Skip to main content
Top
Published in: Journal of Cancer Survivorship 4/2019

01-08-2019 | Care

Building a physical activity intervention into clinical care for breast and colorectal cancer survivors in Wisconsin: a randomized controlled pilot trial

Authors: Lisa Cadmus-Bertram, Amye J. Tevaarwerk, Mary E. Sesto, Ronald Gangnon, Brittany Van Remortel, Preshita Date

Published in: Journal of Cancer Survivorship | Issue 4/2019

Login to get access

Abstract

Background

Cancer survivorship care plans (“care plans”) often recommend an active lifestyle yet are rarely accompanied by programs to help patients enact the prescribed behavior change. As a step towards bridging this gap, this trial tested the feasibility of augmenting care planning with a multi-level physical activity intervention.

Methods

Breast and colorectal cancer survivors were enrolled alongside a self-selected support partner (e.g., spouse, friend). Survivors received a care plan alone (comparison group) versus one augmented with a 12-week physical activity module (intervention group). For the intervention group dyads, both members received a multi-component program including Fitbit trackers, with the survivor’s Fitbit linked to his/her electronic health record (EHR). Treating clinicians received periodic updates regarding the survivors’ physical activity. The primary outcome was ActiGraph-measured physical activity, analyzed using mixed models. Feedback questionnaires were administered to participants and clinicians at 12 weeks.

Results

Survivors (n = 50) were 54.4 ± 11.2 years of age and 2.0 ± 1.5 years post-diagnosis. Survivors in the intervention group increased moderate-to-vigorous-intensity physical activity (MVPA) by 69 ± 84 min/week vs. a 20 ± 71 min/week decrease in the comparison group (p = .001). Likewise, daily steps increased by 1470 ± 1881 vs. a 398 ± 1751 decrease (P = .002). Among responding clinicians, 100% looked at survivors’ activity data within the EHR at least once and 80% said it provided insight into their patients’ lifestyles.

Conclusions

Augmenting a standard care plan with a multi-level, technology-based intervention increased physical activity among cancer survivors.

