Background

Lung cancer is one of the most common types of cancer and often has a particularly poor prognosis. Many patients present with advanced disease including involuntary loss of weight and muscle mass (cachexia). Such patients have poor outcomes including impaired daily activities, reduced independence and quality of life. Physical activity (PA) can improve independence and quality of life in patients with cancer but guidance for patients with cachexia is limited. The aim of this study was to identify enablers of home-based PA for patients with lung cancer and cachexia underpinned by behaviour change theory.

Method

Semi-structured interviews with seven patients with lung cancer and cachexia and seven carers from South Wales were undertaken. Interviews were transcribed verbatim and analysed thematically. The behaviour change wheel, including the Capability, Opportunity, Motivation and Behaviour (COM-B) model, was used to identify enablers to facilitate behaviour change.

Results

The patients and carers perceived that Physical capability was influenced by symptoms, risk and environment. Psychological capability was influenced by knowledge and attitude. Opportunities were created by a suitable environment, equipment/technology, and social support from family and healthcare professionals. Motivation was influenced by perceived benefit, goals and support from family/carers. Enablers of physical activity were: Training, Education, Persuasion, Incentivisation, Environmental restructuring and Enablement. It was suggested PA should be functional, personalised, flexible, of low duration and intensity. Examples include walking, shopping and gardening with the duration starting at 5minutes.

Conclusion

Enablers of home-based PA for people with lung cancer and cachexia were identified, based on a behaviour change theory. Functional activities were valued by patients and carers.  Health professionals should consider these factors in the co-design of a patient’s home PA programme and should work with patients and carers to personalise activities.

Impact statement

This study identified enablers most likely to promote home-based physical activity to maintain independence in patients with lung cancer based on interviews with patients and their carers, unpinned by behaviour change theory. The application of these enablers will promote and maintain activity in patients with lung cancer and cachexia to promote function and wellbeing in this difficult to manage condition, with benefits for patients and healthcare providers