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Exercise interventions for patients with advanced cancer: A systematic review of recruitment, attrition, and exercise adherence rates

  • G. Sheill (a1), E. Guinan (a2), L. Brady (a3), D. Hevey (a4) and J. Hussey (a5)...

Abstract

Purpose

Patients with advanced cancer can experience debilitating physical symptoms, making participation in exercise programs difficult. This systematic review investigated the recruitment, adherence, and attrition rates of patients with advanced cancer participating in exercise interventions and examined components of exercise programs that may affect these rates.

Methods

Relevant studies were identified in a systematic search of CINAHL, PubMed, PsycINFO, and EMBASE to December 2017. Two quality assessment tools were used, and levels of evidence were assigned according to the Oxford Centre for Evidence-Based Medicine (CEBM) guidelines.

Results

The search identified 18 studies published between 2004 and 2017. Recruitment, adherence, and attrition rates varied widely among the studies reviewed. The mean recruitment rate was 49% (standard deviation [SD] = 17; range 15–74%). Patient-reported barriers to recruitment included time constraints and difficulties in traveling to exercise centers. Levels of adherence ranged from 44% to 95%; however, the definition of adherence varied substantially among trials. The average attrition rate was 24% (SD = 8; range 10–42%), with progression of disease status reported as the main cause for dropout during exercise interventions.

Significance of results

Concentrated efforts are needed to increase the numbers of patients with advanced disease recruited to exercise programs. Broadening the eligibility criteria for exercise interventions may improve accrual numbers of patients with advanced cancer to exercise trials and ensure patients recruited are representative of clinical practice.

Copyright

Corresponding author

Author for correspondence: Gráinne Sheill, Discipline of Physiotherapy, School of Medicine, Trinity College Centre for Health Sciences, James's Street, Dublin 8, Ireland. Email: sheillg@tcd.ie

