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

Published online by Cambridge University Press:  21 May 2019

G. Sheill ,
E. Guinan ,
L. Brady ,
D. Hevey  and
J. Hussey
G. Sheill*
Affiliation:
Discipline of Physiotherapy, School of Medicine, Trinity College Centre for Health Sciences, James's Street, Dublin 8, Ireland
E. Guinan
Affiliation:
Associate Professor, Discipline of Physiotherapy, School of Medicine, Trinity College Centre for Health Sciences, James's Street, Dublin 8, Ireland
L. Brady
Affiliation:
Department of Histopathology and Morbid Anatomy, School of Medicine, Trinity College Dublin, Ireland
D. Hevey
Affiliation:
Associate Professor, School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
J. Hussey
Affiliation:
Professor Discipline of Physiotherapy, School of Medicine, Trinity College Centre for Health Sciences, James's Street, Dublin 8, Ireland
*
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
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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.

Keywords

Exerciseadvanced cancerphysical activityrecruitmentsystematic review

Information

Type
Review Article
Information
Palliative & Supportive Care , Volume 17 , Issue 6 , December 2019 , pp. 686 - 696
Copyright
Copyright © Cambridge University Press 2019 

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References

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, 77–83.Google Scholar
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, 293–300.Google Scholar
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, 141–153.Google Scholar
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, 647–657.Google Scholar
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, 865–872.Google Scholar
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.Google Scholar
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, 611–619.Google Scholar
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, 495–501.Google Scholar
Cohen, J (1992) A power primer. Psychological Bulletin 112, 155–159.Google Scholar
Comet Initiative 2013 Core outcome measures for effectiveness studies. http://www.comet-initiative.org/ (Last Accessed 5 January 2018)Google Scholar
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, 328–335.Google Scholar
Courneya, KS and Friedenreich, CM (2007) Physical activity and cancer control. Seminars in Oncology Nursing, 23, 242–252.Google Scholar
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, 116–122.Google Scholar
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, 129–133.Google Scholar
Dittus, KL, Gramling, RE, and Ades, PA (2017) Exercise interventions for individuals with advanced cancer: A systematic review. Preventive Medicine 104, 124–132.Google Scholar
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, 1471–1474.Google Scholar
Elsawy, B and Higgins, KE (2010) Physical activity guidelines for older adults. American Family Physician 81, 55–59.Google Scholar
Fidler, M (1981) Incidence of fracture through metastases in long bones. Acta Orthopaedica Scandinavica 52, 623–627.Google Scholar
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, 1929–1941.Google Scholar
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.Google Scholar
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, 977–983.Google Scholar
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=5653Google Scholar
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, 3169–3177.Google Scholar
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, 2593–2606.Google Scholar
Jack, K, McLean, SM, Moffett, JK, et al. (2010) Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual Therapy 15, 220–228.Google Scholar
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, 1797–1806.Google Scholar
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.Google Scholar
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, 1169–1177.Google Scholar
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), 2329–2335.Google Scholar
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.Google Scholar
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, 2357–2367.Google Scholar
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, 204–210.Google Scholar
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, 383–390.Google Scholar
Maher, CG, Sherrington, C, Herbert, RD, et al. (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy 83, 713–721.Google Scholar
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, 2087–2092.Google Scholar
Oldervoll, LM, Loge, JH, Lydersen, S, et al. (2011) Physical exercise for cancer patients with advanced disease: A randomized controlled trial. The Oncologist 16, 1649–1657.Google Scholar
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, 281–287.Google Scholar
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, 421–430.Google Scholar
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, 457–463.Google Scholar
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), 30–36.Google Scholar
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, 203–208.Google Scholar
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, 618–628.Google Scholar
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, 40–45.Google Scholar
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, 534–541.Google Scholar
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, 843–864.Google Scholar
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.Google Scholar
Siddiqi, AE, Sikorskii, A, Given, CW, et al. (2008) Early participant attrition from clinical trials: Role of trial design and logistics. Clinical Trials 5, 328–335.Google Scholar
Silverberg, E, Boring, CC, and Squires, TS (1990). Cancer statistics, 1990. A Cancer Journal for Clinicians 40, 9–26.Google Scholar
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.Google Scholar
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, 595–601.Google Scholar
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).Google Scholar
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, 1091–1098.Google Scholar
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.Google Scholar
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.Google Scholar
Yu, F (2013) Improving recruitment, retention, and adherence to 6-month cycling in Alzheimer's disease. Geriatric Nursing (New York, NY) 34, 181–186.Google Scholar
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, 615–624.Google Scholar