At the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Karen Basen-Engquist, PhD, MPH, Director of the Center for Energy Balance in Cancer Prevention and Survivorship at The University of Texas MD Anderson Cancer Center, sat down with Oncology Data Advisor after presenting her education session on behavioral strategies to get your patients with cancer exercising and why it is important.
Oncology Data Advisor: Welcome to Oncology Data Advisor. I am here with Dr. Karen Basen-Engquist at the ASCO 2022 Meeting, where she was part of a very interesting session, a practical toolkit to getting your patients moving and why it matters. Dr. Basen-Engquist, what benefits does exercise have for patients with cancer?
Karen Basen-Engquist, PhD, MPH: Oh, exercise is tremendously beneficial for patients with cancer. We have randomized trials that have demonstrated that exercise helps remediate fatigue. It helps improve people's physical functionality. It helps with improving quality of life and reducing symptoms of anxiety and depression. There's also limited data, but still, some data indicating that it may improve sleep, which is another very common problem that cancer patients and survivors have. We also have observational data that indicates that survivors who are physically active—particularly breast, colorectal, and prostate cancer survivors—if they're physically active after their diagnosis, they're less likely to die of their cancer.
Oncology Data Advisor: Do you think exercise should be prescribed as medicine for patients with cancer?
Dr. Basen-Engquist: Absolutely. I think it's something that every oncologist should talk about with their patients, and then every oncology team. I think the nurses are really critical to this too. The doctor doesn't always have time to do everything, and nurses are often so helpful to patients in terms of managing the symptoms and side effects of treatment, that they should be talking about exercise to patients as well. Of course, there are some instances where exercise might not be appropriate at certain times—if a patient is really having trouble staying hydrated because of diarrhea or vomiting or things like that. But once the patient has gotten through that kind of crisis, exercise is likely to be appropriate again.
Oncology Data Advisor: Do you have any strategies you could recommend for clinicians in helping to get their patients to exercise?
Dr. Basen-Engquist: Yes. First of all, raise the subject. Most patients say that they want to hear from their doctors about exercise. They want to know what their health care team thinks about doing that. So please bring it up. We recommend that you ask patients how much they're exercising. If they're not meeting the recommendations of 150 minutes of aerobic, or at least 90 minutes of aerobic for patients under active treatment per week, and they're not doing strength training twice a week, then they're not meeting the recommendations, so they could benefit from increasing their physical activity.
First ask about that, and if they are not meeting the recommendations, do an assessment of where this patient is physically, what kind of program should they go to, or whether they could just exercise on their own. Many patients, especially, if they're planning to do walking or things like that, can do that sort of thing on their own. If they're doing more structured exercise, like strength training, if they're interested in that, they might want to at least initially seek out a more supervised program.
Oncology Data Advisor: That's great advice. Do you think that the patients should set some sort of goal, or do you have any ideas for how to help them set goals?
Dr. Basen-Engquist: Yes. Goal-setting is one of the techniques that we use in working with patients on behavior change. We recommend thinking about both short-term goals, as well as long-term goals. The short-term goals are things like, "I'm going to exercise 10 minutes a day, three times this week, and then next week I'll try to move it up to 12 minutes or four days, or gradually increase." With the short-term goals, we really want people to think about SMART goals, right? Specific, measurable, attainable, realistic, and testable.
So, we want the goals to be something specific where they can easily gauge their progress. We also want patients to think about long-term goals. Providers and nurses can ask patients about sort of the big "why." How could exercise be helpful to you? How could it be helpful to you in kind of achieving some of the things you'd like to achieve? Maybe it's having more energy, so you can engage in activities you value, like spending time with family or traveling or doing your volunteer work or doing your job.
Another tip is to really think about where the patient is in terms of what kind of exercise they're interested in. It's always easier to do something we enjoy."by Author
Oncology Data Advisor: Do you have any other tips that you would like to add for oncology nurses in promoting exercise among their patients?
Dr. Basen-Engquist: Sure. I think another tip is to really think about where the patient is in terms of what kind of exercise they're interested in. It's always easier to do something we enjoy. We know that if a patient really doesn't enjoy a certain type of exercise, they're unlikely to stick with it. When helping a patient identify what kind of activity they most enjoy or are most interested in, or if they just say, "I hate exercise, there's no way there's any kind of activity to enjoy," think about helping them pair it with something they do enjoy. A lot of people watch movies while they're on the treadmill or read on their e-reader while they're walking on a treadmill, or listen to eBooks when they walk outside. So, there are things you can pair together with exercise to make it more pleasurable even for those people who don't like it.
Oncology Data Advisor: Well, thanks so much, that was all great advice.
Dr. Basen-Engquist: You're very welcome. Thanks for helping to get the word out.
About Dr. Basen-Engquist
Karen Basen-Engquist is a Professor of Behavioral Science and Director of the Center for Energy Balance in Cancer Prevention and Survivorship at The University of Texas MD Anderson Cancer Center. Her research interests include exercise, cancer prevention and survivorship, weight management, and energy balance, with a focus on cancer survivors and the role of health behavior interventions in decreasing the severity of late effects of cancer treatment, improving physical functioning, optimizing quality of life, and reducing risk of chronic diseases in these patients. Dr. Basen-Engquist helps lead Active Living After Cancer (ALAC), a program that helps build quality of life in cancer survivors around Houston and El Paso, Texas. Recently, she completed a National Cancer Institute (NCI)–funded Research Project (R01) study that used a social cognitive theory model to investigate the implementation and maintenance of exercise among survivors of endometrial cancer.
For More Information
Basen-Engquist K (2022). Please move: behavioral health strategies to get your patients exercising. Presented at: 2022 ASCO Annual Meeting.
Unke J, Wilson J, Mitchell SJ, et al (2022). Active Living After Cancer (ALAC) program: an avenue to improve physical functioning and moderate-intensity physical activity in gynecologic cancer survivors. J Clin Oncol (ASCO Annual Meeting Abstracts), 40(suppl 16). Abstract e24034. DOI:10.1200/JCO.2022.40.16_suppl.e24034
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.