References

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Adams, RN, Mosher, CE, Blair, CK, et al. (2015) Cancer survivors’ uptake and adherence in diet and exercise intervention trials: An integrative data analysis. Cancer 121, 7783.
Albrecht, TA and Taylor, AG (2012) Physical activity in patients with advanced-stage cancer: A systematic review of the literature. Clinical Journal of Oncology Nursing 16, 293300.
Beaton, R, Pagdin-Friesen, W, Robertson, C, et al. (2009) Effects of exercise intervention on persons with metastatic cancer: A systematic review. Physiotherapy Canada Physiotherapie Canada 61, 141153.
Bourke, L, Doll, H, Crank, H, et al. (2011) Lifestyle intervention in men with advanced prostate cancer receiving androgen suppression therapy: A feasibility study. Cancer Epidemiology, Biomarkers & Prevention 20, 647657.
Bourke, L, Gilbert, S, Hooper, R, et al. (2014) Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: A randomised controlled trial. European Urology 65, 865872.
Chang, BH, Hendricks, AM, Slawsky, MT, et al. (2004) Patient recruitment to a randomized clinical trial of behavioral therapy for chronic heart failure. BMC Medical Research Methodology 4, 8.
Cheville, AL, Girardi, J, Clark, MM, et al. (2010) Therapeutic exercise during outpatient radiation therapy for advanced cancer: Feasibility and impact on physical well-being. American Journal of Physical Medicine & Rehabilitation 89, 611619.
Chiarotto, JA, Akbarali, R, Bellotti, L, et al. (2017) A structured group exercise program for patients with metastatic cancer receiving chemotherapy and CTNNB1 (β-catenin) as a biomarker of exercise efficacy. Cancer Management and Research 9, 495501.
Cohen, J (1992) A power primer. Psychological Bulletin 112, 155159.
Comet Initiative 2013 Core outcome measures for effectiveness studies. http://www.comet-initiative.org/ (Last Accessed 5 January 2018)
Cormie, P, Newton, RU, Spry, N, et al. 2013 Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer and Prostatic Diseases 16, 328335.
Courneya, KS and Friedenreich, CM (2007) Physical activity and cancer control. Seminars in Oncology Nursing, 23, 242252.
Courneya, KS, McKenzie, DC, Reid, RD, et al. (2008) Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Annals of Behavioral Medicine 35, 116122.
de Morton, NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: A demographic study. The Australian Journal of Physiotherapy 55, 129133.
Dittus, KL, Gramling, RE, and Ades, PA (2017) Exercise interventions for individuals with advanced cancer: A systematic review. Preventive Medicine 104, 124132.
Edge, SB and Compton, CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annuals of Surgical Oncology 17, 14711474.
Elsawy, B and Higgins, KE (2010) Physical activity guidelines for older adults. American Family Physician 81, 5559.
Fidler, M (1981) Incidence of fracture through metastases in long bones. Acta Orthopaedica Scandinavica 52, 623627.
Furlan, AD, Pennick, V, Bombardier, C, et al. (2009) 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976) 34, 19291941.
Galvao, DA, Taaffe, DR, Spry, N, et al. (2017) Exercise preserves physical function in prostate cancer patients with bone metastases. Medicine and Science in Sports and Exercise.
Headley, JA, Ownby, KK, and John, LD (2004). The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncology Nursing Forum 31, 977983.
Howick, J, Chalmers, I, Glasziou, P, et al. Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence (background document). OCEBM Web site. Available at http://www.cebm.net/index.aspx?o=5653
Hwang, CL, Yu, CJ, Shih, JY, et al. (2012) Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Supportive Care in Cancer 20, 31693177.
Irwin, ML, Cadmus, L, Alvarez-Reeves, M, et al. (2008) Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial: The Yale Exercise and Survivorship Study. Cancer 112, 25932606.
Jack, K, McLean, SM, Moffett, JK, et al. (2010) Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual Therapy 15, 220228.
Jensen, W, Baumann, FT, Stein, A, et al. (2014) Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: A pilot study. Supportive Care in Cancer 22, 17971806.
Li, T, Wei, S, Shi, Y, et al. (2015) The dose-response effect of physical activity on cancer mortality: Findings from 71 prospective cohort studies. British Journal of Sports Medicine.
Ligibel, JA, Giobbie-Hurder, A, Shockro, L, et al. (2016) Randomized trial of a physical activity intervention in women with metastatic breast cancer. Cancer 122, 11691177.
Litterini, AJ, Fieler, VK, Cavanaugh, JT, et al. (2013) Differential effects of cardiovascular and resistance exercise on functional mobility in individuals with advanced cancer: A randomized trial. Archives of Physical Medicine and Rehabilitation, 94(12), 23292335.
Lowe, SS, Watanabe, SM, Baracos, VE, et al. (2013) Home-based functional walking program for advanced cancer patients receiving palliative care: A case series. BMC Palliative Care 12, 22.
