y, Zheng W et al (2011) Quality of life after breast cancer diagnosis and survival. J Clin Oncol 29:406–412PubMedCrossRefGoogle Scholar
  43. 43.
    Burke SM, Utley A (2013) Climbing towards recovery: investigating physically injured combat veterans' psychosocial response to scaling Mt Kilimanjaro. Dis Rehabil 35(9):732–739CrossRefGoogle Scholar
  44. 44.
    Burke SM, Sabiston CM (2010) The meaning of the mountain: exploring breast cancer survivors' lived experiences of subjective well-being during a climb on Mt Kilimanjaro. Qual Res Sport Exerc 2(1):1–16CrossRefGoogle Scholar
  45. 45.
    Park CL, Edmondson D, Fenster JR, Blank TO (2008) Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs. J Consul Clin Psychol 76(5):863–875CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Shaunna M. Burke
    • 1
  • Jennifer Brunet
    • 2
  • Catherine M. Sabiston
    • 3
  • Sandy Jack
    • 4
  • Michael P. W. Grocott
    • 4
    • 5
  • Malcolm A. West
    • 6
    • 7
  1. 1.Centre for Sport and Exercise Sciences, Faculty of Biological SciencesUniversity of LeedsLeedsUK
  2. 2.Faculty of Health Sciences, School of Human KineticsUniversity of OttawaOttawaCanada
  3. 3.Faculty of Kinesiology & Physical EducationUniversity of TorontoTorontoCanada
  4. 4.Critical Care Research Area, NIHR Respiratory Biomedical Research UnitUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
  5. 5.Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
  6. 6.Colorectal Surgery Research GroupAintree University Hospitals NHS Foundation TrustAintreeUK
  7. 7.Department of Musculoskeletal Biology II, Institute of Ageing and Chronic Disease, Faculties of Health and Life SciencesUniversity of LiverpoolLiverpoolUK

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