Advice on being active should be routine in bowel cancer care

It’s well established that leading an active lifestyle can reduce your risk of developing bowel cancer, as well as a range of other cancers.

But what about after diagnosis? Intuitively, you might think that ‘rest is best’ for cancer patients recovering from treatments that can be both mentally and physically exhausting.

But over years the evidence has begun to build that being active after cancer treatment can significantly reduce fatigue, boost physical health and well-being, and improve quality of life.

And there’s even promising new evidence that being active might improve a person’s chances of surviving the disease, and cut the risk of the cancer coming back.

In this context, being ‘active’ doesn’t have to be anything extreme: it can just mean being on your feet more, and gradually working towards the amount recommended for healthy people of two and a half hours a week of moderate physical activity (e.g. walking, cycling, swimming) – which can be done in chunks.

Taken together, the evidence that getting active can help after, and even during, treatment for bowel cancer, is promising. And it’s also the case for other types of cancer – there’s good evidence that being active can help people recovering from breast and prostate cancer, but more work needs to be done in other cancer types.

So that’s why the results of our new study, published today in BMJ Open, give cause for concern.

We looked at information from a large national questionnaire of bowel cancer patients, including information about how active they were, and whether they were given any advice about being active.

Worryingly – despite all the evidence of its benefit – we found that the majority of bowel cancer patients didn’t remember being given any information about being active.

Physical activity and exercise advice is not yet routine

Our analysis looked at more than 15,000 bowel cancer patients in the UK.  When we looked in detail at the data, more than two-thirds (69 per cent) of this group didn’t remember being given any advice or information on physical activity or exercise. And importantly, these people were significantly less likely to say they kept active.

We also found that a third of the people in this group said they did no physical activity at all.

This supports the idea that activity advice from health professionals can be important in encouraging people to stay active as they recover from their treatment.

Our study is the largest of its kind, but our findings are in line with other surveys carried out in the UK and abroad. They also fit with a recent study from others in our group at the UCL Health Behaviour Centre, in which a large number of UK health professionals who work with cancer patients said they weren’t yet giving physical activity advice to their patients.

Of course, patients recovering from treatment for cancer often get extremely fatigued, and have many other side effects from the treatment, which could leave them reluctant to get more active. They may also be unsure whether it’s safe to be physically active, so may look to doctors and nurses for advice on this during and after their cancer treatment.

For this reason health professionals need clear guidance on the advice to give.

So how can we make such advice part of routine cancer care?

So what guidelines are out there? Experts from the American College of Sports Medicine say that it’s safe for doctors and nurses to recommend that, in general, any patient should avoid being inactive, and should aim for at least 150 minutes of moderate activity per week, along with strengthening and stretching exercises twice a week.

But these are general guidelines, and a number of things have to be considered, like a patient’s previous activity levels, side-effects of treatment, or other conditions. Specific guidelines are needed for doctors and nurses to be able to support bowel cancer patients in getting more active.

As well as cancer-specific guidance, health professionals also need more time in consultations and more services where they can refer their bowel cancer patients for advice and support about how to get more active safely.

Is it our job as scientists working in exercise medicine to help bridge the gap. There are some excellent schemes, such as CANREHAB, to train fitness and health professionals in exercise for cancer. And promising new work is examining whether existing exercise services can be adapted for bowel cancer patients. But more must be done to ensure that appropriate advice becomes part of routine care for all bowel cancer patients in the UK.

Only by doing this will we be able to ensure all bowel cancer patients know about the benefits of being more active and feel confident to get moving more.

Dr Abi Fisher is a senior researcher at the Cancer Research UK Health Behaviour Research Centre at UCL

Reference

• Fisher et al. Recall of PA advice was associated with higher levels of physical activity in colorectal cancer patients. BMJ Open DOI: 10.1136/bmjopen-2014-006853