Physical activity in advanced urological cancers undergoing immune checkpoint inhibitor treatment: a qualitative study exploring patient perspectives and experiences

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PURPOSE: Physical activity (PA) can improve health and treatment outcomes in cancer patients. However, patients with advanced cancer undergoing immune checkpoint inhibitor (ICI) therapy often experience debilitating side-effects that impact PA participation. Because PA experiences in patients with advanced cancer undergoing ICI therapy are not well known, in this study we aimed to explore their perceptions and lived experiences. METHOD: Twelve adults with advanced urological (bladder or renal) cancer undergoing ICI therapy at a tertiary cancer centre, London, UK, participated in individual semi-structured qualitative interviews. A topic guide facilitated discussions. Interviews were audio-recorded and transcribed verbatim. Data was inductively analysed following Braun and Clarke's six-phases of Thematic Analysis. RESULTS: In-person interviews lasting 34-69 min revealed four main themes: 1) Purpose of PA participation, 2) Factors influencing PA participation (facilitators/barriers), 3) Limited ameliorative support from healthcare professionals, and 4) Desired PA support. Overall, participants reported suboptimal PA levels attributed to inadequate PA knowledge and cancer/ICI treatment-related side-effects such as fatigue and pain. PA facilitators included self-motivation, positive valance, and healthcare professionals support regarding PA benefits and safety. CONCLUSIONS: Structured PA is a promising strategy for managing cancer and treatment-related side-effects during ICI therapy; however, findings from this study indicate that it is underutilised. Patients undergoing ICI therapy have distinct PA needs, necessitating personalised support. Integrating PA interventions, such as PA counselling and timely referrals to cancer exercise/rehabilitation specialists into cancer care pathways, is essential. Further research should explore optimal strategies to enhance PA participation and maximise its benefits during ICI treatment.

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