Examining Implementation of Exercise Oncology Programs

Abstract

Despite the large body of evidence of the benefits of exercise for people with cancer, it is often not part of standard care. This thesis addresses two components that are relevant to the widespread implementation of exercise oncology programs in clinical practice: cost-effectiveness and symptom burden. Paper 1: This scoping review identifies and synthesizes the literature on the use of generic utility measures used to evaluate exercise interventions for adults with any type of cancer, and identifies gaps in the current literature. Of the 2,780 citations retrieved, 10 articles were included in this review. Seven articles included economic evaluations; however, results varied considerably between studies and detailed effectiveness data derived from the generic utility measure were often not reported. To date, generic utility measures are underutilized in exercise oncology studies. Consideration should be given to the identified research evidence, population, and methodological gaps. Paper 2: This study explored symptom burden in adults with hematological cancers participating in a community-based exercise program. It is a secondary analysis of the Alberta Cancer Exercise Hybrid Effectiveness-Implementation study, which is 12-week community-based cancer-specific exercise program. Symptom burden was measured using the revised Edmonton Symptom Assessment System. This study examined the effects of exercise on symptom burden and identified variables associated with 12-week symptom burden and change in symptom burden from baseline to 12 weeks. Three hundred fifty-four adults with hematological cancers were included in the analysis. Statistically significant improvement (p <0.05) was observed for physical symptom burden, but not for total symptom burden. Baseline symptom score, program adherence, number of co-morbidities, and program type (virtual vs. in-person) were associated with post-intervention total symptom burden. Hematological cancer type, baseline physical activity level, treatment status, sex, and employment status were associated with change in total symptom burden from baseline to 12 weeks. Many barriers to implementing exercise in standard practice have been identified, including lack of standard referral pathways, lack of reimbursement structures for exercise, and policies directing the inclusion of exercise into standard care. Better economic evidence and evidence to support the creation of referral pathways are both necessary components to bridge the gap between research and practice, and support the implementation of exercise programs for individuals with cancer.