Abstract
BackgroundAddressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations.MethodsFour thousand eight hundred sixty-three unique records identified in Embase, CINAHL, MEDLINE, Web of Science Core Collection, and ProQuest (Health and Medicine) were screened for studies that recruited cancer patients, assessed the co-location of exercise service and cancer treatment units, and reported findings on service implementation. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis.ResultsService implementation was relatively modest across the included studies. Exercise services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events.ConclusionImplementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise-based rehabilitation for individuals on cancer treatment. While this model appears feasible for patients/clinicians, efforts are required to optimize service integration both in the short and long term. Key priorities include seeking [local] actions to address issues relating to funding and organizational buy-in. Important considerations may include developing an implementation plan to guide the implementation process, expanding the patient core management team to include staff from the exercise rehabilitation unit, and exploring the role of patient feedback in increasing clinician participation (e.g., treating oncologists and nurses) in the referral process. Future research should consider effective strategies to promote patients’ sense of self-efficacy and behavioral control and, further, the place of audit and feedback in improving exercise service delivery and overall service implementation.
Highlights
From in vitro models, early preclinical studies, and large population-based observational studies to high-quality clinical exercise efficacy trials and behavior changeEzenwankwo et al BMC Health Services Research (2022) 22:236 studies involving ‘real world’ scenarios, the cancer exercise literature abounds with clear and profound evidence of the mitigating effects and health benefits of exercise in the trajectory of cancer care [1,2,3,4,5,6,7]
As critical to a successful service implementation as this may be, issues relating to funding and organizational buy-in hold even far greater implications for effective service integration and long-term sustainability
Addressing questions around the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway
Summary
Early preclinical studies, and large population-based observational studies to high-quality clinical exercise efficacy trials and behavior changeEzenwankwo et al BMC Health Services Research (2022) 22:236 studies involving ‘real world’ scenarios, the cancer exercise literature abounds with clear and profound evidence of the mitigating effects and health benefits of exercise in the trajectory of cancer care [1,2,3,4,5,6,7]. Early preclinical studies, and large population-based observational studies to high-quality clinical exercise efficacy trials and behavior change. Engaging in regular exercise program is safe and feasible for cancer patients but can improve treatment tolerance [8,9,10], facilitate early recovery [8,9,10], and reduce the length of hospital stay [11, 12]. Recent reports suggest that only about 30% to 47% of cancer patients are meeting current global exercise recommendations [16, 17]. While many factors preclude cancer patients from engaging in regular exercise, lack of access to exercisebased rehabilitation as part of routine care in treatment settings has remained a major barrier [10, 18]. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations
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