Physical activity has many benefits for the overall health of cancer survivors, counteracting negative treatment-related side-effects and improving quality of life, survival, cancer recurrence and risk for secondary cancers 1. However, cancer survivors physical activity levels are low, not allowing them to achieve these health benefits. Oncologists hold a unique position, as they are highly trusted members in a cancer survivors care team. This unique role has the potential to have more influence in changing the behaviour of cancer survivors and increasing their physical activity levels 2. However, oncologists and oncology healthcare providers (OHP) lack knowledge, competence and confidence discussing physical activity with cancer survivors 3, 4. Thus, the educational dilemma is educating oncologists and OHP on physical activity for cancer survivors. The importance of this is to increase providers confidence and competence to have discussions about physical activity with cancer survivors.
To address this dilemma, I plan to develop a webinar series that can be used to educate oncologists and OHP on the benefits of physical activity for cancer survivors, barriers and facilitators to cancer survivors being active, as well as strategies for having these conversations with survivors to facilitate this discussion.
References
- Patel, A. V., Friedenreich, C. M., Moore, S. C., Hayes, S. C., Silver, J. K., Campbell, K. L., … & Denlinger, C. (2019). American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Medicine & Science in Sports & Exercise, 51(11), 2391-2402.
- Jones, L. W., Courneya, K. S., Fairey, A. S., & Mackey, J. R. (2004). Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Annals of Behavioral Medicine, 28(2), 105-113.
- Hardcastle, S. J., Kane, R., Chivers, P., Hince, D., Dean, A., Higgs, D., & Cohen, P. A. (2018). Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: an international survey. Supportive Care in Cancer, 26(11), 3711-3719.
- Nadler, M., Bainbridge, D., Tomasone, J., Cheifetz, O., Juergens, R. A., & Sussman, J. (2017). Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators. Supportive Care in Cancer, 25(7), 2297-2304. doi: 10.1007/s00520-017-3640-9
Enhancing Physical Activity Discussion Practices in Oncologists & Oncology Healthcare Providers 
Hello Denise,
Congratulations for your website and thank you for sharing your dilemma with us. Your subject is very relevant and I’m sure this project will be very useful for oncologists.
I was wondering if they would have the opportunity to ask questions during the webinars? I’m sure that physicians will have a lot of questions and they will want to discuss them with you live.
Also, if I think of my oncologist friends in Quebec City, I think they have a basic knowledge on the subject. Maybe an online questionnaire could allow you to target their needs and then build your webinars.
Finally, I think a pre/post test could be useful in order to see the progress of everyone’s knowledge.
Good luck and I will be happy to read your next steps!
Marilyn
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Hi Marilyn,
Thanks! Ideally I would like them to have the opportunity to ask questions live. This was my initial idea; however, this requires live participation and I worry how feasible that will be. Oncologists are very busy and I think it may be more feasible if they could complete the webinar on their own time. I have thought to maybe supplement the webinar with a discussion forum such as slack, that can be moderated and monitored by myself and subject experts. What are your thoughts on this?
The pre/post evaluation is a great idea and I will definitely have one to measure changes in self-efficacy!
Best,
Denise
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Hi Denise,
I found the appearance of the website is very appealing and comfortable to look at and navigate through.
Regarding Your dilemma, it is a very important step towards improving quality of life of cancer patients especially that you have the evidence to support it.
I would suggest to think of an incentive for those physicians to attend those Webinars or maybe if they already have a departmental meeting for grand rounds to make this your way in to their busy schedules, for an upgrade you might think of making it a CME activity as well.
Those are my thoughts for you, and can’t wait to see your end project !
Nooran
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Hi Nooran,
Thank you for the great feedback! CME was actually brought up by a colleague and I am exploring that option. I am not sure how feasible it is but I am very interested in attempting this as I think it will help with getting oncologists to participate, which will be a very challenging recruitment barrier. However, to be CME accredited the webinars would have to be a minimum of 3 hours, thus 3 1-hour webinars. Oncologists are very busy so I am not sure if time will be a barrier if I go this route.
From your professional experience, which do you think holds more value? Addressing the barrier of time or providing accreditation as incentive? Also, is CME important and used by most medical professionals?
