What Do Primary Healthcare Providers and Complementary and Alternative Medicine Practitioners in Palestine Need to Know about Exercise for Cancer Patients and Survivors: A Consensual Study Using the Delphi Technique

BACKGROUND: Exercise has physiologic and psychological benefits for cancer patients and survivors. Today, various exercises are recommended as adjunct to therapies for cancer patients and survivors. This study was conducted to develop a consensual core list of important knowledge items that primary healthcare providers and complementary and alternative medicine (CAM) practitioners need to know on the role of exercises and physical activities in stimulating anticancer immunity. METHODS: Knowledge items were collected following interviews with key contact experts (4 oncologists, 3 exercise and medicine specialists, 2 researchers, 2 cancer patients, and 3 survivors) and extensive literature review. The collected knowledge items were rated by 9 researchers who conducted research on exercise and cancer. A modified two-iterative Delphi technique was employed among a panel (n = 65) of healthcare providers and CAM practitioners to develop the consensual core list of knowledge items. RESULTS: Of the 49 knowledge items, consensus was achieved on 45 (91.8%) items in 6 categories. Of those, 9 (20.0%) were general items on recommending moderate to vigorous habitual exercises and physical activities. The rest of items were related to the effects of habitual exercises and physical activities on the functions of immune system and exposure to carcinogens 16 (35.6%), anticancer therapies 12 (26.7%), metastasis of cancer 3 (6.7%), metabolism within tumors 3 (6.7%), and myokines release 2 (4.4%). CONCLUSION: Formal consensus was achieved for the first time on a core list of knowledge items on how exercises and physical activities might stimulate anticancer immunity. This core list might be considered at the time of developing training/educational interventions and/or continuing education for primary healthcare providers and CAM practitioners. Future studies are still needed to investigate if such consensual lists might improve congruence in cancer care continuum and improve survival rates and wellbeing of cancer patients and survivors.