Nick Mulcahy

January 24, 2017

Three quarters (75%) of patients with cancer reported decreased physical activity levels after their diagnosis compared with their predisease status, according to the results of a new survey of 662 patients from 12 US hospitals.

Helping patients return to their prediagnosis exercise level or even improve upon it may be rewarding, said lead author Sally A.D. Romero, PhD, a postdoctoral research fellow at Memorial Sloan Kettering Cancer Center in New York City.

Recent research has shown that moderate forms of physical activity can help patients with cancer feel better and, in some cases, may improve outcomes, she said. Currently, cancer survivors are advised to undertake 30 minutes of moderate activity 5 days a week.

The challenge of maintaining or exceeding one's old activity level can be met by patients, she suggested. In the new study, 16% maintained prediagnosis activity levels and 4% increased physical activity.

Dr Romero spoke during a presscast that preceded the 2017 Cancer Survivorship Symposium, to be held later this week in San Diego, California, where the study will be presented.

In the new study, the authors sought to identify the patient and clinical characteristics associated with deflated activity levels, as well as what the patients themselves said were barriers to getting moving.

A drop in activity level was significantly associated with two characteristics: receipt of chemotherapy (adjusted odds ratio [AOR], 3.54; 95% confidence interval [CI], 2.06 - 6.06) and metastatic disease diagnosis (AOR, 1.64; 95% CI, 1.07 - 2.52). Notably, neither body mass index nor age was associated with decreased activity after diagnosis.

The barriers to staying physically active were both cancer-specific and more generalized.

In a one-time survey, patients reported that treatment-associated fatigue (72%) and pain (71%) were the two top factors that slowed them down. But the commonplace psychological problems of low motivation (67%) and poor discipline (65%) were activity barriers number three and four.

Treatment-related side effects (51%) and nausea (35%) were the fifth and sixth reason, followed by sadness (32%) and not enough time (29%). Surgical complications (22%), lack of money (20%), lack of safe environment (11%), and "my doctor told me not to" (6%) completed the list.

The new study adds to the literature on cancer survivors, said Merry Jennifer Markham, MD, from the University of Florida, Gainesville, and an ASCO expert, who moderated the presscast.

"We haven't known the barriers to physical activity among survivors," she said.

"Cancer care teams need to help patients think about physical activity in new ways, while personalizing their care," said study author Dr Romero.

Dr Markham echoed that comment in a press statement: "Patients who were runners before their diagnosis might consider taking long walks instead. It's about tailoring the conversation and the exercise plan for each individual."

Half of the study patients were recruited from 11 community hospitals and half from an urban academic center in Philadelphia, Pennsylvania. The majority of the patients were female (65%), partnered (65%), and overweight (65%). Mean age was 59.9 years.

Common cancer types were breast (32%), lung/thoracic (15%), and hematologic (15%). The majority of patients received chemotherapy (88%), radiation (53%), and/or surgery (53%).

More than half of the survey group had a nonmetastatic diagnosis and was more than 12 months post-diagnosis. "I expected more [patients] would be on the maintaining [activity] level," said Dr Romero about those who were more than a year out from their diagnosis. The fact that only a minority of surveyed patients maintained their activity level was "surprising," she said.

The findings have wide implications, she also suggested, because there are currently more than 15 million cancer survivors in the United States.

Many National Cancer Institute–designated cancer centers offer and are expanding exercise programs tailored to people with cancer and survivors, according to a press statement.

The researchers have disclosed no financial relationships.

2017 Cancer Survivorship Symposium. Abstract 116. To be presented January 27, 2017.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

Follow Medscape Oncology on Twitter: @MedscapeOnc


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.