TOPLINE: 

Among patients with cancer, lack of energy and physical limitations emerged as the most common perceived barriers to adopting healthy lifestyle behaviors, followed by cost and motivation, according to findings from a recent national survey.

METHODOLOGY:

• Healthy lifestyle behaviors, such as exercise and diet, can affect cancer survivors' quality of life, but less is known about barriers that survivors face in adopting these behaviors.
• To better understand potential barriers, researchers from the American Society of Clinical Oncology (ASCO) distributed an online survey to adult cancer patients in the US from March to June 2020, collecting data from 2419 individuals receiving cancer care.
• Researchers included 1987 individuals in the analysis and divided them into groups by disease stage and treatment status, specifically early-stage on-treatment (n = 461), early-stage post-treatment (n = 916), and metastatic on-treatment (n = 610).
• Participants rated the extent to which they perceived that specific barriers impeded their ability to engage in healthy lifestyle changes: strongly agree/agree, no opinion/neutral, or disagree/strongly disagree. These barriers included lack of motivation, time, energy, logistics, cost (defined as insufficient insurance coverage for lifestyle services), resources, physical limitations, cancer effects, and whether providers discussed benefits.
• Researchers also evaluated perceived barriers among individuals not meeting healthy lifestyle guidelines (n = 975), defined as those consuming one to two servings of fruits and vegetables per day or engaging in fewer than two exercise sessions per week.

TAKEAWAY:

• The most common perceived barrier to healthy behaviors was lack of energy (58.7%), with significant differences reported across all groups: 65.7% in the metastatic on-treatment group, 60.3% in the early-stage on-treatment group, and 53.3% in the early-stage post-treatment group (P = .001).
• The second most common perceived barrier was physical limitations (52%), with patients in the metastatic treatment group more likely to flag this barrier compared with those in the early-stage on-treatment group (odds ratio [OR], 1.33; P = .045).
• Cost was also cited as a major barrier overall (46.8%), especially among respondents not meeting exercise (50.9%-52.3%) or dietary goals (42.7%-51.7%) across disease stage and treatment status groups. Similarly, lack of motivation was a notable barrier overall (40.2%), particularly among respondents not meeting healthy lifestyle guidelines (51.3%-62.0%).
• Logistics was largely not considered a major barrier overall, with nearly 60% of respondents saying they disagree/strongly disagree. Patients in the metastatic on-treatment group were less likely to identify time as a barrier compared with those in the early stage on-treatment group (OR, 0.50; P < .0001), with global differences across all three groups (P < .0001).

IN PRACTICE:

"These findings reinforce the need for tailored interventions to help support lifestyle changes throughout cancer treatment, recognizing the impact that patient, disease, and treatment factors have on the uptake and maintenance of physical activity, diet, and weight management programs in patients with cancer," the study authors wrote.

SOURCE:

The study, led by Rebekah L. Wilson, PhD, and Jennifer A. Ligibel, MD, both from Dana-Farber Cancer Institute in Boston, was published online on February 17 in JCO Oncology Practice.

LIMITATIONS: 

The survey respondents may represent a biased sample with greater interest in lifestyle behaviors. Responses may be influenced by recall bias or social desirability bias, where participants provide answers perceived as favorable rather than fully accurate. Participation was voluntary, which may introduce nonresponder bias and limit generalizability. Patients could select only from a predetermined list of barriers, which could mean some barriers were not captured. Additionally, data collection coincided with the early months of the COVID-19 pandemic, which may have influenced perceived barriers such as logistics and resource access.

DISCLOSURES:

This work was made possible through the logistical support of ASCO. Lori J. Pierce, MD, disclosed holding patents and receiving royalties from UpToDate and PFS Genomics, and reported uncompensated relationships with Bristol Myers Squibb and others. No other potential conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.