Patients’ Satisfaction And Adherence To Supervised Exercise Interventions During Systemic Treatment For Metastatic Colorectal Cancer

PURPOSE: Patients with metastatic colorectal cancer (mCRC) undergoing systemic treatment often experience toxicity-induced treatment modifications, which may reduce treatment efficacy. Exercise has shown beneficial effects on patient-reported outcomes and physical fitness in patients with cancer, but trials in patients with mCRC are scarce. The Aerobic Fitness or Muscle Mass Training to Improve Colorectal Cancer Outcome (AMICO) trial (NCT04754672) examines the effects of exercise on toxicity-induced treatment modifications and progression-free survival, and underlying mechanisms of action. The aim was to capture patients’ experiences, adherence and satisfaction with exercise during systemic treatment for mCRC and the perceived role of exercise for treatment tolerance. METHODS: Patients with mCRC receiving first-line systemic treatment were randomized to: 1) continuous aerobic with resistance exercises, 2) continuous aerobic with high-intensity interval exercise, both supervised by a trained physiotherapist, or 3) usual care control (1:1:1). Semi-structured interviews were held with patients in the exercise arms until data saturation. Quantitative data on adherence (exercise logs) and satisfaction (questionnaire) was used to complement and contextualize the qualitative findings. Adherence was expressed as the performed relative to the prescribed exercise dose intensity (ExRDI). RESULTS: All twenty patients participating in the exercise arms were interviewed. Median ExRDI was 63% (range 7-94%), and median satisfaction with the intervention was 8 out of 10 (range 5-10). Patients valued the guidance and knowledge of the physiotherapist and support in group sessions. Patients experienced improved physical fitness, daily function, and mental well-being. Patients reported that exercise helped them to endure treatment, they also reported treatment toxicity, physical problems or other (hospital) appointments as barriers to exercise. Adequate tailoring of training and internal or external motivation were reported as exercise facilitators. CONCLUSIONS: Patients with mCRC appreciated exercise during palliative systemic treatment and perceived several beneficial effects, both physically and mentally. Exercise adherence varied between patients and satisfaction was high. VIDI grant from NWO-ZonMW (grant number 09150171910017) and Cancer Center Amsterdam foundation (CCA2020-1-20)