The experience of cancer-related fatigue, exercise and exercise adherence among women breast cancer survivors: Insights from focus group interviews
Sue Kim PhD, RN
Professor
Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
Search for more papers by this authorJeehee Han PhD, RN
Research Associate
Yonsei University College of Nursing, Seoul, Republic of Korea
Search for more papers by this authorMin Young Lee BS, RN
Graduate Student
Yonsei University College of Nursing, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Min Kyeong Jang KOAPN, PhD, RN
Postdoctoral Fellow
University of Illinois Cancer Center, Chicago, IL, USA
College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
Correspondence
Min Kyeong Jang, 845 South Damen Ave, Room 1142, Chicago, IL 60612-7350, USA.
Email: [email protected]
Search for more papers by this authorSue Kim PhD, RN
Professor
Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
Search for more papers by this authorJeehee Han PhD, RN
Research Associate
Yonsei University College of Nursing, Seoul, Republic of Korea
Search for more papers by this authorMin Young Lee BS, RN
Graduate Student
Yonsei University College of Nursing, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Min Kyeong Jang KOAPN, PhD, RN
Postdoctoral Fellow
University of Illinois Cancer Center, Chicago, IL, USA
College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
Correspondence
Min Kyeong Jang, 845 South Damen Ave, Room 1142, Chicago, IL 60612-7350, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Aims and objectives
To identify the experience of breast cancer survivors regarding cancer-related fatigue, exercise and exercise adherence.
Background
Cancer-related fatigue is a common symptom among cancer survivors that limits quality of life. Despite exercise being recommended as a viable solution to manage cancer-related fatigue, relatively few research studies on the experience of cancer-related fatigue and exercise adherence have been conducted.
Design
This was a qualitative study to identify breast cancer survivors’ experience of cancer-related fatigue, exercise and exercise adherence. This paper adhered to the COREQ checklist in reporting.
Methods
Four focus group interviews were conducted with 16 breast cancer survivors who had fatigue score of 4 out of 10 (moderate fatigue) or greater. Ethical approval was obtained and participants met for focus group interview discussion. The interview guide included questions on cancer-related fatigue, barriers and facilitators of exercising, strategies for exercise adherence and suggestions for a supportive programme.
Results
Four themes were identified through thematic analysis: (a) The insidious and overpowering nature of cancer-related fatigue; (b) exercising when experiencing fatigue surrounded by prevailing myths; (c) multiple barriers to exercise; and (d) facilitative factors to continue exercising despite fatigue.
Conclusions
Participants’ experience of moderate or greater cancer-related fatigue prevented them from exercising, despite knowing its importance, and limited them to passive activities. Misconceptions that exercise is associated with lymphedema and risk of recurrence, poor psychosocial self-image and lack of clear knowledge and exercise programmes for cancer survivors further limited adherence to exercise. In contrast, finding comfort and strength through exercising and interacting with other breast cancer survivors were facilitative factors.
Relevance to clinical practice
The insights shared by breast cancer survivors experiencing cancer-related fatigue can contribute to developing an exercise adherence programme as a way to manage and alleviate fatigue and establish healthy survivorship care.
CONFLICT OF INTEREST
The authors declare that they have no conflicts of interest.
