The exercise in all chemotherapy trial

Abstract

Background Multiple international organizations have called for exercise to become standard practice in the setting of oncology care. The feasibility of integrating exercise within systemic chemotherapy has not been investigated. Methods Patients slated to receive infusion therapy between April 2017 and October 2018 were screened for possible inclusion. The study goal was to establish the acceptability and feasibility of embedding an exercise professional into the chemotherapy infusion suite as a method of making exercise a standard part of cancer care. The exercise prescriptions provided to patients were individualized according to results of brief baseline functional testing. Results In all, 544 patients were screened, and their respective treating oncologists deemed 83% of them to be medically eligible to participate. After further eligibility screening, 226 patients were approached. Nearly 71% of these patients (n = 160) accepted the invitation to participate in the Exercise in All Chemotherapy trial. Feasibility was established because 71%, 55%, 69%, and 63% of the aerobic, resistance, balance, and flexibility exercises prescribed to patients were completed. Qualitative data also supported the acceptability and feasibility of the intervention from the perspective of patients and clinicians. The per‐patient cost of the intervention was $190.68 to $382.40. Conclusions Embedding an exercise professional into the chemotherapy infusion suite is an acceptable and feasible approach to making exercise standard practice. Moreover, the cost of the intervention is lower than the cost of other common community programs. Future studies should test whether colocating an exercise professional with infusion therapy could reach more patients in comparison with not colocating. Lay Summary Few studies have tested the implementation of exercise for patients with cancer by embedding an exercise professional directly into the chemotherapy infusion suite. The Exercise in All Chemotherapy trial shows that this approach is both acceptable and feasible from the perspective of clinicians and patients.

Telerehabilitation’s Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation

“…Patient challenges with program participation related to personal factors such as motivation, fatigue, and other medical issues, similar to in-person rehabilitation [ 6 , 7 , 36 ]. Telerehabilitation offers an opportunity to participate in exercise by minimizing disruption and allowing cancer survivors to exercise at their own pace consistent with their desire to access convenient exercise rehabilitation programs, especially during treatment [ 6 , 37 ]. By increasing access and encouraging exercise adherence through telerehabilitation, there is also opportunity for lower health care expenditure in addition to improved patient outcomes [ 38 ].…”

Cost evaluation of an exercise oncology intervention: The exercise in all chemotherapy trial

“…Our preliminary data clearly demonstrates that this is possible to achieve, given the observation of 0.5 fewer hospital days per patient (see Table 2 ). Our prior publication noted that the exercise intervention was highly acceptable and feasible from the perspective of clinicians and patients alike, 16 suggesting potential for future larger cost‐effectiveness trials.…”

“…We have previously reported this intervention cost. 16 Overall total cost from the payers' perspective were calculated by summing up the costs of the ED visits, hospitalizations, and the intervention.…”

“…The exercise intervention has been described previously 16 . Briefly, the home‐based exercise intervention consisted of a mix of five elements: aerobic, resistance, balance, flexibility, and rest.…”

“…To address this pressing issue, our team used data from a pragmatic pilot trial, Exercise iN All ChemoTherapy (ENACT). The ENACT trial demonstrated that embedding a cancer exercise trainer into the chemotherapy infusion suite to counsel and prescribe home‐based resistance and aerobic exercise is highly acceptable to healthcare providers and patients, and is feasible for patients to complete 16 . For this post‐hoc analysis, we retrospectively examined healthcare utilization within trial participants and matched comparisons, to discern if exercise might alter these potentially avoidable costs.…”