INTRODUCTIONThere are approximately 17 million cancer survivors living in the United States, and by 2040, this estimate is predicted to increase to 26.1 million. 1 Exercise provides a myriad of health benefits to individuals during and after cancer treatment by reducing treatment-related symptoms, improving functional status and quality of life, and lowering the risk of disease recurrence. 2,3 Despite the established benefits, an individual's level of physical activity often decreases during treatment and does not return to prediagnosis levels after treatment completion. 4,5 Although exercise is regarded as safe and beneficial for individuals with cancer, promoting exercise for this population is complex. A patient-centered pathway is needed that can guide oncology and primary care professionals in the efficient assessment of an individual's condition and enable personalized referrals for exercise interventions that promote physical activity. The purpose of this article is to provide a framework for clinical decision making that enables personalized condition assessment, risk stratification, and referral to optimal settings for exercise promotion for cancer survivors. Implementation strategies are also offered to support the integration of this model into an oncology clinical workflow.With guidance from their medical provider, individuals are more likely to engage in exercise and maintain levels of physical activity during cancer treatments. 6 However, the number of individuals with cancer who report receiving exercise-specific guidance from their health care providers is low. 7 Of particular concern is the lack of knowledge and training among health care professionals about exercise prescription for this complex population. 8

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OBJECTIVES The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown. DESIGN Two‐arm single‐institution randomized controlled trial of outpatient OT/PT. SETTING Comprehensive cancer center with two off‐site OT/PT clinics. PARTICIPANTS We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care. INTERVENTION Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs. MEASUREMENTS Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient‐Reported Outcomes Measurement Information System‐Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self‐efficacy (Possibilities for Activity Scale [PActS]). RESULTS Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow‐up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow‐up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided. CONCLUSION OT/PT may positively influence activity expectations and self‐efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953–960, 2019.

Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and nonpharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population.

Purpose To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. Methods A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service’s Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. Results Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks ( SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. Conclusions The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. Implications for Cancer Survivors Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-022-01181-4.

Individualized triage to exercise and rehabilitation is recommended to optimize health, functioning and wellbeing across the cancer continuum. However, ability to identify and triage the right survivor to the right exercise or rehabilitation service at the right time is a barrier. We developed an evidence-based algorithm to identify survivors' need for pre-exercise medical clearance and support individualized triage to appropriate exercise/rehabilitation care. MethodsFrom literature review, we synthesized de ning characteristics of exercise/rehabilitation services and patient characteristics associated with safety and e cacy of each service. We developed a visual model to conceptualize need for high/low specialized care, then organized patient characteristics into a risk-strati ed framework. We conducted an iterative review process with a multidisciplinary expert panel until consensus was reached for the preliminary algorithm. ResultsWe describe eight de ning features of the four levels of exercise/rehabilitation and provide a conceptual model of need for high/low specialized care across the cancer continuum. The preliminary Exercise in Cancer Evaluation and Decision Support (EXCEEDS) Algorithm includes a risk-strati ed series of eleven dichotomous questions, organized in two sections and ten domains. ConclusionsThe EXCEEDS algorithm provides an evidence-based solution to facilitate integration of exercise into routine oncology care via a common language to describe exercise/rehabilitation services, a practical model to conceptualize an individual's need for specialized care, and step-by-step decision support guidance.

Objectives: To determine the feasibility and preliminary effectiveness of a group dynamics–based exercise intervention versus a personal training intervention for increasing physical activity (PA), physical fitness, and quality of life (QOL) in post-treatment breast cancer survivors. Sample & Setting: 26 women with stage I or II breast cancer who attended intervention activities at a local academic institution. Methods & Vriables: Participants were randomly assigned to receive an eight-week intervention in either a group dynamics–based exercise or a personal training setting. Both intervention arms received supervised exercise twice per week, as well as PA education and discussion sessions. Results: Significant increases were noted in both intervention arms for vigorous PA, chest press, and leg press. Increases in overall QOL and total PA were significant only in the group dynamics–based exercise intervention arm. Implications for Nursing: The group dynamics–based exercise intervention produced similar improvements in PA and physical fitness compared to the personal training intervention, and it may have facilitated greater improvements in overall QOL.

287 Background: Specialized cancer rehabilitation is recommended for individuals with breast cancer from diagnosis throughout survivorship to mitigate the negative acute, late and lasting effects of cancer and cancer treatment on upper extremity functioning. However, evidence supporting the impact of community-based outpatient rehabilitation services is lacking, especially for older adults. Methods: Individuals with breast cancer attended cancer-specialized outpatient physical or occupational therapy provided by a single institution with multiple locations across the US in 2019, and completed the Quick DASH (Disabilities of the Arm, Shoulder and Hand). From de-identified rehabilitation records, we abstracted patient and therapy characteristics, Quick DASH scores and therapy satisfaction scores (0-10 point scale) for individuals with a history of breast cancer (identified by ICD code). We used descriptive statistics to summarize characteristics, paired samples t-tests to evaluate Quick DASH scores from initial evaluation (pre) and discharge (post) therapy, and independent samples t-test to compare mean pre-post difference for individuals younger than 65 ( < 65) versus 65 and older (≥ 65). Results: Patients ( N= 556) were 60.56 ± 12.24 (range = 31.52-89.95) years old and predominantly female ( n= 551, 99.1%). They attended cancer rehabilitation (Physical: n= 477, 85.8%, Occupational: n = 79 (14.2%)) for a median of 8 ( IQR= 5.0 – 13.0) sessions over 8.97 ± 7.57 (range = 0.71-47.7) weeks. Average pre-post change in Quick DASH score (-13.51) was significant (p < .01) and exceeded the validated minimal clinically important difference (-11.20). There was no significant difference between average pre-post change for Quick Dash scores between < 65 (n = 334, 60.1%) and ≥ 65 (n = 222, 39.9%) groups (-15.84 vs. -10.01, p = .07). Therapy satisfaction was rated high (median = 10.0, IQR = 10.0-10.0). Conclusions: Specialized rehabilitation for individuals with breast cancer was associated with statistically and clinically significant improvement in upper extremity function and high rates of satisfaction. Older adults demonstrated benefits similar to younger adults. These findings add to the growing evidence for specialized outpatient cancer rehabilitation.