SpringerLink
Log in

Essential elements of optimal dietary and exercise referral practices for cancer survivors: expert consensus for medical and nursing health professionals

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To develop and establish expert consensus on essential elements of optimal dietary and exercise referral practices for cancer survivors.

Methods

A four-round modified, Delphi method (face-to-face and electronic). In round 1, initial statements were drafted based on Cancer Australia’s Principles of Cancer Survivorship and input from key stakeholders through a cancer preconference workshop. In round 2, the initial statements were distributed to a panel (round 1 participants) to establish consensus by rating the importance of each statement using a five-point Likert scale. Statements that required significant changes in wording were redistributed to panel members in round 3 for voting. Round 4 was for consumers, requiring them to rate their level of agreement of final statements.

Results

In total, 82 stakeholders participated in round 1. Response rates for survey rounds 2 and 3 were 59% (n = 54) and 39% (n = 36). Panel members included nurses (22%), dietitians (19%), exercise professionals (16%), medical practitioners (8%), and consumers (4%). The mean “importance” rating for all essential elements was 4.28 or higher (i.e., fairly important, or very important). Round 4’s consumer-only engagement received responses from 58 consumers. Overall, 24 elements reached consensus following some revised wording, including the development of three new statements based on panel feedback.

Conclusion

Our developed essential elements of optimal dietary and exercise referral practices can help provide guidance to medical and nursing health professionals relevant to dietary and exercise referral practices. Future research should conduct an implementation intervention and evaluation of these essential elements to optimise dietary and exercise care in cancer survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Abbreviations

GP:

General practitioner

SD:

Standard deviation

CDMP:

Chronic Disease Management Plan

SCP:

Survivorship care plan

References

  1. Demark-Wahnefried W, Jones LW (2008) Promoting a healthy lifestyle among cancer survivors. Hematol Oncol Clin North Am 22(2):319-viii

  2. Borras JM, Albreht T, Audisio R et al (2014) Policy statement of multidisciplinary cancer care. Eur J Cancer Care 50(3):475–480

    Article  Google Scholar 

  3. Ligibel JA, Pierce LJ, Bender CM, et al (2022) Attention to diet, exercise, and weight in oncology care: results of an American Society of Clinical Oncology national patient survey. Cancer

  4. Keogh JW, Pühringer P, Olsen A, Sargeant S, Jones LM, Climstein M (2017) Physical activity promotion, beliefs, and barriers among Australasian oncology nurses. Oncol Nurs Forum 44(2):235–245

    Google Scholar 

  5. Mitchell L, Macdonald-Wicks L, Capra S (2011) Nutrition advice in general practice: the role of general practitioners and practice nurses. Aust J Prim Health 17:202–208

    Article  Google Scholar 

  6. Vijayvergia N, Denlinger CS (2015) Lifestyle factors in cancer survivorship: where we are and where we are headed. Journal of personalized medicine 5(3):243–263

    Article  Google Scholar 

  7. Crowley J, Ball L, Han DY, McGill AT, Arroll B, Leveritt M, Wall C (2015) Doctors’ attitudes and confidence towards providing nutrition care in practice: comparison of New Zealand medical students, general practice registrars and general practitioners. J Prim Health Care 7(3):244–250

    Article  Google Scholar 

  8. Lobelo F, Duperly J, Frank E (2009) Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med 43(2):89–92

    Article  CAS  Google Scholar 

  9. Reddeman L, Bourgeois N, Angl EN, et al (2019) Qualitative study to inform the design of an e-health intervention. How should family physicians provide physical activity advice? Canadian family physician Medecin de famille canadien 65(9):e411-e9

  10. Mekuria AB, Erku DA, Belachew SA (2016) Preferred information sources and needs of cancer patients on disease symptoms and management: a cross-sectional study. Patient Prefer Adherence 10:1991–1997

    Article  Google Scholar 

  11. Ball LE, Hughes RM, Leveritt MD (2010) Nutrition in general practice: role and workforce preparation expectations of medical educators Aust J Prim Health 16(4):304–310

    Google Scholar 

  12. Kolasa KM, Rickett K (2010) Barriers to providing nutrition counselling cited by physicians: a survey of primary care practitioners. Nutr Clin Pract 25(5):502–509

