Martijn Matthias Stuiver

Purpose: Live-remote supervised exercise helps cancer survivors reduce the negative side effects of their treatment, and group dynamics are an integral aspect of successful rehabilitation outcomes. In this international group concept mapping study, we investigated which aspects of peer interaction and trainer behaviour participants consider important and how feasible those preferences are according to exercise professionals. Methods: Participants who completed a 12-week live-remote exercise programme for cancer survivors were recruited in 5 European countries and Australia. Participants generated statements in response to prompts about patient interaction and trainer behaviour. The next group of participants sorted statements into thematically similar clusters and/or rated them by perceived importance. Exercise specialists rated the same statements according to feasibility. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and qualitative interpretative analysis. Results: A total of 120 participants and 14 exercise specialists participated. The patient interaction prompt generated 45 statements organized into five clusters (mean importance rating 3.29; mean feasibility 3.61). The subjective experience of belonging to the group was the highest rated cluster for this prompt. The trainer behaviour prompt generated 56 unique statements organized into seven clusters (mean importance 3.82; mean feasibility 4.13). High-quality individual and group level instructions were rated as most important for this prompt. Conclusions: Participants and trainers agreed on the relative priorities, and all key aspects were rated as feasible, suggesting favourable conditions for implementation. Adequate instruction and supervision by trainers and a warm, welcoming atmosphere among participants were considered the most important aspects of live-remote training.

In recent years, remote exercise services (“telerehabilitation”) have been increasingly explored and implemented, including in supportive cancer care, on the promise of greater convenience, access independent of geographic location, reduced infection risk, and cost savings. Ethical commentary on telehealth in general is substantial, but sustained discussion of questions specific to telerehabilitation remains comparatively sparse. As contributors to PREFERBALE-II, a European Union–funded project evaluating live-remote exercise for people recovering from cancer treatment, we sought practical guidance on how to deliver such services responsibly, and found little to work with. This prompted this viewpoint, which sets out our own position as researchers and clinicians engaged in this work. We draw on a purposive sample of professional guidance documents, which were assembled through our professional networks and a supplementary web search, and on a narrative reading of qualitative studies chosen to represent accounts of benefits as well as burdens. We read these documents through an analytical lens of responsible innovation. We make 3 arguments. First, the ethical content of current telerehabilitation guidance is largely confined to the products and processes of innovation, covering safety, privacy, consent, and compliance, while the question of purpose, that is, whether, for whom, and why remote rehabilitation should be offered at all, is left largely unasked. Anticipation appears only implicitly, and reflexivity, inclusion, and responsiveness barely at all. Responsibility is repeatedly delegated to individual professionals without commensurate structural support. Second, the situated experience of users and professionals forms part of the ethics of telerehabilitation and is not merely data to be assessed. Reported benefits and burdens depend on social context, including age, digital literacy, connectivity, caregiver availability, language, and sensory or cognitive impairment, so an equity claim made for the modality in general may not hold for the individual patient. Third, the ethics of telerehabilitation consequently has to be institutionalized across 3 overlapping domains: the interpersonal and experiential quality of remote care, the legal and institutional conditions of delivery, and the positioning of telerehabilitation within health systems. We address these arguments primarily to rehabilitation professionals and the associations and standard-setting bodies that issue guidance for them, and secondarily to digital health and ethical, legal, and social implications researchers, policymakers, and health-system decision-makers who commission or implement such services. We offer an agenda for a broader ethics conversation across professional societies, curricula, and affected publics, together with observations from a consortium put forward as hypotheses for study.

Given the importance of a healthy lifestyle for cancer patients' health outcomes and quality of life, this study aimed to synthesize the literature on factors (perceived as) hindering or facilitating healthcare providers' provision of lifestyle information in oncology. Based on this synthesis, we additionally derived recommendations to improve this practice, which were independently validated by experts. A systematic literature review was conducted. PubMed, Web of Science, CINAHL Ultimate, and PsycINFO were searched. We screened titles and abstracts, aided by ASReview, and full texts. Peer-reviewed articles published from 2007-2022 were included, reporting non-interventional studies on factors that HCPs associated with lifestyle information provision to adult cancer patients. We identified 20,176 unique articles, of which 108 articles were included. Most articles studied factors related to information provision about physical activity, smoking, or a combination of lifestyle behaviors. Factors associated with lifestyle information provision fell into four main groups; factors related to the (1) HCP (e.g., knowledge), (2) patient (e.g., interest), (3) relationships between HCPs, patients, and stakeholders (e.g., support), and (4) organization (e.g., resources). The factors were linked to whether, how, and when information is provided. The review provides an overview of factors associated with communication about different lifestyle behaviors across HCPs and cancer types. Based on the findings, we formulated recommendations for future research and for clinical practice, which were validated via interviews with nine oncology HCPs, confirming feasibility with minor adjustments. Overall, lifestyle information provision as a whole and associated factors deserve more attention in clinical practice and scientific research.

