Skip to main content

Advertisement

SpringerLink
Log in

Barriers and engagement in breast cancer survivorship wellness activities

  • Brief Report
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Breast cancer survivors may be at risk for increased rates of emotional distress and poorer quality of life. Survivorship care plans (SCPs) promoting wellness activities may support well-being; however, survivors may not receive or engage in their SCPs. This study aimed to assess receipt and participation in SCP activities as well as barriers to engagement amongst breast cancer survivors.

Methods

Breast cancer survivors (n = 187; 99% female, Mean age = 57.7) consented and completed self-reported assessments of SCP recommendations, engagement and interest in wellness activities, and potential barriers to engagement.

Results

A minority of participants recalled receiving an SCP (21%). The most physician recommended (62%) and completed (53%) activity was exercise. Interest in adding other wellness activities to the SCP was high, with reported interest levels of approximately 50% for several activities (e.g., mind body, nutrition, psychotherapy interventions). Fully half reported that having a physician-designed plan would influence participation in activities. The most common reported barriers to SCP activity engagement were lack of time (82%), work/school (65%), and lack of information (65%).

Conclusion

Few survivors recalled receiving a formal SCP, and lack of information about wellness activities was a commonly reported barrier to participation. Interest in wellness activities was generally high and may indicate the need for more formal prescription or motivation enhancement techniques to promote SCP engagement. There may be a clinical need to emphasize SCP recommendations to enhance recall and increase engagement in wellness activities that may reduce psychological distress and improve quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Data availability

The dataset generated during and analyzed during the current study is available from the corresponding author on reasonable request with approval from the NYU Langone Health IRB.

References

  1. Amerian Cancer Society (2020) Cancer facts & figures 2020. American Cancer Society, Atlanta

    Google Scholar 

  2. Burton CL, Galatzer-Levy IR, Bonanno GA (2015) Treatment type and demographic characteristics as predictors for cancer adjustment: Prospective trajectories of depressive symptoms in a population sample. Health Psychol 34(6):602–609

    Article  PubMed  Google Scholar 

  3. Lam WW et al (2012) Distress trajectories at the first year diagnosis of breast cancer in relation to 6 years survivorship. Psychooncology 21(1):90–99

    Article  PubMed  Google Scholar 

  4. Irvine D et al (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nurs 17(5):367–378

    Article  CAS  PubMed  Google Scholar 

  5. Koch L et al (2013) Quality of life in long-term breast cancer survivors—a 10-year longitudinal population-based study. Acta Oncol 52(6):1119–1128

    Article  PubMed  Google Scholar 

  6. Carreira H et al (2018) Associations between breast cancer survivorship and adverse mental health outcomes: a systematic review. J Natl Cancer Inst 110(12):1311–1327

    Article  PubMed  PubMed Central  Google Scholar 

  7. Koszegi B (2003) Health anxiety and patient behavior. J Health Econ 22(6):1073–1084

    Article  PubMed  Google Scholar 

  8. Cameron LD et al (2005) Cognitive and affective determinants of decisions to attend a group psychosocial support program for women with breast cancer. Psychosom Med 67(4):584–589

    Article  PubMed  Google Scholar 

  9. Hewitt M, Greenfield S, Stovall E (2005) From cancer patient to cancer survivor: lost in transition. National Academies Press, Washington DC

    Google Scholar 

  10. Commission on Cancer, Optimal Resources for Cancer Care: 2020 Standards. American College of Surgeons

  11. D’Souza V, Daudt H, Kazanjian A (2017) Survivorship care plans for breast cancer patients: understanding the quality of the available evidence. Curr Oncol 24(6):e446–e465

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Brennan ME et al (2014) Survivorship care plans in cancer: a systematic review of care plan outcomes. Br J Cancer 111(10):1899–1908

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Stricker CT et al (2011) Survivorship care planning after the institute of medicine recommendations: how are we faring? J Cancer Surviv 5(4):358–370

    Article  PubMed  PubMed Central  Google Scholar 

  14. Choi Y et al (2020) Breast cancer survivorship care plans: what are they covering and how well do they align with national guidelines? Breast Cancer Res Treat 179(2):415–424

    Article  PubMed  Google Scholar 

  15. Smith SL et al (2011) Survivors of breast cancer: patient perspectives on survivorship care planning. J Cancer Surviv 5(4):337–344

    Article  PubMed  Google Scholar 

  16. Mayer DK, Birken SA, Chen RC (2015) Avoiding implementation errors in cancer survivorship care plan effectiveness studies. J Clin Oncol 33(31):3528–3530

    Article  PubMed  Google Scholar 

  17. Birken SA, Mayer DK, Weiner BJ (2013) Survivorship care plans: prevalence and barriers to use. J Cancer Educ 28(2):290–296

