Cancer related fatigue (CrF) is a debilitating side effect reported by cancer survivors, often lasting years following treatment. Although some evidence exists of a beneficial effect of exercise on CrF, there are critical shortcomings in the literature. Previous exercise rehabilitation studies did not specifically target fatigued cancer survivors. Most studies also lacked an appropriate control condition to isolate the effects of exercise per se. This thesis is comprised of three studies. The first study, an efficacy study, compared the effects of a 10-wk exercise intervention to a health education intervention on fatigue, fitness and psychological health outcomes in post-treatment cancer survivors with documented fatigue. The 37 post-treatment cancer survivors (33 females, 20 severe fatigue, 11 moderate fatigue, 30 breast cancer, aged 55±2 y, 2.3±0.3 y since treatment; mean±SEM) were allocated to an exercise group (EXG, n=19) or health education comparison group (HEG, n=18). The intervention effect on FACT-F determined fatigue was significantly greater (p<0.05) in EXG compared to HEG. The net change in fatigue was of considerable magnitude (Cohen’s d = 1.38, 4 times the FACT-F clinical important difference). The EXG also increased (p<0.05) cognitive function, global quality of life, fitness scores and significantly reduced (p<0.05) insomnia and fear of physical activity. The intervention effect on fatigue in EXG was largely achieved by wk 4 and changes were all sustained to 26 wk. There was 100% retention rate at 10-wk in both experimental groups and no adverse events reported. The second study, a qualitative exploratory study, explored survivors’ perceptions and experiences of CrF, management of this fatigue, and experiences of the 10-week exercise programme. Two focus groups and four individual interviews were held with 14 programme participants. The results provide a deeper understanding of the quantitative results observed in the efficacy study. Results suggest that CrF not only affects cancer survivors physically, it affects them mentally, socially and financially. Barriers, facilitators, preferences, and motives to exercise in fatigued survivors are also elucidated. It was concluded that a tailored exercise programme designed specifically to the needs of cancer survivors can have a multitude of physical, psychological, social and educational benefits. The combination of elements in the exercise programme was identified as fundamental and access to such a programme should be a routine part of cancer care. The third study, a qualitative feasibility study, examined the factors influencing the subsequent implementation of the exercise rehabilitation programme in a community setting. Semi-structured individual interviews (n=15) were undertaken with survivors who agreed and declined to participate in the programme, programme delivery agents, and cancer healthcare professionals. Implementation was examined using Fixsen’s Active Implementation Frameworks with Glasgow’s ‘Reach, Effectiveness, Adoption, Implementation, Maintenance Framework’. Implementation appears to be most successful where an enabled environment is created, a collaborative multidisciplinary team are involved, champions exist in recruitment settings and an overall programme leader exists to co-ordinate. Barriers and challenges to programme scale up outside of a major urban centre included accessibility to the target population and financial support from relevant agencies. Future cost effectiveness research needs to be undertaken if exercise programmes are to be incorporated into routine cancer care.
|Publication status||Unpublished - 2018|
- Cancer, cancer fatigue, exercise