Development, implementation, and effects of a cancer center's exercise‐oncology program

Abstract

BACKGROUND: National and international bodies acknowledge the benefit of exercise for people with cancer, yet limited accessibility to related programing remains. Given their involvement in managing the disease, cancer centers can play a central role in delivering exercise-oncology services. The authors developed and implemented a clinically integrated exercise-oncology program at a major cancer center and evaluated its effectiveness and participant experience. METHODS: A hospital-based program with prescribed at-home exercise was developed and accepted referrals over a 42-month period (3.5 years). Implementation was conducted in 2 phases: a pilot phase for women with breast cancer and men with genitourinary cancer and a roll-out phase for all patients with cancer. Enrolled patients were assessed and received an exercise prescription as well as a program manual, resistance bands, and a stability ball from a kinesiologist. Program participation and effectiveness were evaluated up to 48 weeks after the baseline assessment using intention-to-treat analyses. Participants in the roll-out phase were asked to complete a program experience questionnaire at the completion of the 48-week follow-up. RESULTS: In total, 112 participants enrolled in the pilot, and 150 enrolled in the roll-out phase. Program attrition to 48 weeks was 48% and 65% in the pilot and roll-out phases, respectively. In participants who consented to research evaluation of their performance, objective and patient-reported measures of functional capacity improved significantly from baseline in both phases. Participants were highly satisfied with the program. CONCLUSIONS: Despite significant drop-out to program endpoints, our cancer-exercise program demonstrated clinically relevant improvement in functional outcomes and was highly appreciated by participants. Cancer 2019;125:3437-3447.

Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) Algorithm

“…has the potential to optimize patient care via improved decision making about the safest and most e cacious exercise referral to improve patients' long-term health, function, and quality of life across the cancer continuum. American College of Sports Medicine guidelines for exercise testing and prescription [19] Acvtiv Onco Model [20] Chronic [21] American College of Sports Medicine guidelines for exercise testing and prescription [19] Cancer-speci c exercise risk screening tool [22] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 (National Comprehensive Cancer Network, 2020) [23] Macmillan Cancer Rehabilitation pathways [24] Yes or No: New, worsening or di culty managing any of the following conditions: lymphedema, ostomy, signi cant weight uctuations, infection, ataxia, malnourishment, severe fatigue, bone/back/neck pain and unusual weakness Acvtiv Onco Model [20] Macmillan Cancer Rehabilitation pathways [24] High risk signs/symptoms [21] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Macmillan Cancer Rehabilitation pathways [24] Cancer-speci c exercise risk screening tool [22] Acvtiv Onco Model [20] [24] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Focused review of safety considerations in cancer rehab [17] The [25] Exercise in Medicine in Oncology: ACSM 2019 Roundtable [2] Macmillan Cancer Rehabilitation pathways [24] Acvtiv Onco Model [20] Cancer-speci c exercise risk screening tool [22] Association of Clinical Oncology (ASCO) Management of Older Adults Guideline [26] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] International Society of Geriatric Oncology (SIOG) recommendations for management of cancer-related cognitive decline [27] Level 2 side effects Yes or No, presence of ≥1 of the following factors:…”

“…Macmillan Cancer Rehabilitation pathways [24] Acvtiv Onco Model [20] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] Dyspnea Level functional factors Yes or No, presence of ≥1 of the following factors:…”

“…Fall in previous six months Other mobility issues, including: Decreased balance, Decreased gait speed, Mild bodily pain when moving, di culty with ADL/IADL Macmillan Cancer Rehabilitation pathways [24] Association of Clinical Oncology (ASCO) Management of Older Adults Guideline [26] Cancer and Aging Research Group Fall Risk Model [28] Exercise in Medicine in Oncology: ACSM 2019 Roundtable [2] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] Level 1 side effects Yes or No, presence of ≥1 of the following factors:…”

“…Macmillan Cancer Rehabilitation pathways [24] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23]…”

Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study

“…To date, published cancer-specific exercise implementation studies report significant short-term benefit from exercise for physical activity,22 6 min walk test distance,17 22 fatigue,23 QoL22 23 and medical costs 23. However, high programme attrition19 24–26 suggests the need for further exploration on the extent and nature (random or non-random) of programme dropouts and withdrawals. Moreover, the overall uptake of community-based exercise by cancer survivors relative to the larger population of survivors appears low.…”