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 ofknowledge about existing barriers to participation in exercise-based trials, especially amongunderstudied groups such as older patients and those with advanced cancer.Objective: To explore reasons for refusal of participation in an exercise-based study among olderpatients with advanced cancer and identify factors associated with higher likelihood of declining.Methods: A mixed methods design was applied, using qualitative data from interviews andquantitative data from medical records. We investigated potential differences in characteristicsbetween patients who accepted and declined. Qualitative data underwent thematic analysis, andfindings were synthesized to generate meta-inferences.Results: Among 34 invited patients, 20 (59%) agreed to participate in the interviews, and 261 of269 (97%) patients were included in quantitative analyses. Meta-inferences identified factorsrelated to refusing exercise participation, including older age, perceptions of being sufficientlyactive, physical limitations, and awareness of having a poor prognosis.Conclusion: Refusal of participation was particularly related to advanced cancer, physical limita-tions, and older age. To address these barriers, it is recommended to adopt a holistic andsupportive approach and improve the flexibility of recruitment strategies.