Abstract
Objectives: Physical activity (PA) is beneficial to men with prostate cancer in several ways and is associated with better survival outcomes. I aimed to examine factors related to PA behaviour in men with prostate cancer, and design and test an intervention to promote PA amongst men with prostate cancer, as part of standard clinical care.Methods: Prior to the design of the intervention, a systematic review of barriers and facilitators to PA in men with prostate cancer was undertaken. Two analyses of local clinical data relating to the local existing PA pathway were also undertaken. The findings of the review and analyses informed the design of the intervention, which was undertaken with the input of key clinical stakeholders and followed the Behaviour Change Wheel process framework for designing interventions.
A PA intervention was designed based on persuasive peer-support, to be delivered to potentially all prostate cancer patients scheduled for a radical prostatectomy in existing educational seminars. The intervention consisted of a 10-minute presentation about PA, delivered by a former patient and in a narrative style. It took place immediately following an existing 20-minute PA presentation by a cancer exercise specialist.
The intervention was tested in a pilot study that delivered the intervention in both pre-treatment and post-treatment seminars, alternating between seminars containing either: both a 20-minute cancer exercise specialist presentation + 10-minute patient presentation; or a 20-minute cancer exercise specialist presentation only. The pilot study was a mixed methods design. It quantitatively examined the effect of the intervention on self-reported physical activity (SQUASH), exercise motivation (BREQ-3), quality of life (EQ-5D-5L), and fatigue (FACIT-fatigue). Quantitative measures were taken for all participants immediately before, and 90 days after the intervention. Data were accrued on n=148 men undergoing radical prostatectomy for the quantitative aspect (n=79 control; n=69 intervention). Qualitative interviews were undertaken with 14 men who had attended an intervention seminar. Interview transcripts were analysed using thematic analysis with elements of a grounded theory approach.
Results: The systematic review included 17 quantitative reports, and 15 qualitative reports. The review found that a range of psychosocial factors can influence physical activity in men with prostate cancer, including the degree to which advice is provided by the clinical care team, and who is providing it; individual preferences for physical activity between patients and needs that can differ by treatment pathway; and psychological factors relating to peer-support and an individual’s sense of self-determination.
The results from the analyses of local clinical data indicated that: 1) men undergoing curative treatment on the local physical activity pathway (n=120, change in PA at 12 months: p=0.53) were less likely to increase and maintain physical activity than men on systematic treatment (n=76, change in PA at 12 months: p=0.04); and 2) the existing local physical activity pathway is less likely to be participated in by men who are older (adjusted OR: 0.97 per year; 95% CI: 0.95–0.98), live further from the hospital (adjusted OR: 0.94 per mile; 95% CI: 0.90–0.99), or are of a lower socioeconomic status (adjusted OR: 1.09 per deprivation rank decile increase; 95% CI: 1.03–1.16).
Results from the pilot study, following analysis using repeated measures ANOVA models to test Group*Time interaction effects, showed that the intervention did not increase self-reported PA (p=0.38) or exercise behavioural regulations (p-values range: 0.12–0.95; median p-value: 0.87) at 90 days follow up, compared with the control group. However, the intervention did have beneficial effects on quality of life (difference in mean change: +5.3 points, p=0.04) and fatigue (difference in mean change: -2.8 points, p=0.01) compared with the control group. Post hoc analyses indicated that more individuals in the intervention group experienced clinically significant benefits to both quality of life and fatigue (p=0.04 and p=0.06 respectively). Insights from the qualitative analysis described how the patients found the intervention to be beneficial to psychological wellbeing, due to a sense of reassurance about the future being provided by a trusted authority. Qualitative data included reports by some patients that they had increased their physical activity behaviour due to their experience with the intervention. Patients who qualitatively reported increased physical activity due to the intervention all appeared to have a tendency toward optimism.
Conclusions: Peer-support interventions for men with prostate cancer that are brief, delivered to many patients simultaneously, and integrated into clinical care pathways, can still yield benefits to quality of life for patients that are clinically meaningful. The use of peer-support interventions to promote physical activity in men with prostate cancer may only be effective for a certain type of individual with a tendency toward optimism. Supervised, hospital-based exercise programmes may be less likely to be accessed by those who are of a lower socioeconomic status, or who live further from the hospital site.
Future work: Further examination of this style of intervention could investigate the use of more than one patient speaker and examine training needs; consistency of delivery and outcomes; and logistics of sustained delivery. Such investigations could also examine information needs, to discern whether the intervention confers benefits to quality of life by meeting previously unmet information needs of patients.
Furthermore, it is possible that the existing findings of PA behaviour change research in prostate cancer are limited due to systemic self-selection biases. Examination of this question and any related confounders could provide information that is useful to real-world implementation of PA promotion in men with prostate cancer.
| Date of Award | 1 Sept 2020 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Mieke Van Hemelrijck (Supervisor) & Theresa Wiseman (Supervisor) |