Background Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations. Methods Four thousand eight hundred sixty-three unique records identified in Embase, CINAHL, MEDLINE, Web of Science Core Collection, and ProQuest (Health and Medicine) were screened for studies that recruited cancer patients, assessed the co-location of exercise service and cancer treatment units, and reported findings on service implementation. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis. Results Service implementation was relatively modest across the included studies. Exercise services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events. Conclusion Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise-based rehabilitation for individuals on cancer treatment. While this model appears feasible for patients/clinicians, efforts are required to optimize service integration both in the short and long term. Key priorities include seeking [local] actions to address issues relating to funding and organizational buy-in. Important considerations may include developing an implementation plan to guide the implementation process, expanding the patient core management team to include staff from the exercise rehabilitation unit, and exploring the role of patient feedback in increasing clinician participation (e.g., treating oncologists and nurses) in the referral process. Future research should consider effective strategies to promote patients’ sense of self-efficacy and behavioral control and, further, the place of audit and feedback in improving exercise service delivery and overall service implementation.
Objective: Mindfulness-based interventions (MBIs) are increasingly being encouraged for managing treatment-related symptoms but much less is known about the extent to which mindfulness is effective in relieving the psychosocial distress experienced by men with prostate cancer. A systematic review was conducted to synthesise the literature on MBIs for psychological wellbeing and quality of life improvement in men with prostate cancer.Methods: Embase, CINAHL, MEDLINE, PsycINFO, PsycArticles and Web of Science were searched up to 7th November 2020. Included studies were assessed for quality using appropriate appraisal tools. Homogeneous study results were pooled in a meta-analysis while narrative synthesis was used to summarise the findings from heterogeneous results. Effect size was expressed as Cohen's d (95% confidence intervals) and statistical significance (p-value) was set at 0.05.Results: Four studies comprising three randomised trials and one non-randomised study met the inclusion criteria. MBIs for men with prostate cancer showed small to moderate effect for improving psychological outcomes. The pooled result of quality of life and post-traumatic growth in study participants showed moderate (d = −0.29 [−1.29, 0.71], p = 0.57) and large (d = 0.77 [−0.33,1.88], p = 0.000) effects, respectively. Conclusion: MBI is potentially promising for psychological outcomes, quality of life and post-traumatic growth symptoms improvement in men with prostate cancer but recommendations cannot be made based on current evidence due to limited research and inadequate methodological rigour of published literature.Robust research is needed to draw a reliable conclusion about its sustained effect in men with advanced disease.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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