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kadan-Lottick NS et al (2005) Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study. Cancer 104(12):2872–2881

    Article  PubMed  Google Scholar 

  19. Hardcastle SJ et al (2018) Factors influencing non-participation in an exercise program and attitudes towards physical activity amongst cancer survivors. Support Care Cancer 26(4):1289–1295

    Article  PubMed  Google Scholar 

  20. Miedema B, MacDonald I, Tatemichi S (2003) Cancer follow-up care. Patients’ perspectives. Can Fam Physician 49(7):890–895

    PubMed  PubMed Central  Google Scholar 

  21. Greenlee H et al (2016) Survivorship care plans and adherence to lifestyle recommendations among breast cancer survivors. J Cancer Surviv 10(6):956–963

    Article  PubMed  Google Scholar 

  22. Green EK et al (2018) Perceptions of support groups among older breast cancer survivors:“I’ve heard of them, but I’ve never felt the need to go.” Cancer Nurs 41(6):E1

    Article  PubMed  PubMed Central  Google Scholar 

  23. Keesing S, Rosenwax L, McNamara B (2018) The implications of women’s activity limitations and role disruptions during breast cancer survivorship. Womens Health 14:1745505718756381

    CAS  Google Scholar 

  24. Hefferon K et al (2013) Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: a large-scale qualitative study. Health Educ Res 28(5):843–856

    Article  PubMed  Google Scholar 

  25. Nekhlyudov L et al (2017) Going beyond being lost in transition: a decade of progress in cancer survivorship. J Clin Oncol 35(18):1978–1981

    Article  PubMed  PubMed Central  Google Scholar 

  26. Klemanski DL, Browning KK, Kue J (2016) Survivorship care plan preferences of cancer survivors and health care providers: a systematic review and quality appraisal of the evidence. J Cancer Surviv 10(1):71–86

    Article  PubMed  Google Scholar 

  27. Forsythe LP et al (2013) Use of survivorship care plans in the United States: associations with survivorship care. J Natl Cancer Inst 105(20):1579–1587

    Article  PubMed  PubMed Central  Google Scholar 

  28. Massey BL, Myers KB (2012) Survivorship care plans for patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 138(12):1116–1119

    Article  PubMed  Google Scholar 

  29. Faul LA et al (2014) Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901. J Cancer Surviv 8(4):627–637

    Article  PubMed  PubMed Central  Google Scholar 

  30. Schootman M et al (2013) The health and welfare of rural and urban cancer survivors in Missouri. Prev Chronic Dis 10:E152

    Article  PubMed  PubMed Central  Google Scholar 

  31. Merport A et al (2012) The use of cancer treatment summaries and care plans among Massachusetts physicians. Support Care Cancer 20(7):1579–1583

    Article  PubMed  Google Scholar 

  32. Birken SA et al (2019) Survivorship care plan implementation in US cancer programs: a national survey of cancer care providers. J Cancer Educ 34(3):614–622

    Article  PubMed  PubMed Central  Google Scholar 

  33. Zeng Y et al (2014) Meta-analysis of the effects of exercise intervention on quality of life in breast cancer survivors. Breast Cancer 21(3):262–274

    Article  PubMed  Google Scholar 

  34. Brown JC et al (2012) The efficacy of exercise in reducing depressive symptoms among cancer survivors: a meta-analysis. PLoS ONE 7(1):e30955

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Craft LL et al (2012) Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 21(1):3–19

    Article  PubMed  Google Scholar 

  36. Patsou ED et al (2017) Effects of physical activity on depressive symptoms during breast cancer survivorship: a meta-analysis of randomised control trials. ESMO Open 2(5):e000271

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zhu G et al (2016) Effects of exercise intervention in breast cancer survivors: a meta-analysis of 33 randomized controlled trails. Onco Targets Ther 9:2153–2168

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. McNeely ML et al (2006) Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 175(1):34–41

    Article  PubMed  PubMed Central  Google Scholar 

  39. Chen X et al (2011) Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res 4(9):1409–1418

    Article  Google Scholar 

  40. Huang HP et al (2016) A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer 23(4):568–576

    Article  PubMed  Google Scholar 

  41. Duncan M et al (2017) Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors. BMJ Open 7(11):e015860

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hall L et al (2018) Mind-body interventions for fear of cancer recurrence: a systematic review and meta-analysis. Psychooncology 27(11):2546–2558

    Article  PubMed  PubMed Central  Google Scholar 

  43. Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36(1):13–34

    Article  PubMed  Google Scholar 

  44. Ye M et al (2018) A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psychooncology 27(7):1695–1703

    Article  PubMed  Google Scholar 

  45. Aricò D, Raggi A, Ferri R (2016) Cognitive behavioral therapy for insomnia in breast cancer survivors: a review of the literature. Front Psychol 7:1162

