Access to Physical Activity Programmes and Cancer Support in Young Adults Living with and Beyond Cancer Through the Lens of Cancer Inequalities

接受癌症诊断的年轻人数量正在增加，据估计，英国每年有超过14600名20多岁和30多岁的人被诊断出患有癌症。尽管面临潜在威胁生命的诊断的年轻人有不同的需求，但文献中对这一年龄段的研究仍在进行中。癌症治疗方面的发展显著提高了青少年和青年癌症幸存者的存活率，从而使越来越多的人活过了癌症。对于年轻的成年癌症幸存者来说，这可能意味着他们生命中的很大一部分是在风险和合并症增加的情况下度过的。因此，被诊断患有癌症的年轻人代表了人口中的弱势群体，从心理和生理的角度来看，他们面临着许多独特的挑战；已经过了青春期，但尚未达到老年成人服务的需要。因此，人们认识到，需要为年轻人提供干预措施和以证据为基础的规定，以在整个癌症治疗过程中及以后促进身体和心理健康。总部位于英国的癌症慈善机构Trekstock致力于确保20多岁和30多岁的患有癌症的年轻人能够获得必要的、量身定制的支持，以应对癌症诊断对心理和身体的影响。强有力的证据强调了体育活动对改善癌症患者心理健康结果的重要性，因此体育活动提供的一个方面涉及为年轻人提供有组织的体育活动计划。文献中广泛承认，在整个癌症治疗过程中，体育活动可以改善多种健康措施，降低残疾风险。有证据表明，年轻癌症患者久坐不动的比例高，可能会导致生活质量下降，并在治疗期间加重症状。同样，研究表明，在癌症治疗结束后，体育活动可以使个人受益，无论是在情绪健康方面，还是在癌症治疗后的身体影响下生活。然而，尽管有已知的好处，这一人群的体育活动水平仍然很低，无论是在癌症诊断期间还是之后。因此，目前的研究项目旨在评估和优化Trekstock的体育活动服务提供，特别强调这个年龄组的癌症不平等。从文献中可以明显看出，这一领域的研究主要由女性和白人英国人主导。在这项拟议的研究中，我们的目标是探索这种差异，并确保所有面临癌症的年轻人都能获得量身定制的体育活动支持。首先，将对已发表的文献和灰色文献进行系统审查，以探索围绕这些不平等的知识差距。此外，本研究将研究癌症患者和非癌症患者参与体育活动的障碍和促进因素。提出的研究问题包括：1)哪些不平等影响获得癌症支持计划？2)如何解决在获得身体活动规划方面的这些不平等现象？3)目前的身体活动服务存在哪些差距？如何解决这些差距？4)调整身体活动规划，以解决患有癌症或癌症以外的年轻人的不平等问题，会产生什么影响？对于面临类似治疗负担和后遗症的其他人群，本研究旨在促进这一领域的知识，并为所有面临癌症诊断的年轻人增加体育活动计划的可及性。

The number of young adults who receive a cancer diagnosis is increasing, with estimates suggesting more than 14,600 individuals in their 20s and 30s are diagnosed each year in the UK. This age bracket is under researched within the literature, despite the distinct needs of young adults facing a potentially life-threatening diagnosis. Developments in cancer care have markedly improved the survival rates of adolescent and young adult cancer survivors, whereby an increased number of individuals are living beyond cancer. For young adult cancer survivors, this can mean a significant proportion of their life is spent with increased risks and comorbidities. Young adults diagnosed with cancer therefore represent a vulnerable sub-group of the population, who, from both a psychological and physiological perspective face number of unique challenges; having passed puberty, but not yet reached the needs of older adult services. It has therefore been recognised that interventions and evidence-based provisions are needed for young adults, to promote physical and psychosocial wellbeing throughout the cancer care continuum and beyond. UK-based cancer charity, Trekstock, work to ensure young adults in their 20s and 30s living with and beyond cancer have access to essential, tailored support to deal with the psychosocial and physical impact of a cancer diagnosis. With robust evidence highlighting the importance of physical activity to improve psychosocial wellbeing outcomes for individuals living with cancer, one aspect of their provision involves access to structured physical activity programmes for young adults. It is widely acknowledged within the literature that physical activity can improve a multitude of health measures and reduce the risk of disability throughout the cancer care continuum. Evidence suggests high rates of sedentary behaviour in young adults with cancer may result in worse quality of life and increased symptomology during treatment. Similarly, research suggests that physical activity can benefit individuals following the end of cancer treatment, both in terms of emotional wellbeing and in living with the physical after-effects of cancer treatment. However, despite the known benefits, physical activity levels remain low amongst this population group, both during and following a cancer diagnosis. The present research project therefore aims to evaluate and optimise Trekstock's physical activity service provision, with particular emphasis on cancer inequalities in this age group. It is evident from the literature that research in this field is dominated by participants identifying as female and white British. In this proposed study, we aim to explore this disparity with the ambition of ensuring all young adults facing cancer can access tailored physical activity support. Initially, a systematic review of published and grey literature will be undertaken to explore the gap in knowledge surrounding these inequalities. Further, this research will examine the barriers and facilitators to engaging in physical activity experienced by individuals living both with and beyond cancer. Proposed research questions include: 1) What inequalities affect access to cancer support programmes? 2) How can these inequalities in accessing physical activity programmes be addressed? 3) What are the gaps in current physical activity services and how can they be addressed? 4) What is the impact of tailoring physical activity programmes to address inequalities in young people living with and beyond cancer? With implications for other population groups facing a similar treatment burden and after-effects, this research intends to advance knowledge in this field, and increase the accessibility of physical activity programmes for all young adults facing a cancer diagnosis.