    Article  Google Scholar 

  13. Clinical Oncology Society of Australia (2020) Position statement on exercise in cancer care

  14. Rock CL, Thomson C, Gansler T et al (2020) American Cancer Society guidelines for diet and physical activity for cancer prevention. CA A Cancer J Clin 70:245–271

    Article  Google Scholar 

  15. Ligibel JA, Bohlke K, May AM et al (2022) Exercise, diet, and weight management during cancer treatment: ASCO guideline. J Clin Oncol Jco2200687

  16. Campbell KL, Winters-Stone K, Wiskemann J et al (2019) Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 51(11):2375–2390

    Article  Google Scholar 

  17. Hayes SC, Newton RU, Spence RR, Galvão DA (2019) The exercise and sports science Australia position statement: exercise medicine in cancer management. J Sci Med Sport 22(11):1175–1199

    Article  Google Scholar 

  18. Hart NH, Poprawski DM, Ashbury F et al (2022) Exercise for people with bone metastases: MASCC endorsed clinical recommendations developed by the International Bone Metastases Exercise Working Group. Support Care Cancer 30(9):7061–7065

    Article  Google Scholar 

  19. Pekmezi DW, Demark-Wahnefried W (2011) Updated evidence in support of diet and exercise interventions in cancer survivors. Acta Oncol 50(2):167–178

    Article  Google Scholar 

  20. Joseph R, Hart NH, Bradford N et al (2022) Diet and exercise advice and referrals for cancer survivors: an integrative review of medical and nursing perspectives. Support Care Cancer

  21. Mizrahi D, Murnane A, Quinn S et al (2021) Exercise recommendations and referral patterns of oncology professionals. Asia Pac J Clin Oncol

  22. Sialvera TE, Papadopoulou A, Efstathiou SP et al (2018) Structured advice provided by a dietitian increases adherence of consumers to diet and lifestyle changes and lowers blood low-density lipoprotein (LDL)-cholesterol: the increasing adherence of consumers to diet & lifestyle changes to lower (LDL) cholesterol (ACT) randomised controlled trial. J Hum Nutr Diet 31(2):197–208

    Article  CAS  Google Scholar 

  23. Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J (2017) A systematic review of exercise systematic reviews in the cancer literature (2005–2017). PM R 9:S347–S384

    Article  Google Scholar 

  24. Ball L, Lee P, Ambrosini GL, Hamilton K, Tuffaha H (2016) How often should general practitioners provide nutrition care to patients? A forecasting activity to determine the target frequency for chronic-disease management in Australia. Aust J Prim Health 22(5):383–387

    Article  Google Scholar 

  25. Rabin C (2009) Promoting lifestyle change among cancer survivors: when is the teachable moment? Am J Lifestyle Med 3(5):369–378

    Article  Google Scholar 

  26. Cancer Australia (2017) Principles of Cancer Survivorship

  27. Dalkey NC (1969) The Delphi method: an experimental study of group opinion. Santa Monica

  28. Mosadeghrad A (2013) Verification of a quality management theory: using a Delphi study. Int J Health Policy Manag 1:261–271

    Article  Google Scholar 

  29. Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM et al (2014) Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 67(4):401–409

    Article  Google Scholar 

  30. Akins RB, Tolson H, Cole BR (2005) Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. SBMC Medical Research Methodology 5:37

    Article  Google Scholar 

  31. Santaguida P, Dolovich L, Oliver D, Lamarche L, Gilsing A, Griffith, LE, Richardson J, Mangin D, Kastner M, Raina P (2018) Protocol for a Delphi consensus exercise to identify a core set of criteria for selecting health related outcome measures (HROM) to be used in primary health care. BMC Fam Pract 19 152

  32. Kirchherr J, Charles K (2018) Enhancing the sample diversity of snowball samples: Recommendations from a research project on anti-dam movements in Southeast Asia. PLoS ONE 13(8):e0201710

    Article  Google Scholar 

  33. Vogel C, Zwolinsky S, Griffiths C, Hobbs M, Henderson E, Wilkins E (2019) A Delphi study to build consensus on the definition and use of big data in obesity research. Int J Obes 43(12):2573–2586

    Article  Google Scholar 

  34. Boel A, Navarro-Compán V, Landewé R, van der Heijde D (2021) Two different invitation approaches for consecutive rounds of a Delphi survey led to comparable final outcome. J Clin Epidemiol 129:31–39

    Article  Google Scholar 

  35. Ekberg S, Herbert A, Johns K et al (2020) Finding a way with words: Delphi study to develop a discussion prompt list for paediatric palliative care. Palliat Med 34(3):291–299

