Anne Marie L. Husebø, Helen Allan, Bjørg Karlsen, Jon Arne Søreide, Edvin Bru
2015 Cancer Nursing  
Breast cancer treatment can represent a threat to a patient's wellness. The role of exercise in perceived wellness in women with breast cancer merits further study. Objective: To describe how exercise is perceived by women to influence their physical and psychosocial wellness at the time they were receiving chemotherapy. Methods: Five focus group interviews with a total of 27 women with early stage breast cancer were conducted. Prior to the focus groups the women had participated in an exercise
more » ... intervention during chemotherapy treatment. Results: Three themes emerged from the analysis: exercise shapes feelings of psychological wellness; exercise stimulates feelings of physical wellness; and exercise influences social wellness. The women reported feeling stronger in a psychological sense after exercising, that the strength 2 2 exercise improved their upper limb functioning, and that engaging in exercise triggered social support and interactions. Conclusions: Exercise during breast cancer treatment is perceived to enhance the patients' wellness on several dimensions and in particular psychological wellness. Exercise might support the patients' efforts to restore their sense of wellness, and enhance their level of daily life functioning. Implications for Practice: Cancer nurses should promote exercise as a wellness-fostering intervention during chemotherapy treatment. Focusing on how exercise can contribute to feelings of wellness may help women with breast cancer choose exercise as a health promoting activity that contributes to their recovery. of the interaction between the individual, society, and nature" 13 (p.87). The wellness dimensions are interconnected, frequently affecting one-another and high-level wellness exceeds the absence of disease 15 . When facing a life-threatening illness, restoring their sense of wellness through a health behavior change becomes an important goal to many cancer survivors, and wellness processes often originate from a deliberate effort to improve quality of life 16 . 4 4 Physical activity is viewed as one of many health behaviors pursued by cancer survivors, and should be recognized as a component of the survivor's wellness experience 17 . Appropriate exercise is associated with improved physical well-being 18 , enhanced psychological well-being 19 , and can increase general quality of life in cancer patients on chemotherapy treatment in general 20 . In relation to breast cancer survivors, Gho et al. 21 found that survivors who reported sufficient exercise levels during treatment experienced fewer side-effects. Moreover, physically active breast cancer survivors experience less of a decline in overall quality of life compared to sedentary survivors 20 ; physical activity could thus be an effective health promotion behavior towards experiencing enhanced wellness in breast cancer patients. Increased sense of control, distraction from illness and a restored normality has been studied as psychological benefits from exercise programs during breast cancer treatment 17, 22 . How women with breast cancer perceive wellness benefits from home-based exercise during chemotherapy has not been fully documented 22, 23 . It is therefore important to obtain indepth understanding of the role of exercise in women with breast cancer, and how it relates to the women's recovery from the cancer and its treatments. This is particularly true for surgically treated breast cancer patients during the postoperative period when chemotherapy is administered for several months. In order to introduce exercise as a health promoting behavior to this population, cancer nurses could benefit from knowledge of the women's own experience of the benefits of exercise. Thus, this study aims to describe how exercise is perceived to influence physical and psychosocial wellness by women surgically treated for early stage breast cancer who took part in a home-based exercise intervention while receiving chemotherapy. 5 5 Methods Research Design We used a descriptive and exploratory design with focus group interviews to collect data on women's experiences of taking part in an exercise intervention program. An acknowledged advantage of this method is collecting data as a direct outcome of group interaction where participants both share their experience with each other and respond to other group members' experiences 24 . Data were collected during five focus group interviews with participants who had completed a scheduled exercise program. The focus groups were conducted from Sample and Setting Women with early stage breast cancer who had participated in the home-based exercise intervention during adjuvant chemotherapy were recruited to focus groups by purposive sampling 25 . The exercise program involved both a walking prescription of 30 minutes of brisk walking a day and strength exercises to be performed using resistance bands three times per week 26 . The women received a telephone call from the research team every second week and kept exercise diaries. Eligible breast cancer patients were between 18 and 70 years of age, surgically treated for early stage breast cancer (mastectomy or lumpectomy), and allocated to adjuvant chemotherapy according to the national treatment guidelines 27 . The participants had to be able to read, write and speak Norwegian, and they were approved for participation by a clinical oncologist. Of the 29 women who completed the exercise intervention in the parent study, 27 agreed to take part in the focus group interviews as soon as possible after completing the 6 6 intervention. The participants were allocated to one of the five focus groups, each with a total of 5-6 participants. Sample demographics are in Table 1 . The participants' ages ranged from 34 to 69 years, with a mean age of 52 years. The majority lived with a partner and 48 % had children living at home; 52 % of the women were currently employed. Surgical treatment was most commonly (67 %) restricted to a lumpectomy, but 33 % of the women had a mastectomy. An adjuvant chemotherapy treatment containing taxane monotherapy was administrated to 12 of the women. On average, the women performed the exercise intervention program for 19 weeks. An invitation letter including study information was mailed to each eligible patient and included assurance that the data would be treated confidentially. Each participant gave written consent. Transcripts and field notes were maintained and findings were presented in a way that individuals were not identifiable. Audio recordings were only available to the first author and the transcriber, and the anonymized transcripts were available only to the authors. Fann JR, Thomas-Rich AM, Katon WJ, et al. Major depression after breast cancer: a review of epidemiology and treatment. General Hospital Psychiatry. 3// 2008;30(2):112-126. 38.
doi:10.1097/ncc.0000000000000205 pmid:25275583 fatcat:74kq6ykkfndnrmbdak5za2gjvu