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The Influence of Cancer Patient Characteristics on the Recommendation of Physical Activity by Healthcare Professionals

International Journal of Behavioral Medicine volume 27, pages 65–78 (2020)Cite this article

Abstract

Background

Although physical activity (PA) is beneficial for patients with cancer, healthcare professionals (HCP) still scarcely recommend it. This study aimed to determine how HCP’ sociodemographic and professional characteristics and their subjective assessments of patient characteristics are associated with their PA recommendations to patients with cancer.

Methods

A cross-sectional survey (paper-pencil or online) was completed by 929 HCP (159 general practitioners, 382 specialized physicians, and 388 oncology nurses). The survey collected information on HCP’ sociodemographic and professional characteristics, PA recommendation frequency, and the likelihood of 13 patient characteristics influencing PA recommendations (on a 7-point Likert scale).

Results

Descriptive results showed that 37.6% of HCP indicated often recommending PA and 41.7% indicated routinely recommending PA. More professional experience was associated with a higher reported PA recommendation frequency among specialized physicians and oncology nurses. Patient characteristics could be assigned to three higher-level categories. Characteristics from the categories “medical side effects” and “low affinity for PA” were more frequently judged by HCP as reasons for recommending PA and characteristics belonging to “indicators of poor general health” as reasons for not recommending PA. In all professional groups, the inclusion of patient characteristics resulted in additional variance explained in the prediction of a routine PA recommendation.

Conclusions

HCP in this study reported that they frequently recommend PA to patients with cancer. However, HCP consider cancer patient characteristics to influence their decision whether to recommend PA. Future research and interventions should aim to enable HCP to provide adequate PA recommendations to patients with cancer having different characteristics.

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References

  1. Naghavi M, Abajobir AA, Abbafati C, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151–210. https://doi.org/10.1016/S0140-6736(17)32152-9.

    Article  Google Scholar 

  2. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977–1010. https://doi.org/10.1016/S0140-6736(14)62038-9.

    Article  PubMed  Google Scholar 

  3. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961–8. https://doi.org/10.1001/jamaoncol.2016.6914.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T. Exercise for people with cancer: a systematic review. Curr Oncol. 2017;24(4):e290–315. https://doi.org/10.3747/co.24.3619.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91–104. https://doi.org/10.1016/j.ctrv.2016.11.010.

    Article  Google Scholar 

  6. Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71–92. https://doi.org/10.1093/epirev/mxx007.

    Article  Google Scholar 

  7. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, et al. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26. https://doi.org/10.1249/MSS.0b013e3181e0c112.

    Article  Google Scholar 

  8. Ottenbacher A, Yu M, Moser RP, Phillips SM, Alfano C, Perna FM. Population estimates of meeting strength training and aerobic guidelines, by gender and cancer survivorship status: findings from the Health Information National Trends Survey (HINTS). J Phys Act Health. 2015;12(5):675–9. https://doi.org/10.1123/jpah.2014-0003.

    Article  PubMed  Google Scholar 

  9. Karvinen KH, DuBose KD, Carney B, Allison RR. Promotion of physical activity among oncologists in the United States. J Support Oncol. 2010;8(1):35–41. https://doi.org/10.1097/NCC.0b013e31822d9081.

    Article  PubMed  Google Scholar 

  10. Jones LW, Courneya KS, Peddle C, Mackey JR. Oncologists' opinions towards recommending exercise to patients with cancer: a Canadian national survey. Support Care Cancer. 2005;13(11):929–37. https://doi.org/10.1007/s00520-005-0805-8.

    Article  PubMed  Google Scholar 

  11. Park J-H, Oh M, Yoon YJ, Lee CW, Jones LW, Kim SI, et al. Characteristics of attitude and recommendation of oncologists toward exercise in South Korea: a cross sectional survey study. BMC Cancer. 2015;15(1):249–10. https://doi.org/10.1186/s12885-015-1250-9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hardcastle SJ, Kane R, Chivers P, Hince D, Dean A, Higgs D, et al. Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: an international survey. Support Care Cancer. 2018;26(11):3711–9. https://doi.org/10.1007/s00520-018-4230-1.

    Article  PubMed  Google Scholar 

  13. Karvinen K, McGourty S, Parent T, Walker PR. Physical activity promotion among oncology nurses. Cancer Nurs. 2012;35(3):41–8. https://doi.org/10.1097/NCC.0b013e31822d9081.

    Article  Google Scholar 

  14. Nadler M, Bainbridge D, Tomasone J, Cheifetz O, Juergens RA, Sussman J. Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators. Support Care Cancer. 2017;25(7):2297–304. https://doi.org/10.1007/s00520-017-3640-9.

