A Scoping Review Examining the Integration of Exercise Services in Clinical Oncology Settings

Abstract

Background: Addressing 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 provided practical recommendations to inform evidence-based practice, policymaking, and further investigations. Methods: Studies that recruited cancer patients, assessed the co-location of exercise services and cancer treatment units and reported findings on service implementation were included. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis. Results: Exercise service implementation was relatively modest across the included studies. These 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. Conclusion: Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise medicine for individuals on cancer treatment. While this model appears feasible for patients/clinicians, calculated efforts are required to drive uptake. There is no one-size-fits-all approach; hence, sustainable service integration remains a product of many factors, including structures and strategies that reflect the organizational dynamics of the clinical service environment housing the exercise unit.

Integration of exercise prescription into medical provision as a treatment for non-communicable diseases: A scoping review

“…The research outlined six studies providing data from 30 exercise programs. Issues relating to funding, lack of a detailed implementation plans, and low organizational buy-in were the major barriers to effective service integration, particularly at the health service level (57). A further study by Kennedy, investigating the implementation of exercise into routine cancer care, was hindered by a web of interrelated challenges across all levels of the healthcare system.…”

Barriers and Facilitators to the Referral of Patients With Cancer for Physiotherapy Rehabilitation at Uganda Cancer Institute (UCI).

“…If not, we call them to come and attend to the referred patients" Similarly, oncology professionals in high-resource settings admitted the role of physiotherapists and tend to refer patients with cancer for recruited physiotherapists (18). On the other hand, there is a lack of implementation plans, funding and organizational prioritization to employ physiotherapists in oncology facilities, which has limited the referral of patients for rehabilitation in Africa (19).…”

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

“…Even when exercise programs are available to survivors, a low percentage enroll and participate, with estimates ranging from 10% to 14%. 41 One program in a rural area reported that less than 1% of the eligible survivors participated in the program offered at a regional cancer center. 42 This is likely due in part to a lack of referral to the program and to low patient uptake when referred.…”