Why do older patients with advanced cancer decline participation in an exercise-based trial during oncological treatment? - A mixed methods study

BACKGROUND: Exercise is recommended during anti-cancer treatments. However, there is lack of knowledge about existing barriers to participation in exercise-based trials, especially among understudied groups such as older patients and those with advanced cancer.

OBJECTIVE: To explore reasons for refusal of participation in an exercise-based study among older patients with advanced cancer and identify factors associated with higher likelihood of declining.

METHODS: A mixed methods design was applied, using qualitative data from interviews and quantitative data from medical records. We investigated potential differences in characteristics between patients who accepted and declined. Qualitative data underwent thematic analysis, and findings were synthesized to generate meta-inferences.

RESULTS: Among 34 invited patients, 20 (59%) agreed to participate in the interviews, and 261 of 269 (97%) patients were included in quantitative analyses. Meta-inferences identified factors related to refusing exercise participation, including older age, perceptions of being sufficiently active, physical limitations, and awareness of having a poor prognosis.

CONCLUSION: Refusal of participation was particularly related to advanced cancer, physical limitations, and older age. To address these barriers, it is recommended to adopt a holistic and supportive approach and improve the flexibility of recruitment strategies.