    Article  PubMed  Google Scholar 

  15. Sheill G, Guinan E, L ON, Hevey D, Hussey J. Physical activity and advanced cancer: the views of chartered physiotherapists in Ireland. Physiother Theory Pract. 2018;34(7):534–41. https://doi.org/10.1080/09593985.2017.1422821.

    Article  PubMed  Google Scholar 

  16. Fisher A, Williams K, Beeken R, Wardle J. Recall of physical activity advice was associated with higher levels of physical activity in colorectal cancer patients. BMJ Open. 2015;5(4):e006853. https://doi.org/10.1136/bmjopen-2014-006853.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Tarasenko YN, Miller EA, Chen C, Schoenberg NE. Physical activity levels and counseling by health care providers in cancer survivors. Prev Med. 2017;99:211–7. https://doi.org/10.1016/j.ypmed.2017.01.010.

    Article  PubMed  Google Scholar 

  18. Nyrop KA, Deal AM, Williams GR, Guerard EJ, Pergolotti M, Muss HB. Physical activity communication between oncology providers and patients with early-stage breast, colon, or prostate cancer. Cancer. 2016;122(3):470–6. https://doi.org/10.1002/cncr.29786.

    Article  PubMed  Google Scholar 

  19. Kenzik K, Pisu M, Fouad MN, Martin MY. Are long-term cancer survivors and physicians discussing health promotion and healthy behaviors? J Cancer Surviv. 2016;10(2):271–9. https://doi.org/10.1007/s11764-015-0473-8.

    Article  PubMed  Google Scholar 

  20. Haussmann A, Gabrian M, Ungar N, Jooß S, Wiskemann J, Sieverding M et al. What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals' concerns, perceived patient characteristics and perceived structural factors. Eur J Cancer Care. 2018;27(4):e12853. https://doi.org/10.1111/ecc.12853.

  21. Ungar N, Schmidt L, Gabrian M, Haussmann A, Tsiouris A, Sieverding M, et al. Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase. J Behav Med. 2018;42(2):342–52. https://doi.org/10.1007/s10865-018-9980-1.

    Article  PubMed  Google Scholar 

  22. Davies N, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer. 2011;105(Suppl 1):S52. https://doi.org/10.1038/bjc.2011.423.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Godin G. The Godin-Shephard leisure-time physical activity questionnaire. HFJC. 2011;4(1):18–22.

    Google Scholar 

  24. Cohen J. Statistical power analysis for the behavioral sciences. Hilsdale (NJ): Taylor & Francis Inc; 1988.

    Google Scholar 

  25. Costello AB, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. PARE. 2005;10(7):1–9.

    Google Scholar 

  26. Nagelkerke NJ. A note on a general definition of the coefficient of determination. Biometrika. 1991;78(3):691–2.

    Google Scholar 

  27. Haussmann A, Ungar N, Gabrian M, Tsiouris A, Sieverding M, Wiskemann J, et al. Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients. Support Care Cancer. 2018;26(12):4087–96. https://doi.org/10.1007/s00520-018-4279-x.

    Article  PubMed  Google Scholar 

  28. Koutsopoulou S, Papathanassoglou ED, Katapodi MC, Patiraki EI. A critical review of the evidence for nurses as information providers to cancer patients. J Clin Nurs. 2010;19(5–6):749–65. https://doi.org/10.1111/j.1365-2702.2009.02954.x.

    Article  PubMed  Google Scholar 

  29. Karvinen KH, Balneaves L, Courneya KS, Perry B, Truant T, Vallance J. Evaluation of online learning modules for improving physical activity counseling skills, practices, and knowledge of oncology nurses. Oncol Nurs Forum. 2017;44(6):729–38. https://doi.org/10.1188/17.onf.729-738.

    Article  PubMed  Google Scholar 

  30. Ungar N, Tsiouris A, Haussmann A, Herbolsheimer F, Wiskemann J, Steindorf K, et al. To rest or not to rest—health care professionals' attitude toward recommending physical activity to their cancer patients. Psychooncology. 2019;28(4):784–91. https://doi.org/10.1002/pon.5020.

    Article  PubMed  Google Scholar 

  31. Jones LW. Evidence-based risk assessment and recommendations for physical activity clearance: cancer. Appl Physiol Nutr Metab. 2011;36(1 Suppl):S101–12. https://doi.org/10.1139/h11-043.

    Article  PubMed  Google Scholar 

  32. Friedenreich CM, Neilson HK, Farris MS, Courneya KS. Physical activity and cancer outcomes: a precision medicine approach. Clin Cancer Res. 2016;22(19):4766–75. https://doi.org/10.1158/1078-0432.ccr-16-0067.