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REFERENCES
- Abrahams, H. J. G., Gielissen, M. F. M., Schmits, I. C., Verhagen, C. A. H. H. V. M., Rovers, M. M., & Knoop, H. (2016). Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: A meta-analysis involving 12327 breast cancer survivors. Annals of Oncology, 27(6), 965–974. https://doi.org/10.1093/annonc/mdw099
- Alfano, C. M., Molfino, A., & Muscaritoli, M. (2013). Interventions to promote energy balance and cancer survivorship. Cancer, 119(11), 2143–2150. https://doi.org/10.1002/cncr.28062
- Ammitzbøll, G., Søgaard, K., Karlsen, R. V., Tjønneland, A., Johansen, C., Frederiksen, K., & Bidstrup, P. (2016). Physical activity and survival in breast cancer. European Journal of Cancer, 66, 67–74. https://doi.org/10.1016/j.ejca.2016.07.010
- Berger, A. M., Kuhn, B. R., Farr, L. A., Von Essen, S. G., Chamberlain, J., Lynch, J. C., & Agrawal, S. (2009). One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. Journal of Clinical Oncology, 27(35), 6033–6040. https://doi.org/10.1200/JCO.2008.20.8306
- Berger, A. M., Mooney, K., Alvarez-Perez, A., Breitbart, W. S., Carpenter, K. M., Cella, D., …Smith, C.; National Comprehensive Cancer Network. (2015). Cancer-related fatigue, version 2.2015. Journal of the National Comprehensive Cancer Network, 13(8), 1012–1039. https://doi.org/10.6004/jnccn.2015.0122
- Berger, A. M., Mooney, K., Banerjee, C., Breitbart, W. S., Carpenter, K. M., Chang, Y., …Walter, M.; National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. (2018). Cancer-Related Fatigue, Version 2.2018. Retrieved from https://oncolife.com.ua/doc/nccn/fatigue.pdf
- Blaney, J., Lowe-Strong, A., Rankin, J., Campbell, A., Allen, J., & Gracey, J. (2016). The cancer rehabilitation journey: Barriers to and facilitators of exercise among patients with cancer-related fatigue. Physical Therapy, 90(8), 1135–1147. https://doi.org/10.2522/ptj.20090278
- Blaney, J., Lowe-Strong, A., Rankin-Watt, J., Campbell, A., & Gracey, J. (2013). Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: A questionnaire–survey. Psycho-Oncology, 22(1), 186–194. https://doi.org/10.1002/pon.2072
- Bower, J. E. (2005). Prevalence and causes of fatigue after cancer treatment: The next generation of research. Journal of Clinical Oncology, 23(33), 8280–8282. https://doi.org/10.1200/JCO.2005.08.008
- Bower, J. E. (2014). Cancer-related fatigue—mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology, 11(10), 597–609. https://doi.org/10.1038/nrclinonc.2014.127
- Bower, J. E., Wiley, J., Petersen, L., Irwin, M. R., Cole, S. W., & Ganz, P. A. (2018). Fatigue after breast cancer treatment: Biobehavioral predictors of fatigue trajectories. Health Psychology, 37(11), 1025–1034. https://doi.org/10.1037/hea0000652
- Brown, J. C., Huedo-Medina, T. B., Pescatello, L. S., Pescatello, S. M., Ferrer, R. A., & Johnson, B. T. (2011). Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: A meta-analysis. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 20(1), 123–133. https://doi.org/10.1158/1055-9965.EPI-10-0988
- Brunet, J., Taran, S., Burke, S., & Sabiston, C. M. (2013). A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer. Disability and Rehabilitation, 35(24), 2038–2045. https://doi.org/10.3109/09638288.2013.802378
- Casellas-Grau, A., Font, A., & Vives, J. (2014). Positive psychology interventions in breast cancer. A systematic review. Psycho-Oncology, 23(1), 9–19. https://doi.org/10.1002/pon.3353
- Courneya, K. S., Rogers, L. Q., Campbell, K. L., Vallance, J. K., & Friedenreich, C. M. (2015). Top 10 research questions related to physical activity and cancer survivorship. Research Quarterly for Exercise and Sport, 86(2), 107–116. https://doi.org/10.1080/02701367.2015.991265
- de M Alcântara-Silva, T. R., Freitas-Junior, R., Freitas, N. M. A., & Machado, G. D. P. (2013). Fatigue related to radiotherapy for breast and/or gynaecological cancer: A systematic review. Journal of Clinical Nursing, 22(19–20), 2679–2686. https://doi.org/10.1111/jocn.12236
- DeSantis, C., Ma, J., Bryan, L., & Jemal, A. (2014). Breast cancer statistics, 2013. CA: A Cancer Journal for Clinicians, 64(1), 52–62. https://doi.org/10.3322/caac.21203
- Gaillard, S., & Stearns, V. (2011). Aromatase inhibitor-associated bone and musculoskeletal effects: New evidence defining etiology and strategies for management. Breast Cancer Research, 13(2), 205. https://doi.org/10.1186/bcr2818
- Harrington, C. B., Hansen, J. A., Moskowitz, M., Todd, B. L., & Feuerstein, M. (2010). It's not over when it's over: Long-term symptoms in cancer survivors—a systematic review. The International Journal of Psychiatry in Medicine, 40(2), 163–181. https://doi.org/10.2190/PM.40.2.c
