The purpose of this study was to learn more about the lived experiences of cancer survivors related to their physical activity and its impact on their QoL. Upon examination of the vastly different post-cancer experiences amongst the participants revealed in their interviews, the commonalities and rooted connections of improved physical and psychosocial wellbeing from engagement in PA became apparent. In other words, a strong connection between PA and improved physical benefits was expressed by all participants, regardless of the intensity of treatment(s) experienced and the time since completion of their treatment. All participants reported elaborate details regarding their improved physical wellbeing, improved recovery time, and ability to complete daily task from their regular PA. Four participants described having no or very few late or long-term side effects from their cancer treatment, attributing the minimal physical repercussions to their health to their regular PA prior to cancer treatment and, in some cases, during their cancer treatment. To exemplify, Grace reported not experiencing any side effects during, and particularly after, completing treatment. When asked for her thoughts as to why no side effects had occurred, Grace stated “I really do attribute the fact that I went through treatment so easily to the fact that I was so active”, emphasizing that PA was impactful towards the improvements in her physical well-being. Additionally, Kelly, who was treated for small bowel cancer, reported that PA helped her to manage the stomach and pelvic pain she experienced during and shortly after completing treatment.
Participants also reported long-term physical benefits from their PA participation since completing treatment. Most intriguing in this regard was Marie, a breast cancer survivor. She has been taking Anastrozole, an oral endocrine therapy used to reduce the risk of cancer reoccurrence that has the potential side effect of reducing bone density. Once she learned resistance training improves bone density, Marie added resistance training to her exercise regime. As Marie stated, “My bone density actually improved. That’s when I began a really rigorous exercise program. Sort of at that time I was doing research on how to improve my bone density and exercise was one of the things. So, I actually began doing weights”. Catherine who was taking a prescription drug as a breast cancer survivor that exacerbated her rheumatoid arthritis still engaged in PA. Despite the pain from her rheumatoid arthritis when active, Catherine recognized the need for PA to improve and then maintain her current physical health.
Concurrent with the number of statements that indicated PA provided physical benefits after cancer treatment, participants also spoke specifically about how PA facilitated their recovery process. Participants alluded to the idea that they felt stronger and in some instances their recovery was easier because they were routinely physically active. Most notably, participants indicated how valuable PA was in recovering from surgery and for pain management post-treatment by preventing further physical loss, and a method of rehabilitation. Furthermore, survivors communicated that the introduction or re-establishment of PA into daily routine led to a positive recovery and increase in physicality after the completion of their treatment.
Most commonly, participants described their PA as a means of control or positive management of their health. When comparing participants’ responses, the commonality of the desire to remain physically healthy and to reduce their risk of cancer reoccurrence was most evident. The continuous effort to either maintain or adopt regular PA into one’s daily-life was heavily emphasized by all participants. The collective reason was because of the participants’ understanding of the health benefits that routine PA provides to cancer survivors to help manage the late or long-term effects from treatment. Thus, a collective recognition that PA is a healthy approach in the healing process after treatment was noted in each interview. This notion is directly supported by Patrick’s statement; “my belief is that physical activity helps the body heal. I think it’s also good for the mind, which in turn helps the body heal…I think physical activity is an important part of the healing process”.
As the questions in the interviews shifted to potential mental health or emotional benefits of PA, participants’ responses described mental health benefits or feelings of self-gratification from their PA. Participants who experienced ongoing stress stated their awareness and understanding of the benefits and enjoyment of PA. With this, participants provided a variety of supporting explanations of improved mood and energy levels, and positivity after engaging in PA. In particular, being active outside in the fresh air and participating in familiar PA provided mental health benefits and a reduction in personal stress. In fact, these reports of mental and emotional improvement in the participants’ lives were described with elation and positive emotions overall.
The ongoing positive mental well-being experienced from regular PA was considered equally important to the survivors as the physical health benefits. Participants noted that their PA was something to look forward to as it allowed them to get up and out of the house and to interact with others. These positive psychological factors provided reinforcement for PA to become routine in the participants’ daily lives and it helped with adjustments experienced post-treatment. Claire spoke highly about how PA provided a positive coping mechanism for the mental strain she felt while recovering from her treatment, reducing these feelings of mental as well as those from other personal stresses at the time. When Grace reflected on the lifestyle change that she underwent when first diagnosed with cancer and in particular becoming physically active on daily basis, she spoke highly of the increase in her energy and mood while undergoing treatment. It was at this time that Grace expressed in a confident and appreciative tone that PA had been important and personally valuable to her mental wellbeing both during and after cancer treatment. It was during this point in the interview that Grace illustrated one of the greatest illuminations amongst the participants about the impact of PA;
Oh definitely. I don’t think I realized it initially that that was doing it. Even the sky was bluer if you could imagine that… It was probably the worst year of my life, but it was also the best year of my life.
When asked if these feelings persisted after completing treatment, she strongly agreed that PA had made a lasting, significant difference on her mental and physical health. Furthermore, when speaking about routine engagement in PA, participants spoke of it not just because it was important for their physical health bur rather, they engaged in PA because it was viewed as enjoyable and provided self-benefit. David stated in a happy tone about his routine PA; “it’s gone beyond the point of it being a chore, it’s what we normally do”. This statement was in addition to David’s insightful perspective on how PA provided him with a sense of elation and satisfaction towards his personal wellbeing.
During their interviews, participants were asked if PA was a routinely discussed with their physician(s). Most participants said that conversations regarding PA were casual where their physician(s) may have asked if they were physically active and what types of PA they may be doing. Participants were then asked if they thought their physician’s awareness of their previous or current engagement in PA influenced these conversations. Most participants felt that since their physician(s) were aware of their physically active lifestyle, conversations about PA were not required. Still, participants noted that personal conversations related to PA, or physicians’ affirmation of their PA, was beneficial and necessary.
It should be noted that two participants reported difficulty initiating conversations about PA with their physician. It was only when they specifically asked questions about PA and, in particular, when they asked about the intensity of their PA, that a short conversation occurred. Another participant reported feeling unsure about how to introduce PA into her daily life shortly after completing cancer treatment. Conversely, four participants spoke of having an oncologist who was adamant that they should be participating in PA. These participants spoke of how their appointments with their oncologist included a descriptive conversation about what PA they were doing and they were encouraged to be as physically active as possible. Finally, participants were explicitly asked about the Cancer Care Exercise Guidelines in their interviews. The purpose of asking participants about these guidelines was to determine if they were provided to cancer survivors after completion of their cancer treatment. None of the participants were aware of the Cancer Care Exercise Guidelines.
The variation in reported conversations with physicians does not suggest a particular direction physicians’ take in having conversations regarding PA with their patients. Also, the variance in participants’ responses does not indicate if physicians provide PA prescriptions or discuss the PA guidelines with their patients. This raises further questions regarding the importance of promoting the exercise guidelines in cancer care. Further, it raises an important question as to whether exercise guidelines should be integrated into the standard of care of health care provider clinical practice by routinely providing PA prescriptions. Nonetheless, the connection between PA promotion and PA engagement by cancer survivors should not be overlooked. The positive physical and psychosocial responses provided by participants further suggest that PA plays a role in survivors’ QoL. Understanding this, coupled with an awareness of that published clinical guidelines exist on exercise for people with cancer [11], it should be suggested that physicians express the benefits of regular PA to their patients.
During the discussions about receiving, or being aware of, cancer care exercise guidelines, participants mentioned receiving copious amounts of literature upon completion of their treatment. Participants reported some of this literature may have included information about PA, but they could not recall the details of the information provided, or whether it was actually included. Various forms of patient literature exist and offer opportunities for the exercise guidelines to be shared with cancer survivors. Further, the verbal conservations that participants reported having with their physicians in this study serves to support this as an important ongoing strategy for cancer survivors to initiate or sustain regular PA, and offer potential for improving cancer survivors QoL.