    CAS  Article  PubMed  Google Scholar 

  33. Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer. 2015;23(12):3633–43. https://doi.org/10.1007/s00520-015-2916-1.

    Article  PubMed  Google Scholar 

  34. Stene GB, Helbostad JL, Balstad TR, Riphagen II, Kaasa S, Oldervoll LM. Effect of physical exercise on muscle mass and strength in cancer patients during treatment—a systematic review. Crit Rev Oncol Hematol. 2013;88(3):573–93. https://doi.org/10.1016/j.critrevonc.2013.07.001.

    CAS  Article  PubMed  Google Scholar 

  35. van Rooijen SJ, Engelen MA, Scheede-Bergdahl C, et al. Systematic review of exercise training in colorectal cancer patients during treatment. Scand J Med Sci Sports. 2018;28(2):360–70. https://doi.org/10.1111/sms.12907.

    Article  PubMed  Google Scholar 

  36. van Vulpen JK, Peeters PH, Velthuis MJ, van der Wall E, May AM. Effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of cancer-related fatigue: a meta-analysis. Maturitas. 2016;85:104–11. https://doi.org/10.1016/j.maturitas.2015.12.007.

    Article  PubMed  Google Scholar 

  37. Van Veen MR, Hoedjes M, Versteegen JJ, van de Meulengraaf-Wilhelm N, Kampman E, Beijer S. Improving oncology nurses' knowledge about nutrition and physical activity for cancer survivors. Oncol Nurs Forum. 2017;44(4):488–96. https://doi.org/10.1188/17.onf.488-496.

    Article  PubMed  Google Scholar 

  38. Kessels E, Husson O, van der Feltz-Cornelis CM. The effect of exercise on cancer-related fatigue in cancer survivors: a systematic review and meta-analysis. Neuropsychiatr Dis Treat. 2018;14:479–94. https://doi.org/10.2147/ndt.S150464.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. Hilfiker R, Meichtry A, Eicher M, Nilsson Balfe L, Knols RH, Verra ML, et al. Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. Br J Sports Med. 2018;52(10):651–8. https://doi.org/10.1136/bjsports-2016-096422.

    Article  PubMed  Google Scholar 

  40. Joseph JS, Lam V, Patel MI. Preventing osteoporosis in men taking androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. Eur Urol. 2018. https://doi.org/10.1016/j.euo.2018.11.001.

  41. Alibhai SMH, Zukotynski K, Walker-Dilks C, Emmenegger U, Finelli A, Morgan SC, et al. Bone health and bone-targeted therapies for nonmetastatic prostate cancer: a systematic review and meta-analysis. Ann Intern Med. 2017;167(5):341–50. https://doi.org/10.7326/m16-2577.

    Article  PubMed  Google Scholar 

  42. Fornusek CP, Kilbreath SL. Exercise for improving bone health in women treated for stages I–III breast cancer: a systematic review and meta-analyses. J Cancer Surviv. 2017;11(5):525–41. https://doi.org/10.1007/s11764-017-0622-3.

    Article  PubMed  Google Scholar 

  43. Duregon F, Vendramin B, Bullo V, et al. Effects of exercise on cancer patients suffering chemotherapy-induced peripheral neuropathy undergoing treatment: a systematic review. Crit Rev Oncol Hematol. 2018;121:90–100. https://doi.org/10.1016/j.critrevonc.2017.11.002.

    Article  PubMed  Google Scholar 

  44. Zimmer P, Trebing S, Timmers-Trebing U, Schenk A, Paust R, Bloch W, et al. Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial. Support Care Cancer. 2018;26(2):615–24. https://doi.org/10.1007/s00520-017-3875-5.

    Article  PubMed  Google Scholar 

  45. Lee J, Dodd MJ, Dibble SL, Abrams DI. Nausea at the end of adjuvant cancer treatment in relation to exercise during treatment in patients with breast cancer. Oncol Nurs Forum. 2008;35(5):830–5. https://doi.org/10.1188/08.onf.830-835.

    Article  PubMed  Google Scholar 

  46. Uster A, Ruehlin M, Mey S, Gisi D, Knols R, Imoberdorf R, et al. Effects of nutrition and physical exercise intervention in palliative cancer patients: a randomized controlled trial. Clin Nutr. 2018;37(4):1202–9. https://doi.org/10.1016/j.clnu.2017.05.027.

    Article  PubMed  Google Scholar 

  47. Singh B, Disipio T, Peake J, Hayes SC. Systematic review and meta-analysis of the effects of exercise for those with cancer-related lymphedema. Arch Phys Med Rehabil. 2016;97(2):302–315.e13. https://doi.org/10.1016/j.apmr.2015.09.012.