Objectives: This study aims to improve understanding physical activity behaviour in patients with metastatic breast cancer, based broadly on Ajzen's Theory of Planned Behaviour (TPB). We assessed the role of different pathways in the TPB and of cancer specific barriers to find points of leverage for improving exercise support and behaviour in this vulnerable population. In addition, we explored international differences in the model's pathways. Methods: We conducted an international survey ( n = 420) amongst patients with metastatic breast cancer, including items assessing attitude, injunctive subjective norm, intention, perceived behavioural control (PBC), and self‐reported physical activity. Additionally, we examined the relative importance of health‐related barriers on motivational pathways. Results: Model fit indices indicated a reasonable fit for the TPB (cfi = 0.98, rmsea = 0.08) with small (standardized absolute coefficients 0.13–0.30) but statistically significant associations in the expected directions according to the theoretical model, except for subjective norm ( β = 0.05). The interaction of PBC with intention was statistically significant, but adding this term diminished overall model fit (cfi = 0.85, rmsea = 0.13). The presence of health‐related barriers impacted behaviour ( β = −0.19) whilst acting as a mediator for PBC on intention. International differences in the strength of model pathways suggest cultural variation. Conclusions: Findings support the applicability of the TPB for understanding and supporting physical activity behaviour in patients with MBC. Targeting perceived behavioural control may be especially effective in overcoming health‐related barriers in this population. Additionally, improving affective and instrumental attitude towards physical activity could enhance intervention outcomes.

Background/Objectives: Adolescents and young adults (AYAs) with cancer often begin their careers later in life and are at risk of negative work-related outcomes. Research into and tailored support programs for AYAs diagnosed during higher education remain limited. An improved understanding of AYAs’ experiences is essential in guiding the development of age-appropriate support programs. This study explored the impact of cancer and the challenges AYAs face in educational participation and the transition to work. Methods: A qualitative study was conducted with thirteen AYAs diagnosed with cancer during higher education. Participants were interviewed using a semi-structured guide. In collaboration with patient experts as co-researchers, data were analyzed via thematic analysis. Results: Eight analytically derived themes reflected AYA students’ experiences: (1) Meaning and importance of education, (2) Reduced performance, (3) Recovery and expectations, (4) Interruption and delay, (5) Transition to work, (6) Disclosure, (7) Challenges related to the context of students, and (8) Experienced lack of support. The themes were clustered into four overarching thematic categories: Meaningful participation, Impact on performance, Academic progress and career transition, and Challenges in navigation. Conclusions: Our findings provide greater insight into the significance of educational participation for AYAs. AYA students encounter challenges stemming from both diagnosis-related changes in functioning and from contextual factors tied to their roles as students and new starters in the labor market. Navigating the healthcare, education, and social systems is complex and AYAs often lack adequate support when resuming their education or transitioning to work. Tailored support programs in healthcare and educational settings should be developed to help AYAs harness their strong motivation to resume studies, enter the labor market, and achieve their full potential.

Background: Prehabilitation aims to improve patients’ resilience to surgery and enhance postoperative recovery. Understanding rationales for prehabilitation content may identify opportunities for program optimization. This systematic review provides an overview of rationales, intervention, and outcomes used in prehabilitation studies in oncological populations. Patients and Methods: We searched the databases MEDLINE, Embase, and Scopus on 1 March 2024. Comparative prehabilitation studies including patients undergoing oncological surgery were included. Prehabilitation was defined as a preoperative exercise program, alone or combined with other components, with the explicit aim of improving postoperative outcomes. Extracted outcomes included reported rationales, program content, and primary endpoints. Results: In total, 140 studies ( N = 24,925 patients) were included. Most ( N = 125, 89%) reported a rationale for improving physical fitness, particularly cardiorespiratory fitness ( N = 97, 69%). Psychological ( N = 46, 33%) and metabolic ( N = 28, 20%) rationales were reported less frequently. Rationales for specific attributes (e.g., intensity) were rarely described. Exercise was predominantly supervised ( N = 57, 41%), and of these supervised sessions, most were prescribed three times per week ( N = 25, 44%). Almost all studies ( N = 121, 86%) included anaerobic exercise component at moderate-intensity continuous ( N = 39, 32%) or high-intensity interval ( N = 34, 28%) mode. Intended duration varied from 1 to 12 weeks. Most reported primary endpoints were surgical outcomes (e.g., complications) ( N = 59, 42%), although definitions varied. Conclusions: Preoperatively improving physical fitness is a widely used rationale for prehabilitation; however, studies are implicit in rationales for specific program components. Content and duration of prehabilitation showed considerable variation, often determined by feasibility and time to surgery. Prehabilitation studies could benefit from standardized outcomes. Adopting a more mechanistically grounded approach could improve program design and possibly effectiveness. Trial Registration: The review was preregistered in International Prospective Register of Systematic Reviews (PROSPERO; CRD42024512892).

