Quality of life’s role in improving exercise study participation for uterine cancer patients

Certain quality-of-life factors, such as pain and anxiety, have a significant impact on the likelihood of endometrial cancer survivors to complete exercise studies, according to MD Anderson research published recently in Quality of Life Research.

Understanding these factors will help doctors develop strategies for improving study participation and adherence to healthy lifestyle recommendations.

It’s critical for cancer survivors to follow recommended healthy lifestyle guidelines for diet, physical activity and other behaviors because they lower the risk for recurrence and secondary cancers, as well as other conditions such as heart disease and diabetes.

However, adherence is generally low among cancer survivors, according to a study published in 2007 by the Journal of Clinical Oncology. Fewer than 20% of those questioned met daily nutrition guidelines, and less than half complied with recommended physical activity levels.

As obesity is a major risk factor for endometrial cancer and several other diseases, improving adherence is of particular importance for endometrial cancer survivors.

“There is a real need to improve diet and activity in this survivor population, but it is a challenge to develop effective interventions when so many survivors do not follow recommendations and are not able to complete research studies,” said senior author Karen Basen-Engquist, Ph.D., professor of Behavioral Science and director of MD Anderson’s Center for Energy Balance.

Hypothesizing that quality of life may affect adherence, Basen-Engquist and her team analyzed baseline quality-of-life measures and study completion rates in a group of endometrial cancer survivors.

The current study is a secondary analysis of 100 post-treatment endometrial cancer survivors from the Steps to Health study, a previously published single-arm, 6-month longitudinal exercise study. Survivors were recruited from MD Anderson and a Houston-based community practice between 2007 and 2009.

Participants completed validated quality-of-life questionnaires at the beginning of the study. Following an initial health assessment, participants were given personalized exercise prescriptions to perform at least 30 minutes of moderate-intensity exercise five days a week. During the study, survivors received telephone counseling to encourage participation, as well as printed support materials and a pedometer. Follow-up assessments of health and quality of life occurred every two months.

“We found that levels of self-reported pain and anxiety at baseline were significantly associated with study completion,” said first author Jaejoon Song, an analyst in Biostatistics. “What surprised us was the non-linear nature of the associations.”

Overall, survivors with higher pain levels were less likely to complete the study (p=0.025), but the relationship was evident only for individuals reporting the most pain. For those with low to moderate levels of pain, the precise pain level was not related to whether or not a survivor completed the study.

Anxiety levels also factored significantly in study completion (p=0.035), though two different trends were observed. Within the category of survivors with low anxiety, a little bit of anxiety made it more likely they would complete the study. But among those with higher anxiety, those with the highest anxiety level had lower study completion rates.

“These data suggest an optimal level of anxiety among participants where the highest odds of completing the study can be expected,” said Song.

While further studies are necessary to identify definitive links between these quality-of-life factors and study completion, these findings suggest that study adherence may be improved by tailoring interventions based on baseline assessments.

“These results can be a tremendously helpful to researchers and those planning survivor programs for identifying survivors who may need more assistance or support to complete a study or program,” said Basen-Engquist. “As we research and strive to improve the cancer survivorship experience, we need as many people as possible to complete these studies.”