Implications for cancer survivors

Technology-based approaches, including activity trackers, can be used by individuals to work towards an active lifestyle after cancer.
Appendix
Available only for authorised users
Literature
1.
go back to reference American Cancer Society. Breast Cancer Facts & Figures 2017-2018. Atlanta: American Cancer Society, Inc. 2017. American Cancer Society. Breast Cancer Facts & Figures 2017-2018. Atlanta: American Cancer Society, Inc. 2017.
2.
go back to reference American Cancer Society. Colorectal cancer facts & figures 2017–2019. Atlanta: American Cancer Society; 2017. American Cancer Society. Colorectal cancer facts & figures 2017–2019. Atlanta: American Cancer Society; 2017.
3.
go back to reference Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J, et al. The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. Br J Sports Med. 2016;50(6):339–45.CrossRef Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J, et al. The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. Br J Sports Med. 2016;50(6):339–45.CrossRef
4.
go back to reference Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25(7):1293–311.CrossRef Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25(7):1293–311.CrossRef
5.
go back to reference Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28(3):753–65.CrossRef Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28(3):753–65.CrossRef
6.
go back to reference Patterson R, Cadmus L, Emond J, Pierce J. Physical activity, diet, adiposity and breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66(1):5–15.CrossRef Patterson R, Cadmus L, Emond J, Pierce J. Physical activity, diet, adiposity and breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66(1):5–15.CrossRef
7.
go back to reference Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol. 2015;54(5):635–54.CrossRef Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol. 2015;54(5):635–54.CrossRef
8.
go back to reference Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. J Clin Oncol. 2015;33(16):1825–34.CrossRef Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. J Clin Oncol. 2015;33(16):1825–34.CrossRef
9.
go back to reference Je Y, Jeon JY, Giovannucci EL, Meyerhardt JA. Association between physical activity and mortality in colorectal cancer: a meta-analysis of prospective cohort studies. Int J Cancer. 2013;133(8):1905–13.CrossRef Je Y, Jeon JY, Giovannucci EL, Meyerhardt JA. Association between physical activity and mortality in colorectal cancer: a meta-analysis of prospective cohort studies. Int J Cancer. 2013;133(8):1905–13.CrossRef
10.
go back to reference Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.CrossRef Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.CrossRef
11.
go back to reference Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;8:CD007566. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;8:CD007566.
12.
go back to reference Zeng Y, Huang M, Cheng AS, Zhou Y, So WK. Meta-analysis of the effects of exercise intervention on quality of life in breast cancer survivors. Breast Cancer. 2014;21(3):262–74.CrossRef Zeng Y, Huang M, Cheng AS, Zhou Y, So WK. Meta-analysis of the effects of exercise intervention on quality of life in breast cancer survivors. Breast Cancer. 2014;21(3):262–74.CrossRef
13.
go back to reference Peddle CJ, Au HJ, Courneya KS. Associations between exercise, quality of life, and fatigue in colorectal cancer survivors. Dis Colon Rectum. 2008;51(8):1242–8.CrossRef Peddle CJ, Au HJ, Courneya KS. Associations between exercise, quality of life, and fatigue in colorectal cancer survivors. Dis Colon Rectum. 2008;51(8):1242–8.CrossRef
14.
go back to reference Lynch BM, Cerin E, Owen N, Hawkes AL, Aitken JF. Prospective relationships of physical activity with quality of life among colorectal cancer survivors. J Clin Oncol. 2008;26(27):4480–7.CrossRef Lynch BM, Cerin E, Owen N, Hawkes AL, Aitken JF. Prospective relationships of physical activity with quality of life among colorectal cancer survivors. J Clin Oncol. 2008;26(27):4480–7.CrossRef
15.
go back to reference Pinto BM, Ciccolo JT. Physical activity motivation and cancer survivorship. Recent Results Cancer Res. 2011;186:367–87.CrossRef Pinto BM, Ciccolo JT. Physical activity motivation and cancer survivorship. Recent Results Cancer Res. 2011;186:367–87.CrossRef
16.
go back to reference Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.CrossRef Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.CrossRef
17.
go back to reference Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv. 2014. Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv. 2014.
18.
go back to reference Courneya KS, Rogers LQ, Campbell KL, Vallance JK, Friedenreich CM. Top 10 research questions related to physical activity and cancer survivorship. Res Q Exerc Sport. 2015:1–10. Courneya KS, Rogers LQ, Campbell KL, Vallance JK, Friedenreich CM. Top 10 research questions related to physical activity and cancer survivorship. Res Q Exerc Sport. 2015:1–10.
19.
go back to reference Hewitt M, Ganz P. Implementing cancer survivorship care planning: workshop summary: National Academy Press; 2007. Hewitt M, Ganz P. Implementing cancer survivorship care planning: workshop summary: National Academy Press; 2007.
