br It is possible that di erent interview
It is possible that diﬀerent interview methods and settings could have influenced the interviews. Face-to-face interviews diﬀers from telephone interviews by providing another communication dimension using body language which potentially could influence the interviews as well as interpretation of data.
If a relative was present during the interview, he/she was told that the study aimed to capture the patients' perspectives, and thus were asked to remain neutral during the interviews. However, it DZNep cannot be ruled out that the presence of a relative aﬀected the interviews by either limiting the informants’ statements, or by strengthening communica-tion through an increased feeling of security.
The informants in this study were all ethnic Danes or Scandinavians, and we did not capture the experiences of older patients from ethnic minority groups. Older patients with other cultural backgrounds might have other perceptions of PA and exercise due to other traditions. Thus, the uniform ethnic background of the informants weakens the external validity of the study.
4.2. Implications for practice
The information provided from these interviews can be useful in the development of exercise programs for older patients with cancer. Based on the results it will be beneficial to make team-based and supervised exercise programs available for older patients with cancer either in their local communities, or in the hospital setting. Such programs should be supervised by instructors with experience within exercise for patients with cancer. To increase motivation exercise programs could incorporate elements of goal-setting and competition, and information about the beneficial eﬀects of exercise should be provided. Motivation could also be strengthened by gathering patients with similarly
conditions or physical levels on the same teams. To improve adherence, attention must be paid to the patient's handling of symptoms and side eﬀects, and advice about symptom management should be provided if needed.
In this study, the perceptions of PA and exercise were investigated among older patients with advanced cancer who were treated with palliative oncological therapies. Despite decreasing PA levels after the cancer diagnosis, we found positive perceptions of exercise among the informants. Factors related to both cancer and normal aging were identified as barriers towards PA - most profoundly was the over-whelming feeling of fatigue. Improving well-being and QoL, fixed conditions, social support and familiar activities were identified as motivators and facilitators for PA. HCPs working to promote exercise behaviors in older patients with advanced cancer need to take these identified factors into consideration to make exercise programs feasible for flora cancer population.
This study is a part of the Models of Cancer Care Research Program and is supported by grants from the Novo Nordisk Foundation and from Beckett-Fonden. None of the foundations had any role in the study design, analysis and interpretation, or in the drafting or approval of the manuscript.
Declaration of conflict of interest
The authors declare no conflicts of interest.
The authors are grateful to all informants who participated in the study. We would also like to thank all staﬀ nurses at the Department of Oncology, Herlev and Gentofte Hospital, for their collaboration and assistance in identifying eligible patients.
Charlson, M.E., Pompei, P., Ales, K.L., MacKenzie, C.R., 1987. A new method of classi-fying prognostic comorbidity in longitudinal studies: development and validation. J. European Journal of Oncology Nursing 41 (2019) 16–23
Fassier, P., Zelek, L., Partula, V., Srour, B., Bachmann, P., Touillaud, M., Druesne-Pecollo, N., Galan, P., Cohen, P., Hoarau, H., Latino-Martel, P., Menai, M., Oppert, J.M., Hercberg, S., Deschasaux, M., Touvier, M., 2016. Variations of physical activity and sedentary behavior between before and after cancer diagnosis: results from the prospective population-based NutriNet-Sante cohort. Medicine 95 e4629. r> Fisher, A., Wardle, J., Beeken, R.J., Croker, H., Williams, K., Grimmett, C., 2016. Perceived barriers and benefits to physical activity in colorectal cancer patients.
Gerritsen, J.K., Vincent, A.J., 2016. Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Br. J. Sports Med. 50, 796–803.
Granger, C.L., Connolly, B., Denehy, L., Hart, N., Antippa, P., Lin, K.Y., Parry, S.M., 2017. Understanding factors influencing physical activity and exercise in lung cancer: a systematic review. Support. Care Canc. 25, 983–999.