Purpose: Cancer prevalence is steadily rising in Europe. Many survivors experience symptoms and late effects that require management by supportive care. The inequities related to socioeconomic position (SEP) that have been described for primary anti-cancer treatment are likely to extend to the supportive care domain. This scoping review provides an overview of the existing literature assessing this relationship, and the methods used to do so. Methods: A comprehensive search was executed in May 2024 in multiple databases. Studies published after 2000, including real-world data on access to, uptake of, or adherence to supportive care in relation to SEP were included. Results: A total of 29 articles were included for review. Studies reported on a variety of supportive care types and were conducted primarily in Northern and Western Europe. Most studies with statistically significant findings ( n = 14) reported an association between high SEP and increased access to or uptake of supportive care ( n = 12). Conclusions: Research on the association of SEP with access and uptake of supportive care is increasing but still limited. Methodology varies and is mostly exploratory. The majority of the included studies indicate that socioeconomic differences in engagement with supportive cancer care in Europe persist. More research is needed to explain the causal pathways through which SEP affects engagement with supportive care, and how its accessibility can be improved in different European countries. Implications for Cancer Survivors: Efforts should be made across healthcare systems to improve accessibility to supportive cancer care for patients with a low SEP.

Purpose: As survival of patients with metastatic breast cancer (MBC) improves, their work situation is gaining importance. The aim of the current study was to identify factors associated with work status and quality of working life (QWL) in patients with MBC. Additionally, we investigated the effects of an exercise intervention on work status. Methods: Within the multinational PREFERABLE‐EFFECT exercise trial, 287 patients with MBC of working age (18–65 years) reported on their working situation over 9 months as a secondary endpoint. Among a subgroup of participants, QWL was assessed by the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ‐CS) ( N = 59). Results: At baseline, 157 (54.7%) participants were employed, of whom one‐third reported having recently reduced their amount of work because of fatigue (41.7%), cognitive problems (33.3%), or inability to meet work demands (33.3%). Participants wished for more flexible working hours (29.2%) and less productivity pressure (37.5%). Participants were less likely to work if they experienced higher levels of pain ( p = 0.014). Among working participants, an academic education and higher levels of psychological distress were associated with a higher number of working hours (all p < 0.05). Fatigue, an academic education, and performing mentally strenuous tasks at work were negatively associated with QWL (all p < 0.05). The exercise intervention did not affect the number of hours worked during the study. Conclusions: Symptom management might be important for patients' ability to work. To help patients stay employed and improve QWL, employers should consider offering more flexible work arrangements and adapting to their employees' changing needs and abilities. Trial Registration: The PREFERABLE‐EFFECT trial was registered with ClinicalTrials.gov on October 9, 2019 (NCT04120298).

Purpose: Maintaining exercise behavior is crucial for cancer survivors, yet adherence to exercise recommendations remains low. This study explores the experiences and perspectives of community-working physical therapists and survivors of cancer regarding barriers and facilitators that support the maintenance of exercise behavior post-treatment. Methods: A qualitative, exploratory focus group design was employed, using purposive sampling to recruit oncology physical therapists and cancer survivors who had undergone physical therapy. The study assessed current physical therapy practices, barriers, and facilitators to exercise maintenance through thematic content analysis Braun and Clarke. Results: Six focus groups with 26 participants (12 cancer survivors and 14 physical therapists) revealed three main themes: (1) transition challenges from supervised therapy to independent exercise, (2) environmental constraints on exercise adherence, and (3) motivators and supportive factors to help independent exercise. Transition challenges included a lack of knowledge and skills, persistent symptoms, and psychological recovery. Environmental constraints involved prioritizing exercise over work and family and limited financial resources. Motivators and supportive factors included goal-setting, gradual reduction in physical therapy sessions, and building confidence in self-management among cancer survivors. Conclusions: Both physical therapists and cancer survivors experience challenges in concluding the treatment relationship. The identified facilitators for independent exercise can assist physical therapists in developing effective exercise programs that promote patient independence during and after physical therapy treatment. Implications for Cancer Survivors: Understanding these barriers and facilitators can help tailor interventions that enhance long-term exercise adherence, ultimately improving health outcomes and quality of life for cancer survivors.