Translating Research to Practice Using a Team-Based Approach to Cancer Rehabilitation: A Physical Therapy and Exercise-Based Cancer Rehabilitation Program Reduces Fatigue and Improves Aerobic Capacity

Abstract

Background and Objective: Intervention research has shown that exercise-based rehabilitation is safe and effective for reducing disease burden across the cancer continuum. However, the translation of this research to programs implemented in health care settings remains a challenge. This study describes the implementation of a physical therapy–based exercise program for patients who have been diagnosed with cancer and its effectiveness for reducing fatigue and improving aerobic capacity. Methods: Retrospective analysis of a single-group, pre/postprogram assessment for adult patients who have been diagnosed with cancer (N = 546). Six-Minute Walk Test (6MWT) measured aerobic capacity. Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue) and Piper Fatigue Scale (PFS) measured fatigue. Paired-samples t tests examined changes in outcomes from pre- to postprogram assessments. Linear regression explored predictors of postprogram outcomes. Results: Participants were 63.7 ± 12.2 years old, diagnosed with breast (27.1%), hematological (15.4%), head and neck (12.6%), lung (12.3%), prostate (11%), colorectal (7.3%), or other (14.3%) cancers. For those who completed the postprogram measures (N = 169), FACIT-Fatigue scores improved (MΔ = +8.42 ± 9.2, t 79 = −8.21, P = .000), PFS scores improved (MΔ = −2.1 ± 2.0, t 81 = 9.5, P = .000), and 6MWT distance improved (MΔ = +42.9 ± 53.8 m, t 160 = −10.1, P = .000). Age (P = .034) and time since completing chemotherapy (P = .000) or radiation therapy (P = .014) was inversely associated with the 6MWT. Greater exercise session attendance was associated with higher PFS scores (P = .020). Limitations: Only 31% of participants completed postprogram assessments, and limited information was available regarding reasons for dropout/withdrawal. Conclusions: This study provides a real-world example of a cancer rehabilitation program implemented in a health care setting, which was successful in reducing fatigue and improving aerobic capacity.

Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm

“…has the potential to optimize patient care via improved decision making about the safest and most e cacious exercise referral to improve patients' long-term health, function, and quality of life across the cancer continuum. [21] American College of Sports Medicine guidelines for exercise testing and prescription [19] Cancer-speci c exercise risk screening tool [22] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 (National Comprehensive Cancer Network, 2020) [23] Macmillan Cancer Rehabilitation pathways [24] Yes or No: New, worsening or di culty managing any of the following conditions: lymphedema, ostomy, signi cant weight uctuations, infection, ataxia, malnourishment, severe fatigue, bone/back/neck pain and unusual weakness Acvtiv Onco Model [20] Macmillan Cancer Rehabilitation pathways [24] High risk signs/symptoms Yes or No: presence of ≥1 complication or highrisk signs/symptoms associated with the following diseases: Cardiovascular or respiratory disease Previous stroke, neurological condition, or spinal cord injury…”

“…Intervention is typically led by an exercise clinician with oversight from a rehabilitation or other clinical specialist including nursing. Although the effectiveness of these programs has not been reviewed exclusively, many studies have demonstrated positive effects and impacts for cancer survivors, including improved fatigue [21][22][23], function [21,22,24,25], quality of life [22], symptom management [25], tness [22], physical activity level [23], and health-care utilization [25].…”

“…Recent steroid injection and potential for steroid-induces myopathy Uncontrolled diabetes mellitus Physical Activity Readiness Questionnaire (PAR-Q) [21] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Macmillan Cancer Rehabilitation pathways [24] Cancer-speci c exercise risk screening tool [22] Acvtiv Onco Model [20] [24] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Focused review of safety considerations in cancer rehab [17] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] [25] Exercise in Medicine in Oncology: ACSM 2019 Roundtable [2] Macmillan Cancer Rehabilitation pathways [24] Acvtiv Onco Model [20] Cancer-speci c exercise risk screening tool [22] Association of Clinical Oncology (ASCO) Management of Older Adults Guideline [26] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] International Society of Geriatric Oncology (SIOG) recommendations for management of cancer-related cognitive decline [27] Level 2 side effects Yes or No, presence of ≥1 of the following factors:…”

Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) Algorithm

“…has the potential to optimize patient care via improved decision making about the safest and most e cacious exercise referral to improve patients' long-term health, function, and quality of life across the cancer continuum. American College of Sports Medicine guidelines for exercise testing and prescription [19] Acvtiv Onco Model [20] Chronic [21] American College of Sports Medicine guidelines for exercise testing and prescription [19] Cancer-speci c exercise risk screening tool [22] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 (National Comprehensive Cancer Network, 2020) [23] Macmillan Cancer Rehabilitation pathways [24] Yes or No: New, worsening or di culty managing any of the following conditions: lymphedema, ostomy, signi cant weight uctuations, infection, ataxia, malnourishment, severe fatigue, bone/back/neck pain and unusual weakness Acvtiv Onco Model [20] Macmillan Cancer Rehabilitation pathways [24] High risk signs/symptoms [21] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Macmillan Cancer Rehabilitation pathways [24] Cancer-speci c exercise risk screening tool [22] Acvtiv Onco Model [20] [24] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Focused review of safety considerations in cancer rehab [17] The [25] Exercise in Medicine in Oncology: ACSM 2019 Roundtable [2] Macmillan Cancer Rehabilitation pathways [24] Acvtiv Onco Model [20] Cancer-speci c exercise risk screening tool [22] Association of Clinical Oncology (ASCO) Management of Older Adults Guideline [26] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] International Society of Geriatric Oncology (SIOG) recommendations for management of cancer-related cognitive decline [27] Level 2 side effects Yes or No, presence of ≥1 of the following factors:…”

High-Intensity Interval Training for Reducing Cancer-Related Fatigue in Survivors of Cancer: Challenges and Solutions for Translation and Implementation in Cancer Rehabilitation

“…5 This evidence has formed the basis for many cancer rehabilitation programs that implement aerobic exercise training. 6,7 Although the efficacy of MICT for reducing CRF has been well established, the question remains whether other exercise modalities are as effective or potentially more effective. One of the modalities in question is high-intensity interval training (HIIT), which involves alternating intervals of high-intensity exercise and low-intensity exercise or rest.…”