Oncologists Reluctant to Give Exercise Recommendations to Cancer Patients

Both oncologists and cancer patients recognize the benefits of physical activity during treatment, but oncologists may feel ill-equipped to give recommendations on exercise, according to a new study.

“Our results indicate that exercise is perceived as important to patients with cancer, both from a patient and physician perspective; however, physicians are reluctant to consistently include physical activity recommendations in their patient discussions. Our findings highlight the value of examining both patient and provider attitudes and behavioral intentions,” said lead author Agnes Smaradottir, MD, a medical oncologist at Gundersen Health System in La Crosse, Wisconsin. “While we uncovered barriers to exercise recommendations, questions remain on how to bridge the gap between patient and provider preferences.”

The researchers published their results in JNCCN.

Currently, the NCCN Clinical Practice Guidelines in Oncology for Survivorship recommend exercise for cancer survivors.

Exercise can help patients deal with symptom management and reduce the risk of recurrence, however, some of the barriers to implementation of patient-centered exercise programs include limited resources, expert personnel, and knowledge of benefits of exercise.

Smaradottir and colleagues conducted focus groups and interviews with 20 patients with both metastatic and non-metastatic disease, and nine oncology providers. The patients, aged 45 and older, included 10 patients with stage I–III cancer after adjuvant therapy and 10 with stage IV disease undergoing palliative treatment, both across multiple tumor types.

Nearly all of the patients (95%) said they felt exercise is important during cancer treatment, citing overall well-being benefits vs improved disease outcome. Yet, only three patients recalled receiving physical activity instruction from oncology providers during their cancer treatment.

Only one of the nine clinicians surveyed documented discussion of exercise in patient charts.

Most patients (80%) preferred a home-based exercise program provided by the oncologist. Fatigue was the most cited barrier to regular exercise during treatment (50%).

The practitioners said they preferred to refer patients to specialists for exercise recommendations, noting mounting clinic schedules and a lack of education about appropriate physical activity recommendations. They also were concerned about asking patients to be more physically active during chemotherapy and radiation, and also were apprehensive about prescribing physical activity to frail patients with limited mobility.

“We were surprised by the gap in expectations regarding exercise recommendation between patients and providers. Many providers, ourselves included, thought patients would prefer to be referred to an exercise center, but they clearly preferred to have a home-based program recommended by their oncologist,” said Smaradottir.

The researchers suggested an education protocol with a multidisciplinary collaboration between cancer treatment providers and physical therapy specialists, exercise physiologists, and other subspecialties. They emphasized that this should be a patient-centered approach with individual exercise recommendations.

“Indeed, physicians, fellows, and residents who collaborate with a physical activity specialist through a shared-care clinic visit will gain valuable education about how to discuss exercise recommendations with their patients,” said Smaradottir.