Physical activity in advanced urological cancers undergoing immune checkpoint inhibitor treatment: a qualitative study exploring patient perspectives and experiences.
Peat N, Jones G, et al. • Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer • 2026
Patients with advanced urological cancers undergoing immune checkpoint inhibitor therapy reported suboptimal physical activity levels attributed to inadequate PA knowledge and cancer/ICI treatment-related side-effects, with structured PA identified as a promising but underutilised strategy for managing side-effects.
Key Findings
Results
Participants with advanced urological cancer undergoing ICI therapy reported suboptimal physical activity levels during treatment.
Twelve adults with advanced bladder or renal cancer undergoing ICI therapy at a tertiary cancer centre in London, UK participated in the study.
Suboptimal PA levels were attributed to inadequate PA knowledge and cancer/ICI treatment-related side-effects.
Interviews were conducted in-person and lasted between 34 and 69 minutes.
Data was inductively analysed following Braun and Clarke's six-phases of Thematic Analysis.
Results
Four main themes emerged from qualitative analysis of patient PA experiences during ICI therapy.
The four themes were: 1) Purpose of PA participation, 2) Factors influencing PA participation (facilitators/barriers), 3) Limited ameliorative support from healthcare professionals, and 4) Desired PA support.
These themes were derived from individual semi-structured interviews guided by a topic guide.
Interviews were audio-recorded and transcribed verbatim before thematic analysis.
Results
Fatigue and pain were identified as key cancer and ICI treatment-related side-effects that act as barriers to physical activity participation.
Side-effects from both the cancer itself and ICI therapy were reported to impact PA participation.
Fatigue and pain were specifically highlighted among the debilitating side-effects affecting PA levels.
These barriers contributed to overall suboptimal PA participation among participants.
Results
Self-motivation, positive valence, and healthcare professional support regarding PA benefits and safety were identified as facilitators of physical activity participation.
Facilitators were identified as part of the broader theme of 'Factors influencing PA participation.'
Healthcare professional communication about PA benefits and safety was noted as an enabling factor when provided.
Positive valence (i.e., positive feelings or attitudes toward PA) was reported as a personal facilitator.
Results
Participants reported limited support from healthcare professionals regarding physical activity during ICI treatment.
'Limited ameliorative support from healthcare professionals' emerged as a standalone major theme.
This finding suggests a gap between patient PA needs and the support currently provided within cancer care pathways.
Patients undergoing ICI therapy were identified as having distinct PA needs necessitating personalised support.
Results
Patients expressed a desire for structured physical activity support, including PA counselling and referrals to cancer exercise or rehabilitation specialists.
'Desired PA support' was one of the four main themes identified.
Participants indicated interest in integrating PA interventions into cancer care pathways.
Specific strategies mentioned included PA counselling and timely referrals to cancer exercise or rehabilitation specialists.
Structured PA was characterised as 'a promising strategy for managing cancer and treatment-related side-effects during ICI therapy' but was found to be 'underutilised.'
What This Means
This research explores how patients with advanced bladder or renal cancer who are receiving immune checkpoint inhibitor (ICI) therapy — a type of immunotherapy — experience and perceive physical activity (PA). Twelve patients at a London cancer centre participated in in-depth one-on-one interviews lasting between 34 and 69 minutes. Researchers analysed the interview content to identify recurring themes about what motivates or prevents these patients from being physically active during treatment.
The study found that patients were generally less physically active than they could be, largely because of treatment side-effects like fatigue and pain, as well as a lack of clear information about whether and how to exercise safely during ICI therapy. Patients who did manage to stay active were helped by their own motivation, a positive attitude toward exercise, and when their healthcare team talked to them about the benefits and safety of PA. However, many patients felt that healthcare professionals did not adequately address physical activity as part of their care, and patients expressed a clear desire for more structured and personalised support, such as exercise counselling or referrals to rehabilitation specialists.
This research suggests that integrating physical activity support — including tailored advice and specialist referrals — into cancer treatment pathways could be beneficial for patients undergoing ICI therapy. The findings highlight a gap between what patients need in terms of PA guidance and what is currently being provided, and call for further research to identify the best ways to help this specific group of patients become and stay more physically active during treatment.
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Peat N, Jones G, Veal I, Kinsella N, Karagiannis S, Van Hemelrijck M. (2026). Physical activity in advanced urological cancers undergoing immune checkpoint inhibitor treatment: a qualitative study exploring patient perspectives and experiences.. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.1007/s00520-026-11195-8