Survivorship Symposium 2017: Physical and Psychological Factors Contribute to Decreased Physical Activity in 75% of Patients With Cancer


Key Points

  • As many as 75% of patients with cancer reported reducing their physical activity levels following a cancer diagnosis, citing fatigue and pain from their cancer or its treatment and difficulty getting and staying motivated as the barriers to maintaining physical activity levels.
  • The study results suggest new methods are needed to support and facilitate physical activity throughout patients’ cancer care continuum.
  • Cancer care teams can help their patients maintain physical activity while undergoing treatment by addressing their psychological and physical barriers to exercise and personalizing an exercise plan to meet the needs of each patient.


Although, in the past, patients with cancer were often counseled by their physicians to rest and reduce their physical activity, according to the American Cancer Society, emerging data are showing that exercise is not only safe and possible during cancer treatment, it can improve patients’ physical function and quality of life.

However, despite the benefits of physical activity during cancer treatment, a study by Romero et al has found that as many as 75% of patients with cancer report reducing their physical activity levels following a cancer diagnosis. Psychological barriers, including difficulty getting motivated and remaining disciplined as well as physical symptoms, such as fatigue and pain, were identified as contributing to patients’ decreased activity. Interventions targeting these barriers are needed to promote maintenance of physical activity levels throughout the cancer care continuum, noted the study authors.

The study will be presented at the 2017 Cancer Survivorship Symposium in San Diego, California, January 27–28, 2017.

Study Methodology

The researchers conducted a one-time survey of 662 patients, mean age of 59.9 years, with common cancers who were being treated at health-care facilities in Philadelphia, Pennsylvania. The cancer types included breast (32%), lung/thoracic (15%), and hematologic cancers (15%). A total of 53% of the patients had nonmetastatic disease, and 53% were more than 1 year post their cancer diagnosis. The majority of the patients were female (65%); white (81%); overweight/obese (65%); and had received chemotherapy (88%), radiation therapy (53%), and/or surgery (53%).

The researchers conducted chi-square tests and multivariate logistic regression models to examine patient demographics, clinical characteristics, and self-reported barriers associated with decrease in physical activity levels since their cancer diagnosis.

Study Findings

The researchers found that since their cancer diagnosis, 499 participants (75%) reported decreasing their physical activity levels, 16% maintained their physical activity levels, and 4% increased their physical activity levels. In multivariate analyses, decreased physical activity levels were significantly associated with receiving chemotherapy (adjusted odds ratio [AOR] = 3.54, 95% confidence interval [CI] = 2.06–6.06) and having metastatic disease (AOR = 1.64, 95% CI = 1.07–2.52).

In terms of physical activity, the most common barriers were fatigue (78%), pain (71%), difficulty getting motivated (68%), and difficulty remaining disciplined (65%). In bivariate analyses, the presence of symptoms, such as pain, nausea, fatigue, treatment side effects, surgical complications, difficulty getting motivated, difficulty remaining disciplined, and sadness, was significantly associated with decreasing physical activity levels (P < .05).

Helping Patients Overcome Obstacles

“Cancer patients should have dealt with their [oncology health-] care teams regarding exercise to stay as physically active as possible during and after their cancer treatment,” said Sally A.D. Romero, PhD, MPH, lead author of this study and a postdoctoral research fellow at Memorial Sloan Kettering Cancer Center, during a press briefing announcing the study findings. “And cancer care teams need to help patients think about physical activity in new ways while personalizing their care. The care team can provide patients with treatment and integrative therapies and help manage their symptoms, so that patients can continue to maintain their level of physical activity. Also, the cancer care team can refer patients to support groups or exercise classes geared toward cancer patients and survivors.”

“This study highlights the need for physicians to not just recommend exercise, but to ask the next questions of our patients, mainly, “What is keeping you from exercising?” and “How can we help you overcome those barriers?” said Merry Jennifer Markham, MD, ASCO expert and moderator of the press briefing.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.