Introduction

Today, the importance of physical activity (PA), and the underlying biological mechanisms, in the prevention of cancer are well known [1,2]. Both meta-analysis and review of clinical randomized trials reported beneficial effects of physical exercise during and after antineoplastic treatments [3-5]. From the first study [6], many others have been published on the inverse relationship between cancer mortality and PA. PA is associated with various site-specific cancers in many ways. PA reduce cancer incidence, cancer progression, cancer recurrence and impact survival rates; it has an important role in the prevention of neoplastic disease, as a support during oncological treatments, in post-treatment and follow up [7-9]. In breast cancer, PA during adjuvant therapy reduce loss of muscle strength and cancer-related fatigue. Duration and intensity of PA also play an important role: longer exercise sessions or exercising with higher intensity will result in a greater reduction in cancer risk. Despite international guidelines include regular PA as a recommendation for cancer patients [2,9], we need to explore how increase PA among cancer patients that undergoing treatment.

The principal aim of this study was to measure the prevalence of PA among cancer patients being treated at a large Italian university hospital and the associated characteristics.

Materials and methods

This survey involved more than 400 patients who voluntarily agreed to answer an anonymous questionnaire while they were in the waiting room for their scheduled oncological visit, in this single center, cross-sectional study.

A clinician gave information about the study, and obtained study consent from patients. Before the visit, a researcher gave patients the questionnaires and they individually completed them. If necessary, help was provided.

This study was approved by the “Sapienza” Ethics Committee (CE REF:7086/2023), and all subjects provided written informed consent. The study is conducted in accordance with the Declaration of Helsinki, and data were collected between October and November 2023.

Instruments

Regular physical activity (gymnastics, swimming, brisk walking) and frequency (occasionally/ habitually) have been explored.

Sociodemographic, clinical and lifestyle data (gender, age, marital status, years of school, family history of oncological pathologies, diagnosis, surgery, chemotherapy, radiotherapy, immunotherapy, hospitalization, cancer severity, side-effects, diet, alcohol and smoking, Complementary and Alternative Medicine (CAM) and dietary supplements use) have also been collected.

Hospital Anxiety and Depression Scale [10] has been used to measure anxiety and depression status. HADS score > 11, in each domain, has been considered positive for anxiety or depression. In this study, the internal consistency of the scale was α =0.91.

Statistical Analysis

Data were presented as count (n) and percentage (%) or mean and standard deviation (SD), to describe demographic and clinical characteristics of the whole sample and separately for males and females or PA (no/yes) group.

For analysis purpose, patients were subdivided into four groups with respect to age (<56;56-65;66-75;>75), into two categories for years of education (<=8 years of school versus >8 years of school) and married status (no/yes). Data about severity was subdivided in 5 classes (very mild; mild; moderate; severe; very severe). Data about surgery, CHT, immunotherapy, radiotherapy, fatigue, articular or muscular pain, nausea, headache, hair loss were dichotomic (no/yes), as data about CAM and dietary supplements used, due to their heterogeneity.

The internal consistency of the HADS scale was estimated with a Cronbach alpha coefficient by the item-total correlations.

Multivariate regression models were built to assess the association between PA (compared to no-PA) and all variables resulted associates at the univariate analyses, while simultaneously adjusting for possible confounding factors as age, gender, and severity of cancer. Bivariate and multivariate odds ratios (ORs), and associated 95% confidence intervals (CIs) were estimated using logistic regression models.

All statistical analyses have been performed using STATA, version 11.0 (StataCorp, College Station, Tex).

Results

Among 405 patients (207; 51.11% males and 198; 48.89% females), 127 (31.36%) practiced PA and 278 (68.64%) didn’t. Eighty-nine (22.14%) and 80 (19.90%) reported a HADS domain’s score>11 and were classified as probable cases of clinical depression or anxiety, respectively. In Table 1 demographic and clinical characteristics are shown, separately by gender. Males resulted significantly older than females. Prevalence of lung and kidneybladder cancer were higher in males. Differently, schooling, diet, CAM or dietary supplements, muscular pain, headache, hair loss, anxiety (as measured by HADS) and, partially, physical activity (p-value=0.090) were higher in females. No significant differences were observed on surgery, CHT, immunotherapy, radiotherapy, cancer severity, fatigue, nausea, and depression, as measured by HADS.

Table 1: Demographic and clinical characteristics, separate by males and females (N; %).

In Table 2 demographic and clinical characteristics are reported, separately by PA.

Table 2: Demographic and clinical characteristics, separately by physical activity (no/yes) (N; %).