20.
go back to reference Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in translation. Washington, DC: Institute of Medicine; 2005. Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in translation. Washington, DC: Institute of Medicine; 2005.
21.
go back to reference Halpern MT, Viswanathan M, Evans TS, Birken SA, Basch E, Mayer DK. Models of cancer survivorship care: overview and summary of current evidence. J Oncol Pract. 2014;11(1):319–27. Halpern MT, Viswanathan M, Evans TS, Birken SA, Basch E, Mayer DK. Models of cancer survivorship care: overview and summary of current evidence. J Oncol Pract. 2014;11(1):319–27.
22.
go back to reference Katon W, Von Korff M, Lin E, Walker E, Simon GE, Bush T, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273(13):1026–31.CrossRef Katon W, Von Korff M, Lin E, Walker E, Simon GE, Bush T, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273(13):1026–31.CrossRef
23.
go back to reference Ayanian JZ, Zaslavsky AM, Arora NK, Kahn KL, Malin JL, Ganz PA, et al. Patients’ experiences with care for lung cancer and colorectal cancer: findings from the cancer care outcomes research and surveillance consortium. J Clin Oncol. 2010;28(27):4154–61.CrossRef Ayanian JZ, Zaslavsky AM, Arora NK, Kahn KL, Malin JL, Ganz PA, et al. Patients’ experiences with care for lung cancer and colorectal cancer: findings from the cancer care outcomes research and surveillance consortium. J Clin Oncol. 2010;28(27):4154–61.CrossRef
24.
go back to reference Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701.CrossRef Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701.CrossRef
25.
go back to reference Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011;26(11):1479–98.CrossRef Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011;26(11):1479–98.CrossRef
26.
go back to reference Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258–71.CrossRef Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258–71.CrossRef
27.
go back to reference Ball K, Jeffery RW, Abbott G, McNaughton SA, Crawford D. Is healthy behavior contagious: associations of social norms with physical activity and healthy eating. Int J Behav Nutr Phys Act. 2010;7:86.CrossRef Ball K, Jeffery RW, Abbott G, McNaughton SA, Crawford D. Is healthy behavior contagious: associations of social norms with physical activity and healthy eating. Int J Behav Nutr Phys Act. 2010;7:86.CrossRef
28.
go back to reference Coa KI, Smith KC, Klassen AC, Caulfield LE, Helzlsouer K, Peairs K, et al. Capitalizing on the "teachable moment" to promote healthy dietary changes among cancer survivors: the perspectives of health care providers. Support Care Cancer. 2015;23(3):679–86.CrossRef Coa KI, Smith KC, Klassen AC, Caulfield LE, Helzlsouer K, Peairs K, et al. Capitalizing on the "teachable moment" to promote healthy dietary changes among cancer survivors: the perspectives of health care providers. Support Care Cancer. 2015;23(3):679–86.CrossRef
29.
go back to reference McDermott AY, Mernitz H. Exercise and older patients: prescribing guidelines. Am Fam Physician. 2006;74(3):437–44.PubMed McDermott AY, Mernitz H. Exercise and older patients: prescribing guidelines. Am Fam Physician. 2006;74(3):437–44.PubMed
30.
go back to reference Patrick K, Pratt M, Sallis RE. The healthcare sector’s role in the U.S. National Physical Activity Plan. J Phys Act Health. 2009;6(Suppl 2):S211–9.CrossRef Patrick K, Pratt M, Sallis RE. The healthcare sector’s role in the U.S. National Physical Activity Plan. J Phys Act Health. 2009;6(Suppl 2):S211–9.CrossRef
31.
go back to reference Weidinger KA, Lovegreen SL, Elliott MB, Hagood L, Haire-Joshu D, McGill JB, et al. How to make exercise counseling more effective: lessons from rural America. J Fam Pract. 2008;57(6):394–402.PubMed Weidinger KA, Lovegreen SL, Elliott MB, Hagood L, Haire-Joshu D, McGill JB, et al. How to make exercise counseling more effective: lessons from rural America. J Fam Pract. 2008;57(6):394–402.PubMed
32.
go back to reference Gell NM, Grover KW, Humble M, Sexton M, Dittus K. Efficacy, feasibility, and acceptability of a novel technology-based intervention to support physical activity in cancer survivors. Support Care Cancer. 2017;25(4):1291–300.CrossRef Gell NM, Grover KW, Humble M, Sexton M, Dittus K. Efficacy, feasibility, and acceptability of a novel technology-based intervention to support physical activity in cancer survivors. Support Care Cancer. 2017;25(4):1291–300.CrossRef
33.
go back to reference Hartman SJ, Natarajan L, Palmer BW, Parker B, Patterson RE, Sears DD. Impact of increasing physical activity on cognitive functioning in breast cancer survivors: rationale and study design of memory & motion. Contemp Clin Trials. 2015;45(Pt B):371–6.CrossRef Hartman SJ, Natarajan L, Palmer BW, Parker B, Patterson RE, Sears DD. Impact of increasing physical activity on cognitive functioning in breast cancer survivors: rationale and study design of memory & motion. Contemp Clin Trials. 2015;45(Pt B):371–6.CrossRef
34.
