Enablers and Barriers in Delivery of a Cancer Exercise Program: The Canadian Experience

Mina, Daniel Santa; Petrella, Anika; Currie, Kristen L.; Bietola, K.; Alibhai, Shabbir M.H.; Trachtenberg, John; Ritvo, Paul; Matthew, Andrew

doi:10.3747/co.22.2650

Cited by 46 publications

(54 citation statements)

References 42 publications

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“…In fact, post-ACE participants identified facilitators of ACE as a program that (1) was safe, (2) offered variability in exercise programming and (3) was led by an exercise specialist knowledgeable in cancer. Consistent with the literature, the main barrier of time, along with disease and treatment symptoms, and accessibility were reported by SEG participants at both pre-and post-ACE SEG time points [28,29].…”

Section: Discussionsupporting

confidence: 84%

A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study

Suderman

Dolgoy

Yurick

et al. 2020

IJERPH

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Background: Our aim was to understand cancer survivor needs prior to, and following the Alberta Cancer Exercise (ACE) pilot randomized trial as a means to inform implementation of a province-wide cancer-specific, community-based exercise program. Methods: Questionnaires and semi-structured stakeholder engagement sessions were conducted with cancer survivors to explore preferences, barriers and facilitators/benefits at two timepoints: (1) pre-ACE: prior to initiation of the ACE pilot trial (n = 13 survivors and n = 5 caregivers); and (2) post-ACE: following participation in the ACE pilot trial (n = 20 survivors). Descriptive statistics were used to summarize quantitative data from questionnaires. Stakeholder engagement data were analyzed using a framework analysis approach. Emergent themes were then mapped to actionable outcomes. Results: Pre-ACE, survivors indicated a preference for exercise programs that were (1) supervised by exercise specialists knowledgeable about cancer, (2) included support from other health care providers, (3) were held in community locations that were easily accessible. Post-ACE, participants identified (1) a lack of exercise counseling from health care providers, (2) the need for earlier introduction of exercise in the care pathway, and (3) supported referral to exercise programming. Conclusions: An integrated knowledge translation approach identified actionable outcomes to address survivor needs related to exercise in clinical cancer and community-based contexts.

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Section: Discussionsupporting

confidence: 84%

A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study

Suderman

Dolgoy

Yurick

et al. 2020

IJERPH

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“…Strategies to motivate and support participants facing financial stress are needed to reduce the disparities in participation. Survivors have reported financial constraints as a barrier to exercise [ 32 ]. They also report spending 1/3 of their household income on cancer care [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

A longitudinal implementation evaluation of a physical activity program for cancer survivors: LIVESTRONG® at the YMCA

Faro

Arem

Heston³

et al. 2020

Implement Sci Commun

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Purpose: Increased physical activity (PA) levels in cancer survivors are associated with decreased risk of recurrence and mortality as well as additional positive health outcomes. PA interventions have shown to be efficacious, though many lack translation to and sustainability in community settings. We used dimensions of the RE-AIM framework to evaluate LIVESTRONG® at the YMCA, a nationwide community-based PA program for cancer survivors delivered at Ys. Methods: This was a longitudinal study design using national LIVESTRONG at the YMCA data compiled between 2010 and 2018. Data is from all YMCAs who deliver LIVESTRONG at the YMCA, submitted by Program Directors to the YMCA-USA. We assessed reach (number of participants), adoption (associations offering the program), implementation (conducting 3 fidelity checks), and organizational level maintenance (associations recently offering program). We also examined relationships between organizational characteristics (years of program existence and association area household income) and program implementation factors with member conversion rates. Results: As of 2018, LIVESTRONG at the YMCA has reached 62,044 survivors and 245 of the 840 (29.2%) of Y associations have adopted the program. Among the adopters, 91% were aware of fidelity checks; implementation of observational (62.3%), goal setting (49.9%), and functional (64.6%) checklists varied. Most (95.1%) adopters reported offering ≥ 1 LIVESTRONG session per year (organizational-level maintenance) and a facility-level mean membership conversion percentage of 46.9 ± 31.2%. Fewer years implementing the program and higher association area household income were significantly associated with a greater membership conversion rate vs their comparison. In a multiple regression model controlling for organizational characteristics, conducting the fidelity checks independently (observational, β = 8.41; goal-setting, β = 9.70; and functional, β = 9.61) and collectively (β = 10.82; 95% CI 5.90-16.80) was positively associated with higher membership conversion rates. Conclusions: LIVESTRONG at the YMCA, in its early years, has shown promise for high reach, while adoption at more associations could be facilitated. Implementing fidelity checks along with organizational characteristics were associated with membership conversion rate. Identification of association-level strategies to increase reach, adoption, implementation, and maintenance may increase the impact of this community-based PA program.