    Article  PubMed  Google Scholar 

  48. Wiskemann J, Kuehl R, Dreger P, Schwerdtfeger R, Huber G, Ulrich CM, et al. Efficacy of exercise training in SCT patients—who benefits most? Bone Marrow Transplant. 2014;49(3):443–8. https://doi.org/10.1038/bmt.2013.194.

    CAS  Article  PubMed  Google Scholar 

  49. Dong ST, Butow PN, Costa DS, Lovell MR, Agar M. Symptom clusters in patients with advanced cancer: a systematic review of observational studies. J Pain Symptom Manag. 2014;48(3):411–50. https://doi.org/10.1016/j.jpainsymman.2013.10.027.

    Article  Google Scholar 

  50. Bail JR, Traeger L, Pirl WF, Bakitas MA. Psychological symptoms in advanced cancer. Semin Oncol Nurs. 2018;34:241–51. https://doi.org/10.1016/j.soncn.2018.06.005.

    Article  PubMed  Google Scholar 

  51. Heywood R, McCarthy AL, Skinner TL. Efficacy of exercise interventions in patients with advanced cancer: a systematic review. Arch Phys Med Rehabil. 2018. https://doi.org/10.1016/j.apmr.2018.04.008.

  52. Dittus KL, Gramling RE, Ades PA. Exercise interventions for individuals with advanced cancer: a systematic review. Prev Med. 2017;104:124–32. https://doi.org/10.1016/j.ypmed.2017.07.015.

    Article  PubMed  Google Scholar 

  53. Nadler MB, Desnoyers A, Langelier DM, Amir E. The effect of exercise on quality of life, fatigue, physical function, and safety in advanced solid tumor cancers: a meta-analysis of randomized control trials. J Pain Symptom Manag. 2019. https://doi.org/10.1016/j.jpainsymman.2019.07.005.

  54. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. Jama. 1995;274(9):700–5. https://doi.org/10.1001/jama.274.9.700.

    CAS  Article  PubMed  Google Scholar 

  55. Nadler MB, Bainbridge D, Fong AJ, Sussman J, Tomasone JR, Neil-Sztramko SE. Moving Cancer Care Ontario's exercise for people with cancer guidelines into oncology practice: using the theoretical domains framework to validate a questionnaire. Support Care Cancer. 2019;27(6):1965–8. https://doi.org/10.1007/s00520-019-04689-1.

    Article  PubMed  Google Scholar 

  56. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33. https://doi.org/10.1136/qshc.2004.011155.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  57. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95. https://doi.org/10.1007/s12160-013-9486-6.

    Article  PubMed  Google Scholar 

  58. Statistisches Bundesamt. "Statistisches Jahrbuch 2018—Kapitel 4 Gesundheit." https://www.destatis.de/DE/Themen/Querschnitt/Jahrbuch/jb-gesundheit.pdf?__blob=publicationFile&v=6. Accessed 9 May 2019.

  59. Lahtinen P, Leino-Kilpi H, Salminen L. Nursing education in the European higher education area—variations in implementation. Nurse Educ Today. 2014;34(6):1040–7. https://doi.org/10.1016/j.nedt.2013.09.011.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was part of the Momentum Project that has been supported by the German Cancer Aid under Grant numbers 110512, 110551, and 111223. We thank Martina Gabrian, Fiona Rupprecht, Lena Radke, Nina Immel, Sara Kuru, Sophie Madlinger, Elisa Ebler and Xenia Peukert for their help in the recruitment and data management. Furthermore, sincere thanks to Amy Richardson for diligently proofreading this manuscript.

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Affiliations

  1. Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany

    Alexander Haussmann & Karen Steindorf

  2. Medical Faculty, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany

    Alexander Haussmann

  3. Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany

    Alexander Haussmann, Nadine Ungar & Monika Sieverding

  4. Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany

    Angeliki Tsiouris & Joachim Wiskemann

  5. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz University, Untere Zahlbacher Str. 8, 55131, Mainz, Germany

    Angeliki Tsiouris

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  1. Alexander Haussmann
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Correspondence to Karen Steindorf.

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Haussmann, A., Ungar, N., Tsiouris, A. et al. The Influence of Cancer Patient Characteristics on the Recommendation of Physical Activity by Healthcare Professionals. Int.J. Behav. Med. 27, 65–78 (2020). https://doi.org/10.1007/s12529-019-09833-z

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Keywords

  • Counseling
  • Exercise
  • Healthcare
  • Oncology
  • Patient characteristics