Advertisement

Supportive Care in Cancer

, Volume 25, Issue 7, pp 2297–2304 | Cite as

Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators

  • Michelle NadlerEmail author
  • Daryl Bainbridge
  • Jennifer Tomasone
  • Oren Cheifetz
  • Rosalyn A. Juergens
  • Jonathan Sussman
Original Article

Abstract

Background

Despite the reported benefits of physical activity in alleviating the impact of cancer and its treatments, oncology care providers (OCPs) are not routinely discussing exercise with their patients, suggesting a knowledge to action gap. We sought to determine OCP’s knowledge, beliefs, barriers, and facilitators to exercise discussion.

Methods

A survey was administered to OCPs at the cancer center in Hamilton, Ontario. Questions comprised of demographics, knowledge and beliefs regarding exercise guidelines, and barriers and facilitators to exercise discussion. Analysis of survey responses was descriptive. Pearson’s chi-squared test was used to examine select associations.

Results

There were 120 respondents (61% response rate) representing a diversity of professions. Approximately, 80% of OCPs were not aware of any exercise guidelines in cancer and self-reported poor knowledge on when, how, and which patients to refer to exercise programs. OCPs who reported meeting Canada’s Physical Activity guidelines were significantly more likely to identify correct guidelines (p = 0.023) and to report good knowledge on how to provide exercise counseling (p = 0.014). Across OCP groups, barriers to exercise discussion included poor knowledge, lack of time, and safety concerns. Most felt that educational sessions and having an exercise specialist on the clinical team would be beneficial.

Conclusions

OCPs have low knowledge regarding exercise counseling, but believe that discussing exercise is a multidisciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.

Keywords

Neoplasms Medical oncology Exercise Physical activity Guideline Patient care team Knowledge Knowledge translation 

Notes

Authors’ contribution

Conceptualization M.N., J.S.; methodology M.N., J.T., O.C., R.J., J.S.; validation and investigation M.N., D.B., J.T. J.S.; resources J.S.; writing M.N., D.B., J.S., review and editing M.N., D.B., J.T., O.C., J.S.; administration M.N.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study received funding from the supportive cancer care research unit at the JCC.

