Most patients report decreased physical activity 1 year after cancer diagnosis

Most patients with cancer reported decreased levels of physical activity 1 year after diagnosis, according to a cross-sectional study scheduled for presentation at the Cancer Survivorship Symposium.

Less physical activity was especially common among patients with advanced disease and those who underwent chemotherapy.

Sally Romero

“Currently, there are 15.5 million Americans alive with cancer diagnosis. Many will experience a variety of symptoms, such as pain, fatigue and other symptoms that can affect and impact their ability to maintain physical activity levels,” Sally Romero, PhD, MPH, postdoctoral research fellow at Memorial Sloan-Kettering Cancer Center, said during a press conference. “While there is previous research that shows physical activity is a great prevention from cancer, new emerging data shows that moderate forms of physical activity can potentially improve quality of life and cancer outcomes among cancer patients.”

To determine factors associated with decreased physical activity since cancer diagnosis and identify barriers to staying physically active, Romero and colleagues administered a one-time survey to 662 patients (mean age, 59.9 ± 11.6 years) with common cancers recruited from 11 community hospitals and an urban academic medical center in Philadelphia.

The survey asked whether a patient had decreased their physical activity since diagnosis, maintained it or increased it, Romero said.

Common cancers in the cohort included breast (32%), lung/thoracic (15%) and hematologic cancers (15%). A majority of patients were female (65%), white (81%), obese/overweight (65%) and had a nonmetastatic cancer diagnosis (53%).

Of those with nonmetastatic cancer, 53% had been diagnosed more than 12 months prior to taking the survey.

Overall, 75% of patients reported they decreased their physical activity levels since diagnosis. Sixteen percent of patients reported they maintained their levels, and four percent increased their physical activity.

Multivariate analysis showed decreased physical activity was associated with receipt of chemotherapy after diagnosis (adjusted OR = 3.54; 95% CI, 2.06-6.06) and metastatic disease (adjusted OR = 1.64; 95% CI, 1.07-2.52).

“Patients who received chemotherapy had 3.5-higher odds of decreasing physical activity since diagnosis compared to those who did not receive it,” Romero said. “Similarly, those with advanced disease had 1.6-higher odds of decreasing their levels of physical activity compared with patients without metastatic disease.”

No associations were observed between decreased activity and age, sex and BMI.

The finding that most patients had decreased physical activity was “surprising,” Romero said.

“It is expected patients will decrease physical activity to some extent, but [we were surprised] because a majority of patients were at least 1 year from cancer diagnosis and still reported decreasing physical activity,” Romero said. “By this time, I would expect more in the maintain level and not as many in the decrease level. We saw that three-fourths of our patients are decreasing it, even after cancer treatment.”

Common barriers to increasing or maintaining physical activity reported by patients included fatigue (78%), pain (71%), lack of motivation (67%) and lack of self-discipline (65%).

Romero said interventions targeting these barriers are needed to promote maintenance of physical activity among patients.

“It is easy to work with our patients to help them overcome these physical and psychological barriers,” Romero said. “Cancer patients should consult with their care teams regarding exercise to stay as physically active as possible during and after their treatment.”

Thirty minutes of moderate activity 5 days a week is the ideal amount of physical activity patients should be getting, Romero said. Further, cancer care teams need to make more effort to provide patients with treatment and “integrative therapies” to help manage symptoms so patients can maintain their level of physical activity, she said.

“The care teams can also refer patients to support groups or exercise classes geared towards cancer patients and survivors,” Romero said.

The study highlights the need for clinicians to ask their patients the right questions in terms of physical activity, Merry Jennifer Markham, MD, associate professor in the division of hematology and oncology at University of Florida Health, and an ASCO expert, said during the press conference.

“We learn that exercise is important in staying healthy after a cancer diagnosis, but what we haven’t known are the barriers patients face when it comes to exercising,” Markham said. “This study also highlights the need for physicians to not just recommend exercise but ask the next questions of our patients, such as, ‘what is keeping you from exercising?’ and ‘how can we help you overcome those barriers?’” – by Melinda Stevens

Reference:

Romero S, et al. Abstract 162. Scheduled for presentation at: Cancer Survivorship Symposium; Jan. 27-28, 2017; San Diego.

Disclosures: The researchers report no relevant financial disclosures.