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“…In facility-based programming, health professional supervision can facilitate expedient adaptation and progression of the intervention to optimize patient safety and intervention efficacy (45). The disadvantages of facility-based programming relate to the accessibility of the facility (e.g., distance, traffic, cost of fuel/parking, timing of facility-hours) and the general lack of program availability due to the institutional cost of intervention delivery (46,47). Alternatively, home-based programs are less resource intensive for institutions to deliver and may impose fewer barriers to participant engagement which adds flexibility to accommodate schedules.…”

Section: Prehabilitation Programmentioning

confidence: 99%

A Pragmatic Non-Randomized Trial of Prehabilitation Prior to Cancer Surgery: Study Protocol and COVID-19-Related Adaptations

Mina

Sellers

et al. 2021

Front. Oncol.

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BackgroundExperimental data highlight the potential benefits and health system cost savings related to surgical prehabilitation; however, adequately powered randomized controlled trial (RCT) data remain nascent. Emerging prehabilitation services may be informed by early RCT data but can be limited in informing real-world program development. Pragmatic trials emphasize external validity and generalizability to understand and advise intervention development and implementation in clinical settings. This paper presents the methodology of a pragmatic prehabilitation trial to complement emerging phase III clinical trials and inform implementation strategies.MethodsThis is a pilot pragmatic clinical trial conducted in a large academic hospital in Toronto, Ontario, Canada to assess feasibility of clinical implementation and derive estimates of effectiveness. Feasibility data include program referral rates, enrolment and attrition, intervention adherence and safety, participant satisfaction, and barriers and facilitators to programming. The study aims to receive 150 eligible referrals for adult, English-speaking, preoperative oncology patients with an identified indication for prehabilitation (e.g., frailty, deconditioning, malnutrition, psychological distress). Study participants undergo a baseline assessment and shared-decision making regarding the intervention setting: either facility-based prehabilitation or home-based prehabilitation. In both scenarios, participants receive an individualized exercise prescription, stress-reduction psychological support, nutrition counseling, and protein supplementation, and if appropriate, smoking cessation program referrals. Secondary objectives include estimating intervention effects at the week prior to surgery and 30 and 90 days postoperatively. Outcomes include surgical complications, postoperative length of stay, mortality, hospital readmissions, physical fitness, psychological well-being, and quality of life. Data from participants who decline the intervention but consent for research-related access to health records will serve as comparators. The COVID-19 pandemic required the introduction of a ‘virtual program’ using only telephone or internet-based communication for screening, assessments, or intervention was introduced.ConclusionThis pragmatic trial will provide evidence on the feasibility and viability of prehabilitation services delivered under usual clinical conditions. Study amendments due to the COVID-19 pandemic are presented as strategies to maintain prehabilitation research and services to potentially mitigate the consequences of extended surgery wait times.

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Enablers and Barriers in Delivery of a Cancer Exercise Program: The Canadian Experience

Abstract: Background Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-

Cited by 46 publications

References 42 publications

A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study

A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study

A longitudinal implementation evaluation of a physical activity program for cancer survivors: LIVESTRONG® at the YMCA

A Pragmatic Non-Randomized Trial of Prehabilitation Prior to Cancer Surgery: Study Protocol and COVID-19-Related Adaptations

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