References

  1. 1.
    Canadian Cancer Society. Canadian Cancer Statistics Publication. http://www.cancer.ca/en/cancer-information/cancer-101/canadian-cancer-statistics-publication/?region=on. Accessed June 2016
  2. 2.
    Society AC (2016) Lifetime Risk of Developing or Dying From Cancer. Available from: http://www.cancer.org/cancer/cancerbasics/lifetime-probability-of-developing-or-dying-from-cancer
  3. 3.
    Ewertz M, Jensen AB (2011) Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol 50(2):187–193CrossRefPubMedGoogle Scholar
  4. 4.
    Shao YH et al (2013) Fracture after androgen deprivation therapy among men with a high baseline risk of skeletal complications. BJU Int 111(5):745–752CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Harrington CB et al (2010) It's not over when it's over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med 40(2):163–181CrossRefPubMedGoogle Scholar
  6. 6.
    Schmitz KH et al (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426CrossRefPubMedGoogle Scholar
  7. 7.
    Stene GB et al (2013) Effect of physical exercise on muscle mass and strength in cancer patients during treatment—a systematic review. Crit Rev Oncol Hematol 88(3):573–593CrossRefPubMedGoogle Scholar
  8. 8.
    Speed-Andrews AE, Courneya KS (2009) Effects of exercise on quality of life and prognosis in cancer survivors. Curr Sports Med Rep 8(4):176–181CrossRefPubMedGoogle Scholar
  9. 9.
    Irwin ML et al (2011) Physical activity and survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer Prev Res (Phila) 4(4):522–529CrossRefGoogle Scholar
  10. 10.
    Ballard-Barbash R et al (2012) Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst 104(11):815–840CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Courneya KS et al (2016) Effects of a structured exercise program on physical activity and fitness in colon cancer survivors: one year feasibility results from the CHALLENGE trial. Cancer Epidemiol Biomark Prev 25(6):969–977CrossRefGoogle Scholar
  12. 12.
    Segal R, Zwaal C, Green E, Tomasone J, Loblaw A, Petrella T (2015) A quality initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Exercise for People with Cancer Google Scholar
  13. 13.
    Blaney JM et al (2013) Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey. Psychooncology 22(1):186–194CrossRefPubMedGoogle Scholar
  14. 14.
    Peeters C et al (2009) Evaluation of a cancer exercise program: patient and physician beliefs. Psychooncology 18(8):898–902CrossRefPubMedGoogle Scholar
  15. 15.
    Park JH et al (2015) Characteristics of attitude and recommendation of oncologists toward exercise in South Korea: a cross sectional survey study. BMC Cancer 15:249CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Cheville AL et al (2012) Insights into the reluctance of patients with late-stage cancer to adopt exercise as a means to reduce their symptoms and improve their function. J Pain Symptom Manag 44(1):84–94CrossRefGoogle Scholar
  17. 17.
    Anderson AS, Steele R, Coyle J (2013) Lifestyle issues for colorectal cancer survivors—perceived needs, beliefs and opportunities. Support Care Cancer 21(1):35–42CrossRefPubMedGoogle Scholar
  18. 18.
    Graham ID et al (2006) Lost in knowledge translation: time for a map? J Contin Educ Heal Prof 26(1):13–24CrossRefGoogle Scholar
  19. 19.
    Juravinski Cancer Centre, Hamilton Health Sciences (2016) Treatment and services: JCC clinics; Available from: http://www.jcc.hhsc.ca/body.cfm?id=307. Accessed July 2016.
  20. 20.
    Park JH et al (2015) The effect of oncologists' exercise recommendations on the level of exercise and quality of life in survivors of breast and colorectal cancer: a randomized controlled trial. Cancer 121(16):2740–2748CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Cheifetz O (2007) Cancer and exercise: a survey of patients' knowledge and preferences. Hamilton, OntarioGoogle Scholar
  22. 22.
    Godin G, Shephard RJ (1985) A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 10(3):141–146PubMedGoogle Scholar
  23. 23.
    MacCallum RC et al (2002) On the practice of dichotomization of quantitative variables. Psychol Methods 7(1):19–40CrossRefPubMedGoogle Scholar
  24. 24.
    (CSEP), C.S.E.P. Canadian Physical Activity Guidelines for Adults 18–64 years. 2011 2016]. http://www.csep.ca/guidelines. Accessed July 2016
  25. 25.
    Davis DA et al (1995) Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 274(9):700–705CrossRefPubMedGoogle Scholar
  26. 26.
    Fisher A et al (2015) Recall of physical activity advice was associated with higher levels of physical activity in colorectal cancer patients. BMJ Open 5(4):e006853CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Jones LW et al (2004) Effects of an oncologist's recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Ann Behav Med 28(2):105–113CrossRefPubMedGoogle Scholar
  28. 28.
    McGowan K (2016) Physical exercise and cancer-related fatigue in hospitalized patients: role of the clinical nurse leader in implementation of interventions. Clin J Oncol Nurs 20(1):E20–E27CrossRefPubMedGoogle Scholar
  29. 29.
    Frank E et al (2010) Predictors of Canadian physicians' prevention counseling practices. Can J Public Health 101(5):390–395Google Scholar
  30. 30.
    Abramson S et al (2000) Personal exercise habits and counseling practices of primary care physicians: a national survey. Clin J Sport Med 10(1):40–48CrossRefPubMedGoogle Scholar
  31. 31.
    Duijts SF et al (2011) Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors—a meta-analysis. Psychooncology 20(2):115–126CrossRefPubMedGoogle Scholar
  32. 32.
    Midtgaard J et al (2013) Efficacy of multimodal exercise-based rehabilitation on physical activity, cardiorespiratory fitness, and patient-reported outcomes in cancer survivors: a randomized, controlled trial. Ann Oncol 24(9):2267–2273CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    J., H., Supportive Treatment for Cancer - Part 1: Exercise Treatment. 2012, Health Care Knowledge Centre: Brussels: Belgian.Google Scholar
  34. 34.
    Cormie P et al (2013) Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis 16(4):328–335CrossRefPubMedGoogle Scholar
  35. 35.
    Cormie P et al (2014) Functional benefits are sustained after a program of supervised resistance exercise in cancer patients with bone metastases: longitudinal results of a pilot study. Support Care Cancer 22(6):1537–1548CrossRefPubMedGoogle Scholar
  36. 36.
    Ligibel JA et al (2016) Randomized trial of a physical activity intervention in women with metastatic breast cancer. Cancer 122(8):1169–1177CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Michelle Nadler
    • 1
    Email author
  • Daryl Bainbridge
    • 2
  • Jennifer Tomasone
    • 3
  • Oren Cheifetz
    • 4
  • Rosalyn A. Juergens
    • 2
    • 5
  • Jonathan Sussman
    • 2
    • 5
  1. 1.McMaster Michael G DeGroote School of MedicineHamiltonCanada
  2. 2.Department of OncologyMcMaster UniversityHamiltonCanada
  3. 3.School of Kinesiology and Health StudiesQueen’s UniversityKingstonCanada
  4. 4.Hamilton Health SciencesHamiltonCanada
  5. 5.Escarpment Cancer Research Institute (ECRI)HamiltonCanada

Personalised recommendations