Best,
Denise
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Hi Denise,
I would say time is more important when I am looking for an online activity, a 3 hour webinar is too long. this would be like a Minnie workshop.
In terms of CME, I haven’t practiced in Canada so I don’t know how important is it for physicians here, but maybe some of the practicing physicians would help you figure this out. Where I come from our medical license renewal would require some hours of CME so that is why I suggested it.
Thank you!
Nooran
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Hi Denise.
I think this is SO important. We often do not take time to counsel about lifestyle management in clinic.
I think webinars are a great way to disseminate information.
Do you anticipate them to be short or long?
Looking forward to seeing more.
Carolyne
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Hi Carolyne,
I was planning to make them short (1 webinar under an hour), as oncologists are very busy and I know time will be a barrier. However, in thinking about buy in from the oncologists I am considering CME accreditation, which would require a minimum of 3 hours in length (this can be broken up into 3 1-hour webinars). An hour is still fairly short, but again oncologists are very busy. I will hopefully meet with someone who has been running a CME accredited program and balance the pros and cons of each to determine the webinar length.
From your professional experience, which do you think holds more value? Addressing the barrier of time or providing accreditation as incentive?
Best,
Denise
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Good question… Any chance it can be fractioned? Like 2 or three short videos and once you’ve done the three you get one credit ?
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Hi Denise,
Great initiative! It’s very helpful for patients to have access on how to improve lifestyle factors related to their oncologic illness and often this is difficult to address in clinic.
I really like the webinar format as it fits your educational goals. To promote the website further you may want to link it with oncology support networks such as Canadian Cancer Survivor Network.
You can check out their Youtube channel for some ideas on prior Webinar formats:
https://www.youtube.com/channel/UCgwUAdqUGt9gjxVMtfR6Uzg
Helena
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Hi Helena,
Thank you for your feedback and making me aware of these webinars! This is good to get an idea for webinar designs and see what works and what can be improved on. I found a study that explored webinars for education of both patients and healthcare providers and outlined their delivery in Figure 1 (Chiswell et al., 2016). The outline is meant as a starting point to standardize delivery formats. Interestingly, the webinars you linked did in fact follow a similar format, with a clear introduction giving an overview of the session, core content delivery by a subject expert and questions at the end. I think this is an effective format to use. What are your thoughts?
Chiswell, M., Smissen, A., Ugalde, A., Lawson, D., Whiffen, R., Brockington, S., & Boltong, A. (2016). Using webinars for the education of health professionals and people affected by cancer: processes and evaluation. Journal of Cancer Education, 33(3), 583-591. doi: 10.1007/s13187-016-1138-7.
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Hi Denise,
Congrats on your website, and amazing initiative!
As you know I also have a huge interest in exercise and prevention. So please keep me posted on your next steps!
In our Cardiovascular Rehab and Prevention institution, we see family physicians taking the lead to refer patients that due to different reasons were not sent to our program. But usually,
in our dedicated program for Breast Cancer survivors, patients are referred by their oncologist. About your audience, do you think that it would be interesting to include family physicians as your target audience in the future?
Looking forward to hearing your thoughts!
Good luck!
Carolina
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Hi Carolina, thank you!
I think in the future, it would be great if every healthcare professional was trained in this area of knowledge, as healthcare has becoming increasingly interdisciplinary. However, for the purpose of this project and the specific population of cancer survivors, I think the oncologists are the target audience. This is because oncologists are very trusted by patients and therefore hold a unique position, relative to other healthcare professionals. There is evidence both of cancer survivors preferring their physical activity information come from oncologists and evidence they would be more motivated to exercise if recommended by their oncologist (Wong et al., 2018; Jones et al., 2004).
In your practice, do you notice the same oncologists referring patients or is there a large number of them referring? I ask this as I wonder if the ones referring patients are the ones intrinsically interested in exercise. In a way this is like selection bias.
Wong JN, Mcauley E, Trinh L. Physical activity programming and counseling preferences among cancer survivors: a systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2018;15(1):48-69. doi:10.1186/s12966-018-0680-6.
Jones LW, Courneya KS, Fairey AS, Mackey JR. Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Annals of Behavioral Medicine. 2004;28(2):105-113. doi:10.1207/s15324796abm2802_5.
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