    Article  PubMed  PubMed Central  Google Scholar 

  46. De Cicco P et al (2019) Nutrition and breast cancer: a literature review on prevention, treatment and recurrence. Nutrients 11(7):1514

    Article  PubMed Central  Google Scholar 

  47. Wurz A, St-Aubin A, Brunet J (2015) Breast cancer survivors’ barriers and motives for participating in a group-based physical activity program offered in the community. Support Care Cancer 23(8):2407–2416

    Article  PubMed  PubMed Central  Google Scholar 

  48. Clifford BK et al (2018) Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer 26(3):685–700

    Article  PubMed  Google Scholar 

  49. Ventura EE et al (2013) Barriers to physical activity and healthy eating in young breast cancer survivors: modifiable risk factors and associations with body mass index. Breast Cancer Res Treat 142(2):423–433

    Article  PubMed  PubMed Central  Google Scholar 

  50. Spencer JC, Wheeler SB (2016) A systematic review of motivational interviewing interventions in cancer patients and survivors. Patient Educ Couns 99(7):1099–1105

    Article  PubMed  Google Scholar 

  51. Malins S et al (2020) Reducing dropout in acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy for chronic pain and cancer patients using motivational interviewing. Br J Clin Psychol 59(3):424–438

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Kristin Szuhany’s time was sponsored by the National Center for Advancing Translational Sciences (NCATS; 5KL2 TR001446-05) and the National Institute of Mental Health (NIMH; K23MH122773). We wish to thank our colleagues at the Perlmutter Cancer Center and generous donors to Dr. Chachoua who supported this work. No funding sources played any role in in the writing of this manuscript or in the decision to submit the article for publication.

Funding

Kristin L. Szuhany’s time was funded through research Grants sponsored by NIH/NCATS, the Institutional Clinical and Translational Science Award (CTSA: 5KL2 TR001446-05) and the National Institute of Mental Health (NIMH; K23MH122773). The work was funded by donors to Dr. Chachoua and the Perlmutter Cancer Center.

Author information

Authors and Affiliations

  1. Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA

    Kristin L. Szuhany, Matteo Malgaroli, Gabriella Riley, Carly D. Miron, Jane Rosenthal & Naomi M. Simon

  2. University of Denver, Denver, CO, USA

    Rebecca Suzuki

  3. NYU Rory Meyers College of Nursing, New York, NY, USA

    Jae Hyung Park

  4. Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA

    Abraham Chachoua & Marleen Meyers

  5. Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, NY, USA

    Jane Rosenthal, Abraham Chachoua & Marleen Meyers

Authors
  1. Kristin L. Szuhany
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matteo Malgaroli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriella Riley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carly D. Miron
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rebecca Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jae Hyung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jane Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Abraham Chachoua
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marleen Meyers
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Naomi M. Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KLS made substantial contributions to the conception and design of the work, the analysis and interpretation of the data, drafted the manuscript and approved the version to be published. MM made substantial contributions to the conception and design of the work, the interpretation of the data, revision of the manuscript, and approved the version to be published. GR, CDM, JHP, and RS contributed to drafting the manuscript and approved the version to be published. JR, AC, and MM made substantial contributions to the design of the work and acquisition of data, reviewed the manuscript, and approved this version to be published. NMS made substantial contributions to the conception and design of the work, the interpretation of the data, revised the manuscript, and approved the version to be published.

Corresponding author

Correspondence to Kristin L. Szuhany.

Ethics declarations

Conflict of interest

In the past 36 months, Naomi M. Simon reports the following: (1) research grants from the Department of Defense, NIH, PCORI, American Foundation for Suicide Prevention, and Janssen (2) speaking/CME/consulting from Axovant Sciences, Springworks, Praxis Therapeutics, and Aptinyx, and (3) equity (spouse) from G1 Therapeutics. Dr. Chachoua reports sitting on the board of Tilray. Kristin L. Szuhany, Matteo Malgaroli, Gabriella Riley, Carly D. Miron, Rebecca Suzuki, Jae Hyung Park, Jane Rosenthal, and Marleen Meyers have no relevant conflicts of interest to report.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the NYU Langone Institutional Review Board.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Informed consent for publication of aggregate data was obtained from all participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Szuhany, K.L., Malgaroli, M., Riley, G. et al. Barriers and engagement in breast cancer survivorship wellness activities. Breast Cancer Res Treat 188, 317–325 (2021). https://doi.org/10.1007/s10549-021-06279-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-021-06279-4

Keywords

Search

Navigation