Supportive Care in Cancer

, Volume 27, Issue 4, pp 1215–1222 | Cite as

Missed opportunities for physical activity management at key points throughout the chemotherapy pathway for colorectal survivors: an observational interview study

  • I. Veal
  • N. Peat
  • G. D. Jones
  • V. TsianakasEmail author
  • J. Armes
Original Article



Physical activity (PA) is central to self-management for people with colorectal cancer (CRC) to support health behaviour and function secondary to cancer treatment. However, there is limited evidence on how health professionals (HPs) promote PA during cancer treatment. This study aimed to investigate how and when PA is promoted throughout the chemotherapy pathway among colorectal cancer survivors.


A qualitative study was conducted with adults with CRC receiving chemotherapy at a large cancer centre. Cross-sectional observation of clinical consultations was conducted at four points during the chemotherapy pathway: prior, midpoint, final cycle, and 8 weeks following chemotherapy. Following completion of treatment, audio-recorded, semi-structured interviews were conducted with patients and HPs and transcribed verbatim. Codes and themes were identified and triangulated from all the data using framework analysis. Observational themes are reported and complimented by interview data.


Throughout the chemotherapy pathway (pre, midpoint, end), many opportunities were missed by HPs to promote PA as a beneficial means to maintain functioning and ameliorate cancer treatment side effects. When discussed, PA levels were used only to determine fitness for future oncological treatment. No PA promotion was observed despite patients reporting low PA levels or treatment side effects. Post-treatment, PA promotion was more routinely delivered by HPs, as evidenced by problem-solving and onward referrals to relevant HPs.


PA promotion was largely absent during treatment despite it being a key component of patient self-management following treatment. This suggests considerable missed opportunities for HPs to provide cancer survivors with PA evidence-based interventions. Further research is necessary to identify how best to ensure PA is promoted throughout the cancer journey.

Implication for cancer survivors

These findings suggest many may not be receiving support to be physically active during treatment.


Self-management Colorectal neoplasms Qualitative Physical activity 



This study was undertaken as part of a Masters in Clinical Research programme and funded by the National Institute of Health Research (NIHR) through the ICA HEE/NIHR Integrated Clinical Academic Programme.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee Research Ethics Committee (15/EE/04/34) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • I. Veal
    • 1
    • 2
  • N. Peat
    • 1
  • G. D. Jones
    • 1
  • V. Tsianakas
    • 2
    Email author
  • J. Armes
    • 3
  1. 1.Guy’s and St Thomas’ NHS Foundation Physiotherapy DepartmentLondonUK
  2. 2.Florence Nightingale Faculty of Nursing & MidwiferyKing’s College LondonLondonUK
  3. 3.School of Health SciencesUniversity of SurreyGuildfordUK

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