Personalised Exercise Rehabilitation in Cancer Survivorship: Findings from a Triage and Referral Implementation study

Abstract

Purpose: Screening, triage and referral systems are proposed as efficient, needs-based models of cancer rehabilitation. This study aimed to evaluate the feasibility and real-world application of the PERCS Triage and Referral system. Methods: Utilising a pre-post design, the reach, effectiveness, and implementation of PERCS was evaluated quantitatively in the context of a physiotherapy-led clinic for patients diagnosed with cancer during COVID-19. Assessments at baseline and 12-weeks (T1) included medical, social and physical activity history, patient-reported outcomes, and performance-based measures. Following assessment, the PERCS system allocated participants to one of three exercise pathways. Results: Sixty-four participants were recruited over 5 months (25.2% recruitment rate; female n=39; mean age 61.4 (12.4) years). Almost all participants (90.6%) required support to become more physically active. The majority (n=43, 66%) were referred to community exercise programmes and n=15 (23%) required physiotherapy rehabilitation. Five required medical pre-clearance and one was re-triaged at 1-week. Mean cost per participant for community exercise services was €107.70. At T1, adherence to physical activity guidelines increased for aerobic (44% to 83%) and resistance (13% to 67%) exercise. Improvements were observed in hand grip strength (x̄ 2.59kg, p=0.001), 30 second sit-to-stand (x̄+3.7stands, p<0.001) and 6-minute walk test (x̄ +37.3m, p=0.001). Conclusion: PERCS appropriately triaged patients to the right level of exercise and rehabilitation for individual needs and was effectively implemented. Participants experienced improvements in physical activity and physical functioning metrics. Implications for Cancer Survivors: Triage and referral systems can support effective and patient-centred implementation of exercise into cancer care. ClinicalTrials.gov registration: NCT05615285