- Holmes, M. D., Chen, W. Y., Feskanich, D., Kroenke, C. H., & Colditz, G. A. (2005). Physical activity and survival after breast cancer diagnosis. Journal of the American Medical Association, 293(20), 2479–2486. https://doi.org/10.1001/jama.293.20.2479
- Irwin, M. L., Smith, A. W., McTiernan, A., Ballard-Barbash, R., Cronin, K., Gilliland, F. D., … Bernstein, L. (2008). Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: The health, eating, activity, and lifestyle study. Journal of Clinical Oncology, 26(24), 3958–3964. https://doi.org/10.1200/JCO.2007.15.9822
- Jung, K., Won, Y., Oh, C., Kong, H., Lee, D. H., & Lee, K. H. (2017). Cancer statistics in Korea: Incidence, mortality, survival, and prevalence in 2014. Cancer Research and Treatment, 49(2), 292–305. https://doi.org/10.4143/crt.2017.118
- Kampshoff, C. S., Jansen, F., van Mechelen, W., May, A. M., Brug, J., Chinapaw, M. J., & Buffart, L. M. (2014). Determinants of exercise adherence and maintenance among cancer survivors: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 80. https://doi.org/10.1186/1479-5868-11-80
- Kessels, E., Husson, O., & Van der Feltz-Cornelis, C. M. (2018). The effect of exercise on cancer-related fatigue in cancer survivors: A systematic review and meta-analysis. Neuropsychiatric Disease and Treatment, 14, 479–494. https://doi.org/10.2147/NDT.S150464
- Krueger, R. A. (2014). Focus groups: A practical guide for applied research. India: SAGE Publications Asia-Pacific Pte, Ltd.
- Mason, C., Alfano, C. M., Smith, A. W., Wang, C.-Y., Neuhouser, M. L., Duggan, C., … McTiernan, A. (2013). Long-term physical activity trends in breast cancer survivors. Cancer Epidemiology and Prevention Biomarkers, 22(6), 1153–1161. https://doi.org/10.1158/1055-9965.EPI-13-0141
- McMillan, E. M., & Newhouse, I. J. (2011). Exercise is an effective treatment modality for reducing cancer-related fatigue and improving physical capacity in cancer patients and survivors: A meta-analysis. Applied Physiology, Nutrition, and Metabolism, 36(6), 892–903. https://doi.org/10.1139/h11-082
- Meneses-Echávez, J. F., González-Jiménez, E., & Ramírez-Vélez, R. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: A systematic review and meta-analysis. BMC Cancer, 15(1), 77. https://doi.org/10.1186/s12885-015-1069-4
- Miltenburg, N., & Boogerd, W. (2014). Chemotherapy-induced neuropathy: A comprehensive survey. Cancer Treatment Reviews, 40(7), 872–882. https://doi.org/10.1016/j.ctrv.2014.04.004
- Mustian, K. M., Alfano, C. M., Heckler, C., Kleckner, A. S., Kleckner, I. R., Leach, C. R., … Miller, S. M. (2017). Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: A meta-analysis. Journal of the American Medical Association Oncology, 3(7), 961–968. https://doi.org/10.1001/jamaoncol.2016.6914
- Mustian, K. M., Cole, C. L., Lin, P. J., Asare, M., Fung, C., Janelsins, M. C., … Magnuson, A. (2016). Exercise recommendations for the management of symptoms clusters resulting from cancer and cancer treatments. Seminars in Oncology Nursing, 32(4), 383–393. https://doi.org/10.1016/j.soncn.2016.09.002
- Noal, S., Levy, C., Hardouin, A., Rieux, C., Heutte, N., Ségura, C., … Joly, F. (2011). One-year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer. International Journal of Radiation Oncology*Biology*Physics, 81(3), 795–803. https://doi.org/10.1016/j.ijrobp.2010.06.037
- Park, E. H., Min, S. Y., Kim, Z., Yoon, C. S., Jung, K.-W., Nam, S. J., … Hur, M. H. (2017). Basic facts of breast cancer in Korea in 2014: The 10-year overall survival progress. Journal of Breast Cancer, 20(1), 1–11. https://doi.org/10.4048/jbc.2017.20.1.1
- Phillips, S. M., & McAuley, E. (2013). Physical activity and fatigue in breast cancer survivors: A panel model examining the role of self-efficacy and depression. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 22(5), 773–781. https://doi.org/10.1158/1055-9965.EPI-12-0983
- Piacentine, L. B., Robinson, K. M., Waltke, L. J., Tjoe, J. A., & Ng, A. V. (2018). Promoting team-based exercise among African American breast cancer survivors. Western Journal of Nursing Research, 40(12), 1885–1902. https://doi.org/10.1177/0193945918795313
- Pinto, B., Stein, K., & Dunsiger, S. (2015a). Peers promoting physical activity among breast cancer survivors: A randomized controlled trial. Health Psychology, 34(5), 463. https://doi.org/10.1037/hea0000120
- Pinto, B., Stein, K., & Dunsiger, S. (2015b). Peer mentorship to promote physical activity among cancer survivors: Effects on quality of life. Psycho-Oncology, 24(10), 1295–1302. https://doi.org/10.1002/pon.3884
- Playdon, M. C., Bracken, M. B., Sanft, T. B., Ligibel, J. A., Harrigan, M., & Irwin, M. L. (2015). Weight gain after breast cancer diagnosis and all-cause mortality: Systematic review and meta-analysis. Journal of the National Cancer Institute, 107(12), 1–15.
