Program Helps Medically Underserved, Minority Cancer Survivors Be More Active

July 3, 2024, by Linda Wang

Physical activity can have many benefits for cancer survivors, from improving their quality of life to potentially making it less likely that their disease will come back. Yet studies have shown that many cancer survivors struggle to get the recommended levels of physical activity, particularly those affected by health inequities.

Now, according to the results of a new study, a program in Texas has shown it can get these cancer survivors moving more by supporting them in the communities where they live, and by getting their caregivers to become more active as well.

The cancer survivors and caregivers were participants in a 12-week program called Active Living After Cancer. After completing the program, the percentage of survivors getting recommended levels of physical activity jumped dramatically, from 29% to 60%. Survivors also reported improvements in their physical functioning and overall quality of life. Caregivers made similar gains in all three areas.

The findings were published April 30 in the Journal of the National Cancer Institute.  

“I was surprised to see such substantial improvements,” said the study’s lead investigator, Scherezade K. Mama, Dr.P.H., of the University of Texas MD Anderson Cancer Center. “I think it speaks to the need” for such community-based physical activity programs.

Lindsey Page, Ph.D., M.P.H., of NCI’s Office of Cancer Survivorship, said the results confirm the value of efforts to help improve physical activity among survivors, particularly given that a lack of activity is a significant contributor to cancer health disparities.

“It’s really important to have programs like this, so that all cancer survivors have equitable access to physical activity,” Dr. Page said.

Adapting a successful physical activity program 

Research has shown that physical activity can have beneficial effects for people with cancer. 

One study, for example, found that high levels of physical activity were associated with longer survival in women diagnosed with breast cancer. Another study found that physical activity, at or above national recommendations, was associated with less treatment-related cognitive impairment, often called “chemo brain.” 

Based on positive evidence from such studies, in fact, expert guidelines recommend that cancer survivors get regular physical activity (see Box).

The Active Living After Cancer program was originally developed by Karen Basen-Engquist, M.D., and colleagues at MD Anderson to help breast cancer survivors increase their level of physical activity. Following the program’s success, it was adapted for medically underserved and minority breast cancer survivors to meet their specific needs. 

More recently, it was further adapted and made available to survivors of any cancer type, particularly those from medically underserved groups. So, Dr. Mama and her colleagues wanted to assess whether the program was effective for this larger group of cancer survivors. 

They also included caregivers, who also often fail to get enough physical activity. Including caregivers also serves another function, Dr. Mama said, because “particularly among racial and ethnic minorities, family support and social support in general is really important for behavior change.”

Modest improvements in quality of life 

Dr. Mama and her colleagues at MD Anderson partnered with nonprofit health-based organizations in Houston and El Paso and trained health educators to deliver the physical activity program to survivors in their own communities. 

From 2017 to 2020, the community partners recruited 540 cancer survivors and 87 caregivers from the greater Houston and El Paso areas. Of those, 474 survivors and 68 caregivers completed the follow-up assessment. Most participants were female, Hispanic, and medically underserved. The program was free to participants and was delivered in English and Spanish. 

During weekly sessions, participants engaged in a variety of exercises, received training in cognitive and behavioral skills such as time management and goal setting, and discussed topics such as nutrition. 

Each participant received a resistance band and a pedometer and was encouraged to do at least 30 minutes a day of moderate to vigorous physical activity, 5 days a week. Participants completed an exercise questionnaire and fitness assessment at the beginning and end of the 12-week program.

Overall, about 76% of participants stayed in the program for all 12 weeks, on average attending nearly 80% of the sessions. 

In addition to many more survivors meeting physical activity recommendations after completing the program, they also had modest improvements in their physical functioning, as measured by how many times in 30 seconds they could get up from a sitting position. 

Among participants who completed the program, the mean number of these sit-to-stand repetitions increased from 12.3 to 14.3. Participants also reported improvements in their physical and mental well-being. 

Asian participants and those with at least a college education had the greatest increases in physical activity. 

Caregivers also reported increased physical activity, as well as improved physical function, quality of life, and mental well-being. Over the 3-year evaluation period, the percentage of caregivers meeting physical activity recommendations increased from 36% to 71%. 

Involving caregivers in the program was crucial, Dr. Page said.

“We know that people tend to be more active when they have people who can support them,” she said. “And by engaging the caregiver as part of the program, you have that additional partner who’s not only at the session with you, but also at home to encourage physical activity outside of program sessions.” 

And there’s an added bonus as well. “You're also providing a service for caregivers that can help them maintain their health and physical function,” Dr. Page continued.

Serving as a model for other survivorship programs

Dr. Page said she hopes to see the program expand to include survivors in other parts of the country, especially those who live in rural areas, many of whom have limited access to survivorship programs.

She suggests that future work also focus on ensuring that there are avenues of care for those survivors who initially might not receive medical clearance to participate in a physical activity program like Active Living After Cancer.

Those survivors who might require additional support or supervision to engage in such programs may still benefit from getting more physical activity, Dr. Page said.

Dr. Mama noted they’ve expanded the program to additional locations across Texas and will be offering a fully virtual option for those who can’t attend in person. They are also putting together a toolkit with the hopes of sharing it with other community cancer centers and clinics across the United States, so they can develop their own physical activity programs for cancer survivors. 

After 2 decades of working with cancer survivors, the program is achieving the goals she and others set out for it, Dr. Mama said. The program has been a “catalyst for lifelong changes” for participating cancer survivors, she said, potentially helping them live longer, healthier lives.