Authors Keogh HWL, Patel A, Macleod RD, et al.
Review Date January 2015
Citation European Journal of Cancer Care 2014; 23: 263-273
Prostate cancer accounts for 18% of all new cancer cases in Australia every year. While survival is likely—88% men are living 5 years after diagnosis—many experience a reduced quality of life, partly due to the side effects of treatment. Androgen deprivation therapy (ADT) is a commonly used treatment that reduces cancer progression by reducing the effects of ‘male’ hormones. Side effects include reduced muscle and bone mass, and increased fat mass. Physical activity plays a pivotal role in men’s recovery from prostate cancer and treatment side effects. Researchers have only recently begun using qualitative methods to capture rich data on perceptions of physical activity amongst men with prostate cancer. This research has focused on men’s perceived benefits of activity; less is known about their views on barriers and facilitators, and few have accounted for ADT use among participants.
The primary aim of this study was to better understand the barriers and facilitators to physical activity in men with prostate cancer. A secondary aim was to gain insight into how ADT use might influence these perceptions.
Two focus groups were conducted: one with men who had used ADT continuously for at least 6 months and another with men who had never used ADT. Participants were recruited via urologists in private practice and a public hospital; nineteen letters of invitation were sent. Each focus group discussion was audiotaped and transcribed. Transcripts were analysed by three researchers using an inductive thematic approach.
Six men who were using ADT and eight men who had never used ADT agreed to participate in the study. Each focus group was between 50 and 70 minutes in duration.
Facilitators to physical activity Men in both groups reported their spouse as being highly influential in their undertaking of exercise due to their advice and/or being their exercise partner. The second facilitator to physical activity was advice from their clinician (e.g. urologist and/or GP). This advice focused on weight status and cardio-metabolic health risk.
Several men in the non-ADT group had ongoing issues with incontinence which led them to do continence physiotherapy which in turn lessened their concern about exercising. Those in the ADT group appeared to have a greater sense of personal involvement in their survivorship and believe their clinicians needed to provide more specific advice with regards to exercise they should be doing after diagnosis. As a result, these men were independent in sourcing information relating to their physical activity needs. This group also highlighted the need to hear advice from other survivors, not just clinicians.
Barriers to physical activity Men in both groups reported additional co-morbidities and increased age as perceived barriers to exercising.
Participants in the ADT group felt that therapy may have exacerbated their fatigue and reduced their motivation to be physically active, and that their doctors were not currently addressing all of their concerns about how these side-effects could be reduced. The non-ADT group cited time constraints associated with their employment as being a key barrier to physical activity.
Cancer clinicians need to discuss with their patients the role physical activity plays within their overall treatment. For those on ADT therapy, these discussions may need to be more detailed and include more time for men to ask questions and discuss their concerns. Should the man be comfortable to do so, spouses or other close family or friends may also be invited into these discussions. The authors recommend clinicians first outline the benefits of physical activity, and then identify the primary facilitators and barriers for the individual patient so as to develop strategies that will assist their physical activity engagement.
Points to Note
- Physical activity is important for men recovering from prostate cancer. Little is known about the facilitators and barriers to men’s physical activity post-diagnosis, and the potential differences in these between those who have ADT therapy and those who do not.
- Focus groups with those who had undergone ADT and those who had not were conducted with participants recruited via urologists in public and private clinics.
- Men in both groups identified their spouse and clinician as facilitators of physical activity, and their increased age and co-morbidities as barriers.
- Men in the ADT group highlighted issues with their clinicians as a barrier to activity while men in the non-ADT group discussed factors not directly related to their health care such as their employment.
- This study found the support and encouragement of men’s spouses (presumably most were female) to be a facilitator in their physical activity. Many women shoulder the burden of their male partner’s health due to traditional gender roles prevalent within Western society; clinicians should be careful not to add to this. While spouses may be invited into discussions it’s important that all health advice is directed to the individual man.