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Physical problems, functional limitations, and preferences for physical therapist-guided exercise programs among Dutch patients with metastatic breast cancer: a mixed methods study

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Abstract

Purpose

In this study we aimed (1) to identify the most prevalent physical symptoms and functional limitations that limit physical activity of patients with palliative treatment for metastatic breast cancer (MBC) and (2) to identify their preferences for exercise-based physical therapy programs, as a first step towards the development of physical therapist (PT)-guided exercise programs for patients with MBC.

Methods

We performed a mixed-method study that comprised a cross-sectional survey and two focus group sessions among patients with MBC. Survey results were analyzed using descriptive statistics. The focus groups were audio-taped, transcribed verbatim, and analyzed independently by two researchers, using directed content analysis.

Results

A total of 114 women (response rate 61%) completed the survey (mean age 63.5, SD 10.2). Eighty-six percent of the women reported at least some level of physical problems limiting their ability to be physically active, of whom 46% reported substantial problems. The most prevalent problems were fatigue, painful joints, painful muscles, and shortness of breath. Uptake of exercise appeared to be limited. Exercise preferences varied strongly. Fifty-three percent indicated a preference for some form of PT-supervision, and 34% for a prolonged period of time (> 8 weeks). Focus group results clarified that patients’ preferences for supervision, by PTs with special qualifications in oncology, were related to feelings of insecurity about their ability to self-manage physical functioning.

Conclusions

Patients with MBC experience a broad range of physical health problems that limit their ability to be physically active. While preferences vary strongly, patients with MBC would value the availability of high quality, PT-guided, tailored exercise programs.

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Acknowledgments

We thank Adriënne Veraart†, Rachel Verbeek, and Fleurine van Beek for their contributions to the project and Pink Ribbon for supporting this research.

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Author notes

  1. M. R. ten Tusscher and W. G. Groen shared first authorship

Authors and Affiliations

  1. Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    M. R. ten Tusscher & Martijn M. Stuiver

  2. Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    W. G. Groen & N. K. Aaronson

  3. Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    E. Geleijn & Martijn M. Stuiver

  4. Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    G. S. Sonke

  5. Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam/Cancer Center Amsterdam, Amsterdam, The Netherlands

    I. R. Konings, M. J. Van der Vorst & A. van Zweeden

  6. Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands

    M. J. Van der Vorst

  7. Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands

    A. van Zweeden

  8. ACHIEVE Centre of Applied Research, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands

    Martijn M. Stuiver

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  1. M. R. ten Tusscher
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Correspondence to Martijn M. Stuiver.

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Conflict of interest

Dr. Aaronson, Dr. Stuiver, and E. Geleijn report a grant from the Dutch Cancer Foundation KWF/Pink Ribbon supporting this study. Dr. Sonke reports unrelated grants from Astra-Zeneca, Novartis, Roche, and Merck.

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ten Tusscher, M.R., Groen, W.G., Geleijn, E. et al. Physical problems, functional limitations, and preferences for physical therapist-guided exercise programs among Dutch patients with metastatic breast cancer: a mixed methods study. Support Care Cancer 27, 3061–3070 (2019). https://doi.org/10.1007/s00520-018-4619-x

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