go back to reference Phillips SM, Collins LM, Penedo FJ, Courneya KS, Welch W, Cottrell A, et al. Optimization of a technology-supported physical activity intervention for breast cancer survivors: Fit2Thrive study protocol. Contemp Clin Trials. 2018;66:9–19.CrossRef Phillips SM, Collins LM, Penedo FJ, Courneya KS, Welch W, Cottrell A, et al. Optimization of a technology-supported physical activity intervention for breast cancer survivors: Fit2Thrive study protocol. Contemp Clin Trials. 2018;66:9–19.CrossRef
35.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRef Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRef
36.
go back to reference Tevaarwerk AJ, Wisinski KB, Buhr KA, Njiaju UO, Tun M, Donohue S, et al. Leveraging electronic health record systems to create and provide electronic cancer survivorship care plans: a pilot study. J Oncol Pract. 2014;10(3):e150–9.CrossRef Tevaarwerk AJ, Wisinski KB, Buhr KA, Njiaju UO, Tun M, Donohue S, et al. Leveraging electronic health record systems to create and provide electronic cancer survivorship care plans: a pilot study. J Oncol Pract. 2014;10(3):e150–9.CrossRef
38.
go back to reference Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74.CrossRef Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74.CrossRef
39.
go back to reference Cadmus-Bertram L, Marcus BH, Patterson RE, Parker BA, Morey BL. Use of the Fitbit to measure adherence to a physical activity intervention among overweight or obese, postmenopausal women: self-monitoring trajectory during 16 weeks. JMIR Mhealth Uhealth. 2015;3(4):e96.CrossRef Cadmus-Bertram L, Marcus BH, Patterson RE, Parker BA, Morey BL. Use of the Fitbit to measure adherence to a physical activity intervention among overweight or obese, postmenopausal women: self-monitoring trajectory during 16 weeks. JMIR Mhealth Uhealth. 2015;3(4):e96.CrossRef
40.
go back to reference Cadmus-Bertram LA, Marcus BH, Patterson RE, Parker BA, Morey BL. Randomized trial of a Fitbit-based physical activity intervention for women. Am J Prev Med. 2015;49(3):414–8.CrossRef Cadmus-Bertram LA, Marcus BH, Patterson RE, Parker BA, Morey BL. Randomized trial of a Fitbit-based physical activity intervention for women. Am J Prev Med. 2015;49(3):414–8.CrossRef
41.
go back to reference Bandura A. Social foundations of thought and action: a social cognitive theory. Prentice Hall: Englewood Cliffs, NJ; 1986. Bandura A. Social foundations of thought and action: a social cognitive theory. Prentice Hall: Englewood Cliffs, NJ; 1986.
43.
go back to reference Freedson PS, Melanson E, Sirard J. Calibration of the computer science and applications. Inc accelerometer Med Sci Sports Exerc. 1998;30(5):777–81.CrossRef Freedson PS, Melanson E, Sirard J. Calibration of the computer science and applications. Inc accelerometer Med Sci Sports Exerc. 1998;30(5):777–81.CrossRef
44.
go back to reference Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the "silver tsunami": prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25(7):1029–36.CrossRef Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the "silver tsunami": prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25(7):1029–36.CrossRef
45.
go back to reference Phillips SM, Cadmus-Bertram L, Rosenberg D, Buman MP, Lynch BM. Wearable technology and physical activity in chronic disease: opportunities and challenges. Am J Prev Med. 2018;54(1):144–50.CrossRef Phillips SM, Cadmus-Bertram L, Rosenberg D, Buman MP, Lynch BM. Wearable technology and physical activity in chronic disease: opportunities and challenges. Am J Prev Med. 2018;54(1):144–50.CrossRef
47.
go back to reference Tevaarwerk AJ, Sesto ME. Continued challenges to the adoption and implementation of survivorship care plans. J Oncol Pract. 2018;14(10):573–6.CrossRef Tevaarwerk AJ, Sesto ME. Continued challenges to the adoption and implementation of survivorship care plans. J Oncol Pract. 2018;14(10):573–6.CrossRef
48.
go back to reference Phillips SM, Conroy DE, Keadle SK, Pellegrini CA, Lloyd GR, Penedo FJ, et al. Breast cancer survivors’ preferences for technology-supported exercise interventions. Support Care Cancer. 2017;25(10):3243–52.CrossRef Phillips SM, Conroy DE, Keadle SK, Pellegrini CA, Lloyd GR, Penedo FJ, et al. Breast cancer survivors’ preferences for technology-supported exercise interventions. Support Care Cancer. 2017;25(10):3243–52.CrossRef
49.
go back to reference Irwin ML, Cartmel B, Harrigan M, Li F, Sanft T, Shockro L, et al. Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer. 2017;123(7):1249–58.CrossRef Irwin ML, Cartmel B, Harrigan M, Li F, Sanft T, Shockro L, et al. Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer. 2017;123(7):1249–58.CrossRef
50.
go back to reference Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. Am J Prev Med. 2007;32(5 Suppl):S112–8.CrossRef Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. Am J Prev Med. 2007;32(5 Suppl):S112–8.CrossRef
Metadata
Title
Building a physical activity intervention into clinical care for breast and colorectal cancer survivors in Wisconsin: a randomized controlled pilot trial
Authors
Lisa Cadmus-Bertram
Amye J. Tevaarwerk
Mary E. Sesto
Ronald Gangnon
Brittany Van Remortel
Preshita Date
Publication date
01-08-2019
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 4/2019
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-019-00778-6

Other articles of this Issue 4/2019

Journal of Cancer Survivorship 4/2019 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine