Twenty people expressed interest in participating in the study with thirteen (5 male; 8 female) individuals providing data. Details related to their cancer, treatment, side effects, and physical activity according are shared in Table 2. It should be noted that what is reported in this table is based on the participants’ lived experiences and does not represent their medical diagnosis or treatment. Similarly, the physical activity levels included in this table are based upon the participants’ self-report and interpretation versus an objective measurement.
Table 2: Cancer treatment and physical activity of 13 cancer survivors
Participant*
|
Cancer Diagnosis
|
Treatment(s)
|
Duration of Cancer Treatment
|
Side Effects from Treatment
|
PA Level** Prior to Diagnosis
|
PA Level After Treatment
|
Types of PA
|
Marie
|
Invasive ductal carcinoma (breast cancer)
ER positive, HER2/NEU negative
|
Mastectomy
Prophylactic hysterectomy
8 cycles chemotherapy
25 radiation treatments
|
Diagnosis: July, 2005
Completion:
March, 2007
|
Nausea
Joint pain
Fatigue
Low immune system
Inability to sleep
Hair loss
High FSH
|
Very high
|
Very high
|
Walking
Yoga
Weight training
Golf
Aerobic classes
Pickle ball
|
David
|
Chronic lymphocytic
leukemia
|
Chemotherapy
|
Diagnosis 2006
Completion
2009
|
Low hemoglobin level
Vomiting immediately after chemo
|
Very high
|
Very high
|
Walking
Running
Tennis
Hockey
|
Mark
|
Colon cancer
|
Surgery, resection of the lower bowel
8 cycles chemotherapy
25 radiation treatments
|
Diagnosis
May, 2017
Completion
August, 2018
|
Recovery from surgery
Lack of energy
Hiccups
Chemo-induced-peripheral- neuropathy
High sensitivity to cold
|
High
|
High
|
Walking
Outdoor activity
|
Catherine
|
Breast cancer
|
Surgery
4 cycles
chemotherapy
25 radiation treatments
|
Diagnosis
November, 2016
Completion
June, 2017
|
High blood pressure
Fatigue
Hair loss
Chemo burn
|
Moderate
|
Moderate
|
Walking
Swimming
Aqua fit classes
|
Kelly
|
Small bowel cancer
|
Surgery
12 cycles chemotherapy
|
Diagnosis
February, 2018
Completion
January, 2019
|
Hand and foot syndrome
Blocked tear ducts
Fatigue
|
High
|
Moderate
|
Walking
Aerobics classes
Gym
|
Graham
|
Non-Hodgkin’s Lymphoma
|
5-6 months of chemotherapy
One month radiation
|
Diagnosis
May, 1995
Completion
March, 1996
|
Hair loss
Nausea
|
Moderate
|
Moderate
|
Gym
Swimming
Running
|
Patrick
|
Prostate cancer
|
Surgery
|
Diagnosis
March, 2018
Completion
May, 2019
|
Recovery from surgery
Weaken of pelvic floor from surgery
|
High
|
High
|
Hockey
Gym
Walking
|
Grace
|
Invasive ductal carcinoma (i.e., breast cancer)
Estrogen Positive
HER2 Positive
|
4 cycles chemotherapy
16 radiation treatments
|
Diagnosis
December, 2015
Completion
March, 2017
|
Hair loss
|
Moderate
|
Moderate
|
Walking
Swimming
|
Claire
|
Breast cancer
|
Surgery
Radiation
Chemotherapy
|
Treatment received 10 years ago.
|
Radiation burns
Fatigue
Nausea
Illness
|
Moderate
|
Moderate
|
Walking
Swimming
Aqua fit
classes
|
Jane
|
Breast cancer
|
Mastectomy
4 cycles chemotherapy
|
Diagnosis
October, 2016
Completion
Fall, 2018
|
Change in heart beat proficiency
Allergic reaction to chemo-therapy
Headaches
Body Aches
Hair loss
|
Moderate
|
Moderate
|
Walking
Skiing
Biking
Volleyball
Squash
Aqua Fit
Gym
|
Anna
|
Breast cancer
|
Double mastectomy
6 cycles chemotherapy
25 radiation treatments
|
Diagnosis
March, 2016
Completion
Early 2017
|
Radiation burns
Low white blood cell count
Memory difficulty
Skin sensitivity
|
Low
|
Moderate
|
Walking
Aqua fit
classes
|
Lisa
|
Primary mediastinal large B-cell lymphoma
|
6 cycles chemotherapy
25 radiation treatments
|
Diagnosis
June, 2018
Completion
January, 2019
|
Hair loss
Body pain
Bone pain
Fatigue
Cognitive confusion
Neuropathy
Exhaustion
|
Moderate
|
Low
|
Walking
Outdoor activities and play with kids
|
Andrew
|
Prostate cancer
|
Surgery
|
Diagnosis
May, 2017
Completion
May, 2017
|
Recovery from surgery
Weight loss
Vomiting
|
Moderate
|
Low
|
Walking
Running
Swimming
Basketball
|
* Pseudonyms
** PA Level = Physical activity self-reported, where very high = at least an hour each day; high = between 30 and 60 minutes each day, moderate = about 30 minutes each day; low = less than 30 minutes each day
The ongoing reflection of the data during collection and analysis provided insight into the commonalities among the participants as they reflected on their cancer journeys, their physical activity and its influence on their QoL. Key quotes and statements were highlighted, organized and categorized based on the three main themes that arose from the analysis; physical benefits, psychosocial benefits, and continuing cancer care. These themes, the quotes and lived experiences within them, were then individually and collectively connected to participants’ QoL.
Physical Benefits
Four participants described having little or no late or long-term side effects from their cancer treatment. These participants believed their regular PA prior to cancer treatment and, in some cases, during their cancer treatment was the reason for the non-existence or limited side-effects. To exemplify, when Grace was asked why she thought she did not experience side effects, she answered “I really do attribute the fact that I went through treatment so easily to the fact that I was so active”. Similarly, Kelly reported she believed PA helped her manage the stomach and pelvic pain she experienced during and shortly after completing treatment.
Participants also reported of the benefits they believed they experienced from their PA since completing treatment. Most intriguing in this regard was Marie, a breast cancer survivor. She had been taking an oral endocrine therapy to reduce the risk of cancer reoccurrence that has the potential side effect of reducing bone density. When Marie learned resistance training improves bone density, she added it to her exercise regime. Marie shared,
“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”.
Another example is Catherine. Although she took a prescription drug that exacerbated her rheumatoid arthritis, she continued to engage in PA because she believed she needed it to maintain/improve her current physical health and recovery from cancer treatment.
Concurrent with the belief that PA provided physical benefits after cancer treatment, participants also spoke specifically about how PA facilitated their recovery process. Participants alluded that they felt stronger and in some instances their recovery was easier because they were routinely physically active. Most notably, the participants indicated the value of PA for pain management post-treatment, for reducing further physical loss following surgery, and as part of their rehabilitation. Overall, the participants were emphatic in expressing the importance of regular physical activity for them to help manage the late or long-term effects from their cancer treatment. 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”.
Psychosocial Benefits
Participants described mental health benefits or feelings of self-gratification from their PA. This positive mental well-being was considered equally important to the survivors as the physical health benefits they experienced from their PA. 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 Claire spoke highly of her PA as a positive coping mechanism for the mental strain she felt while recovering from her treatment, reducing these feelings of mental strain as well as those from other personal stresses at the time. When Grace reflected on her lifestyle change 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. In a confident and appreciative tone, Grace shared that PA had become important and personally valuable to her mental wellbeing both during and after cancer treatment. Grace illustrated the effect of PA for her in the following; “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. Similarly, others said it was not just because it was important for their physical health but rather, they engaged in PA because it was enjoyable and benefitted them personally. David stated in a happy tone; “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.
Continuing Cancer Care
Regarding conversation with their healthcare team regarding PA, most participants said these 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, these participants believed personal conversations related to PA, or physicians’ affirmation of their PA, were beneficial and necessary.
Two participants reported difficulty initiating conversations about PA with their physician. It was only when they specifically asked about an acceptable level of intensity for 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 shared their experience with their oncologist who was adamant that they should be participating in PA. These participants spoke of how these appointments with their oncologist included a descriptive conversation about what PA they were doing and they were explicitly encouraged to be as physically active as possible. Finally, participants were explicitly asked about the Cancer Care Exercise Guidelines in their interviews to determine if they were provided to cancer survivors following completion of their cancer treatment. No participants was aware of the Cancer Care Exercise Guidelines. However, it should be pointed out that during the discussions about receiving, or being aware of, cancer care exercise guidelines, participants mentioned receiving copious reading material upon completion of their treatments. Participants suggested some of this literature may have included information about PA, but they could not recall whether it was actually included.