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

Abstract

PurposeIndividualized triage to exercise and rehabilitation is recommended to optimize health, functioning and well-being 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 defining characteristics of exercise/rehabilitation services and patient characteristics associated with safety and efficacy of each service. We developed a visual model to conceptualize need for high/low specialized care, then organized patient characteristics into a risk-stratified framework. We conducted an iterative review process with a multidisciplinary expert panel until consensus was reached for the preliminary algorithm. ResultsWe describe eight defining 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-stratified 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.

Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline

“…National efforts are focusing on building algorithms and decision-support tools to point to the most safe, feasible, and effective intervention for a given patient. 97,98…”

“…Many patients can safely perform unsupervised exercise, whereas others may need supervised cancer-specific exercise, clinically supervised exercise, or to participate in a cancer rehabilitation program before undertaking exercise on their own. National efforts are focusing on building algorithms and decision-support tools to point to the most safe, feasible, and effective intervention for a given patient 97,98.…”

Exercise Across the Cancer Care Continuum: Why It Matters, How to Implement It, and Motivating Patients to Move

“…Exercise oncology program delivery can be classified as follows: clinically supervised; supervised, cancer-specific, community-based; or unsupervised community-based. 26 Examples of clinically supervised programs include the Personal Optimism With Exercise Recovery (POWER) program located at the Huntsman Cancer Institute, University of Utah, and the UNC Cancer Rehab program located at the Cancer Rehabilitation Institute, University of Northern Colorado. Both programs are 12 weeks long and include a comprehensive assessment to tailor the cancer survivor's exercise prescription to their needs and goals.…”

“…49 These barriers can be overcome by developing a workflow in the oncology practice to counsel patients and refer them to exercise programs or resources. Several articles have been published to guide the development of such workflows, 26,31,50 but central to these efforts is developing procedures to (1) assess survivors' current physical activity and whether it is safe for them to exercise without medical supervision; (2) advise them to increase their physical activity; and (3) refer them to appropriate exercise programming based on their physical activity levels, medical conditions, and goals and preferences. 31 Although the oncologist should be involved in the workflow, others in the practice, such as nurses and patient navigators, can participate as well, reducing the amount of time that oncologists must invest.…”

Long‐COVID and long‐term cancer survivorship—Shared lessons and opportunities

“…Specifically in cancer rehabilitation, a prospective surveillance for rehabilitation in breast cancer proposes ongoing assessments over time to address long term effects of treatment (Stout et al, 2012). Additional approaches for Long‐COVID may include decision support pathways and algorithms, as developed for cancer survivors, to the most appropriate type and setting for rehabilitation care, ranging from acute inpatient rehabilitation through community‐based exercise programmes (Covington et al, 2021; Stout et al, 2020).…”