10.1093/jnci/djv275 Google Scholar
- Przezdziecki, A., Sherman, K. A., Baillie, A., Taylor, A., Foley, E., & Stalgis-Bilinski, K. (2013). My changed body: Breast cancer, body image, distress and self-compassion. Psycho-Oncology, 22(8), 1872–1879. https://doi.org/10.1002/pon.3230
- Robertson, L., Richards, R., Egan, R., & Szymlek-Gay, E. A. (2013). Promotion and support of physical activity among cancer survivors: A service provider perspective. Psycho-Oncology, 22(2), 441–446. https://doi.org/10.1002/pon.3032
- Robinson, K. M., Piacentine, L. B., Waltke, L. J., Ng, A. V., & Tjoe, J. A. (2016). Survivors speak: A qualitative analysis of motivational factors influencing breast cancer survivors’ participation in a sprint distance triathlon. Journal of Clinical Nursing, 25(1–2), 247–256. https://doi.org/10.1111/jocn.13067
- Runowicz, C. D., Leach, C. R., Henry, N. L., Henry, K. S., Mackey, H. T., Cowens-Alvarado, R. L., … Jacobs, L. A. (2016). American cancer society/American society of clinical oncology breast cancer survivorship care guideline. CA: A Cancer Journal for Clinicians, 66(1), 43–73. https://doi.org/10.3322/caac.21319
- Ryan, J. L., Carroll, J. K., Ryan, E. P., Mustian, K. M., Fiscella, K., & Morrow, G. R. (2007). Mechanisms of cancer-related fatigue. The Oncologist, 12(1), 22–34. https://doi.org/10.1634/theoncologist.12-S1-22
- Sagen, Å., Kåresen, R., & Risberg, M. A. (2009). Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Acta Oncologica, 48(8), 1102–1110. https://doi.org/10.3109/02841860903061683
- Schmitz, K. H., & Speck, R. M. (2010). Risks and benefits of physical activity among breast cancer survivors who have completed treatment. Women’s Health, 6(2), 221–238.
10.2217/WHE.10.1 Google Scholar
- Siegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019. CA: A Cancer Journal for Clinicians, 69(1), 7–34. https://doi.org/10.3322/caac.21551
- Tomlinson, D., Diorio, C., Beyene, J., & Sung, L. (2014). Effect of exercise on cancer-related fatigue: A meta-analysis. American Journal of Physical Medicine & Rehabilitation, 93(8), 675–686. https://doi.org/10.1097/PHM.0000000000000083
- Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
- Ussher, J., Kirsten, L., Butow, P., & Sandoval, M. (2006). What do cancer support groups provide which other supportive relationships do not? the experience of peer support groups for people with cancer. Social Science & Medicine, 62(10), 2565–2576. https://doi.org/10.1016/j.socscimed.2005.10.034
- Vallance, J., Plotnikoff, R. C., Karvinen, K. H., Mackey, J. R., & Courneya, K. S. (2010). Understanding physical activity maintenance in breast cancer survivors. American Journal of Health Behavior, 34(2), 225–236. https://doi.org/10.5993/AJHB.34.2.10
- Weis, J. (2011). Cancer-related fatigue: Prevalence, assessment and treatment strategies. Expert Review of Pharmacoeconomics & Outcomes Research, 11(4), 441–446. https://doi.org/10.1586/erp.11.44
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