Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review

Abstract

Purpose While calls have been made for exercise to become standard practice in oncology, barriers to implementation in real-world settings are not well described. This systematic scoping review aimed to comprehensively describe barriers impeding integration of exercise into routine oncology care within healthcare systems. Methods A systematic literature search was conducted across six electronic databases (since 2010) to identify barriers to implementing exercise into real-world settings. An ecological framework was used to classify barriers according to their respective level within the healthcare system. Results A total of 1,376 results were retrieved; 50 articles describing implementation barriers in real-world exercise oncology settings were reviewed. Two hundred and forty-three barriers were identified across all levels of the healthcare system. Nearly 40% of barriers existed at the organizational level (n = 93). Lack of structures to support exercise integration and absence of staff/resources to facilitate its delivery were the most common issues reported. Despite the frequency of barriers at the organizational level, organizational stakeholders were largely absent from the research. Conclusions Implementing exercise into routine cancer care is hindered by a web of interrelated barriers across all levels of the healthcare system. Organizational barriers are central to most issues. Future work should take an interdisciplinary approach to explore best practices for overcoming implementation barriers, with organizations as a central focus. Implications for Cancer Survivors This blueprint of implementation barriers highlights critical issues that need to be overcome to ensure people with cancer have access to the therapeutic benefits of exercise during treatment and beyond.

Tailoring the Evidence for Exercise Oncology within Breast Cancer Care

“…Furthermore, if HCP barriers to exercise referral—such as lack of time, knowledge, and exercise resources—are not adequately addressed [ 16 ], exercise engagement will continue to remain low across the breast cancer continuum. To address this, HCPs must have the awareness and ability to refer to a CEP within the clinical setting, to facilitate screening, triage, and referral, so that patients can access clinic or community-based exercise resources.…”

“…Additionally, exercise is not yet considered part of standard supportive cancer care—not even in breast cancer, where the bulk of the evidence exists [ 13 , 14 ]. Barriers continue to persist for healthcare providers to refer to exercise, and for those with breast cancer to access exercise resources and programs [ 15 , 16 ]. To address this, a culture shift in cancer care must occur, with clinical care pathways developed and implemented to screen, identify, and triage individuals for appropriate exercise and rehabilitation services throughout the breast cancer continuum.…”

Exploring Peer Support Characteristics for Promoting Physical Activity Among Women Living Beyond a Cancer Diagnosis: A Qualitative Descriptive Study

“…Leading clinicians and researchers in physical activity and oncology care highlight the need to increase the availability, accessibility, and uptake of physical activity among individuals living beyond a cancer diagnosis (Adams et al, 2021;Basen-Engquist et al, 2017;Kennedy et al, 2021;Mina et al, 2018). A potential source for increasing physical activity, in particular among women, is the development of social support opportunities (McDonough et al, 2019(McDonough et al, , 2021.…”

Co-designing Healthy Living after Cancer Online: an online nutrition, physical activity, and psychosocial intervention for post-treatment cancer survivors

“…Face-to-face interventions have demonstrated efficacy in improving health behaviours; however, these interventions are not routinely implemented in clinical care at the completion of cancer treatment [11]. This evidence-practice gap has emerged due to implementation barriers experienced at the three levels of cancer survivorship care: (1) organisational level barriers, such as the cost and lack of reimbursement for delivering interventions, no established pathways for managing referrals and follow-ups, and absence of specialised staff to deliver the intervention; (2) provider level barriers, including limited time, competing priorities, not aware of existing programs, and not self-identifying as the right person to provide advice; and (3) consumer-level barriers, such as lack of guidance and support, not understanding the benefits of participating in health programs, low engagement in interventions due to competing priorities, and/or high levels of fatigue [12][13][14][15]. Cancer survivors who live in rural and remote areas of Australia experience additional accessibility barriers, imposed by the time and financial costs of travel [16].…”