Abstract
BackgroundIn order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it.MethodsOutpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting moderate/severe tiredness/weakness during self-assessment (MIDOS II) were enrolled. We assessed Fatigue-(FACF-F) and Depression (PHQ8) Scores, demographics, cancer-specific parameters, motivation for PA, physical, psychological and social barriers.Results141 of 440 eligible patients (32.0%) with different diagnoses agreed to participate. Patients frequently reported “I feel weakened due to my tumor therapy” (n = 108; 76.6%), physical symptoms (tiredness, weakness, dyspnea, joint-problems, pain, nausea [n = 107; 75.9%]) and fatigue (n = 99; 70.2%) as barriers to PA. However, no significant group differences regarding these barriers were found between physically active and inactive patients. Social barriers were rarely chosen. Motivated patients were 5.6 times more likely to be physically active (p < 0.001), also motivation turned out to be the strongest predictor for a physically active behavior (β = 1.044; p = 0.005). Motivated attitude towards PA was predicted by fatigue (β = − 2.301; p = 0.008), clinically relevant depression (β = − 1.390, p = 0.039), knowledge about PA and quality of life (QoL) (β = 0.929; p = 0.002), PA before diagnosis (β = 0.688; p = 0.005 and Interest in exercise program (β = 0.635; p = 0.008).Conclusion“I feel weakened due to my tumor therapy” is the most reported barrier to PA among both, physically and inactive patients. Motivation for PA is the strongest predictor of performing PA. Interest in PA, knowledge about PA/QoL and PA before diagnosis are main predictors of a motivated attitude. Absence/presence of social barriers did not associate with motivation, fatigue and depression proved to be a negative predictor. Programs including information, motivational counseling and individualized training should be offered for ACP to overcome barriers and reduce fatigue.Trial registrationGerman Register of Clinical Trials DRKS00012514, registration date: 30.5.2017.
Highlights
In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer
Our analysis found that the statement “I feel weakened due to my tumor therapy” was the most common patientreported barrier for PA, followed by several physical symptoms and a
advanced cancer patients (ACP) seem to have different needs regarding the implication of PA: our study clearly demonstrates that physical barriers are more important in this cohort
Summary
In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. Up to 91% of patients suffer from a level of weakness and tiredness that is more severe than the drowsiness experienced by healthy people and cannot be relieved by rest [2,3,4]. This symptom complex indicates the presence of cancer-related fatigue (CRF). Despite the scientific advice less than 30% of survivors manage to meet the current guidelines [15] These findings are concordant to the results of few studies that examined PA behaviour in ACP with specific cancer types like prostate and lung cancer [16, 17]
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