Lynch, ME, Brooks, D, Mohanan, S, et al. (2013) In vivo tibial compression decreases osteolysis and tumor formation in a human metastatic breast cancer model. Journal of Bone and Mineral Research 28, 23572367.
Mack, JW, Cronin, A, Taback, N, et al. (2012) End-of-life care discussions among patients with advanced cancer: A cohort study. Annals of Internal Medicine 156, 204210.
Maddocks, M, Mockett, S, and Wilcock, A (2009). Is exercise an acceptable and practical therapy for people with or cured of cancer? A systematic review. Cancer Treatment Reviews 35, 383390.
Maher, CG, Sherrington, C, Herbert, RD, et al. (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy 83, 713721.
Martin, SB, Morrow, JR Jr, Jackson, AW, et al. (2000) Variables related to meeting the CDC/ACSM physical activity guidelines. Medicine and Science in Sports and Exercise 32, 20872092.
Oldervoll, LM, Loge, JH, Lydersen, S, et al. (2011) Physical exercise for cancer patients with advanced disease: A randomized controlled trial. The Oncologist 16, 16491657.
Oldervoll, LM, Loge, JH, Paltiel, H, et al. (2005) Are palliative cancer patients willing and able to participate in a physical exercise program? Palliative & Supportive Care 3, 281287.
Oldervoll, LM, Loge, JH, Paltiel, H, et al. (2006) The effect of a physical exercise program in palliative care: A phase II study. Journal of Pain and Symptom Management 31, 421430.
Penttinen, H, Nikander, R, Blomqvist, C, et al. (2009) Recruitment of breast cancer survivors into a 12-month supervised exercise intervention is feasible. Contemporary Clinical Trials 30, 457463.
Porock, D, Kristjanson, LJ, Tinnelly, K, et al. (2000) An exercise intervention for advanced cancer patients experiencing fatigue: A pilot study. Journal of Palliative Care, 16(3), 3036.
Quist, M, Rørth, M, Langer, S, et al. (2012) Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study. Lung Cancer (Amsterdam, Netherlands) 75, 203208.
Salakari, MR, Surakka, T, Nurminen, R, et al. (2015) Effects of rehabilitation among patients with advances cancer: A systematic review. Acta Oncologica (Stockholm, Sweden) 54, 618628.
Scianni, A, Teixeira-Salmela, LF, and Ada, L (2012) Challenges in recruitment, attendance and adherence of acute stroke survivors to a randomized trial in Brazil: A feasibility study. Rev Bras Fisioter 16, 4045.
Sheill, G, Guinan, E, O Neill, L, et al. (2018) Physical activity and advanced cancer: The views of chartered physiotherapists in Ireland. Physiotherapy Theory and Practice 34, 534541.
Sheill, G, Guinan, EM, Peat, N, et al. (2018) Considerations for exercise prescription in patients with bone metastases: a comprehensive narrative review. PM & R 10, 843864.
Sheill, G, Guinan, E, Neill, LO, et al. (2017) Physical activity and advanced cancer: the views of oncology and palliative care physicians in Ireland. Irish Journal of Medical Science.
Siddiqi, AE, Sikorskii, A, Given, CW, et al. (2008) Early participant attrition from clinical trials: Role of trial design and logistics. Clinical Trials 5, 328335.
Silverberg, E, Boring, CC, and Squires, TS (1990). Cancer statistics, 1990. A Cancer Journal for Clinicians 40, 926.
Sygna, K, Johansen, S, and Ruland, CM (2015) Recruitment challenges in clinical research including cancer 16patients and their caregivers. A randomized controlled trial study and lessons learned. Trials, 428.
Temel, JS, Greer, JA, Goldberg, S, et al. (2009) A structured exercise program for patients with advanced non-small cell lung cancer. Journal of Thoracic Oncology 4, 595601.
Uster, A, Ruehlin, M, Mey, S, et al. (2017) Effects of nutrition and physical exercise intervention in palliative cancer patients: A randomized controlled trial. Clinical Nutrition (Edinburgh, Lothian).
van den Dungen, IA, Verhagen, CA, van der Graaf, WT, et al. (2014) Feasibility and impact of a physical exercise program in patients with advanced cancer: A pilot study. Journal of Palliative Medicine 17, 10911098.
Viswanathan, M, Ansari, MT, Berkman, ND, et al. (2008). Assessing the risk of bias of individual studies in systematic reviews of health care interventions. Rockville, MD: Methods Guide for Effectiveness and Comparative Effectiveness Reviews.
Walsh, JM, Hussey, J, Guinan, E, et al. (2010) ‘Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population’: a feasibility study PEACH trial: prescribed exercise after chemotherapy. BMC Cancer 10, 42.
Yu, F (2013) Improving recruitment, retention, and adherence to 6-month cycling in Alzheimer's disease. Geriatric Nursing (New York, NY) 34, 181186.
Zimmer, P, Trebing, S, Timmers-Trebing, U, et al. (2017) 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. Supportive Care in Cancer 26, 615624.

Keywords

Exercise interventions for patients with advanced cancer: A systematic review of recruitment, attrition, and exercise adherence rates

  • G. Sheill (a1), E. Guinan (a2), L. Brady (a3), D. Hevey (a4) and J. Hussey (a5)...

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