    Article  Google Scholar 

  36. Khodyakov D, Stockdale E, Smith N, Booth M, Altman L, Rubenstein LV (2017) Patient engagement in the process of planning and designing outpatient care improvements at the veterans administration health-care system: findings from an online expert panel. Health expectations : an international journal of public participation in health care and health policy 20(1):130–145

    Article  Google Scholar 

  37. Avancini A, Pala V, Trestini I et al (2020) Exercise levels and preferences in cancer patients: a cross-sectional study. Int J Environ Res Public Health 17(15):5351

    Article  Google Scholar 

  38. Muscaritoli M, Arends J, Bachmann P et al (2021) ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr 40(5):2898–2913

    Article  Google Scholar 

  39. Barnes K, Ball L, Galvão DA, Newton RU, Chambers SK, Harrison C (2019) Physical activity counselling and referrals by general practitioners for prostate cancer survivors in Australia. Aust J Prim Health 25(2):152–156

    Article  Google Scholar 

  40. Chen YY, Hsieh CI, Chung KP (2019) Continuity of care, follow-up care, and outcomes among breast cancer survivors. Int J Environ Res Public Health 16(17):3050

    Article  Google Scholar 

Download references

Acknowledgements

The authors acknowledge all participants on the expert panel for their expert advice. The authors would specifically like to acknowledge Jocelyn Foo for her contribution.

Funding

RJC received salary support from the National Health and Medical Research Council (APP1194051). All other authors declare that no funds, grants, or other support were received to specifically support completion of this study or preparation of this manuscript.

Author information

Authors and Affiliations

  1. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

    Ria Joseph, Nicolas H. Hart, Matthew P. Wallen, Chad Y. Han, Oluwaseyifunmi Andi Agbejule & Raymond J. Chan

  2. Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia

    Nicolas H. Hart, Natalie Bradford, Elizabeth P. Pinkham, David Wyld, Megan Crichton, Laisa Teleni & Raymond J. Chan

  3. Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia

    Nicolas H. Hart

  4. Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia

    Nicolas H. Hart

  5. School of Science, Psychology and Sport, Federation University Australia, Victoria, Australia

    Matthew P. Wallen

  6. Physiotherapy Department and Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia

    Elizabeth P. Pinkham

  7. Cancer Council Queensland, Brisbane, QLD, Australia

    Brigid Hanley & Gemma Lock

  8. Cancer Care Services, Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, QLD, Australia

    David Wyld

  9. School of Medicine, The University of Queensland, Brisbane, QLD, Australia

    David Wyld

  10. Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia

    Laurelie Wishart & Raymond J. Chan

  11. Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia

    Laurelie Wishart

  12. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia

    Laurelie Wishart

  13. Flinders Medical Centre and Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Bogda Koczwara

  14. Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, USA

    Alexandre Chan

  15. Nutrition and Dietetics Research Group, Bond University, Robina, QLD, Australia

    Megan Crichton

  16. School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia

    Justin J. Holland

  17. Nutrition and Dietetics, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia

    Kelli Edmiston

  18. Physiotherapy, Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, QLD, Australia

    Leonie Naumann

  19. Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, QLD, Australia

    Teresa Brown

Authors
  1. Ria Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas H. Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natalie Bradford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew P. Wallen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chad Y. Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elizabeth P. Pinkham
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Brigid Hanley
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gemma Lock
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David Wyld
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Laurelie Wishart
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bogda Koczwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alexandre Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Oluwaseyifunmi Andi Agbejule
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Megan Crichton
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Laisa Teleni
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Justin J. Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Kelli Edmiston
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Leonie Naumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Teresa Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Raymond J. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ria Joseph, Nicolas H. Hart, Natalie Bradford, and Raymond J. Chan. The first draft of the manuscript was written by Ria Joseph, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ria Joseph.

Ethics declarations

Ethics approval

Provided by the Human Research Ethics Committee of Queensland University of Technology (ID: 2000000940).

Consent to participate

Written informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 38 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joseph, R., Hart, N.H., Bradford, N. et al. Essential elements of optimal dietary and exercise referral practices for cancer survivors: expert consensus for medical and nursing health professionals. Support Care Cancer 31, 46 (2023). https://doi.org/10.1007/s00520-022-07509-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-022-07509-1

Keywords

Search

Navigation