Novel Program May Make Exercise More Accessible to Patients with Cancer

Patients with cancer appeared receptive to the idea of having an exercise professional in the infusion room offering them exercise advice while they were receiving chemotherapy, according to study results recently published in Cancer.

“To our knowledge, we are the first to document the feasibility and acceptability of embedding an exercise professional into the chemotherapy infusion suite as a way of implementing exercise as standard of care for patients with cancer,” the study authors wrote.

Previous research has shown that exercise benefits patients with cancer and improves common symptoms that can occur during chemotherapy treatment. Moreover, the American College of Sports Medicine recently recommended prescribing specific exercise programs to help patients address many common cancer health-related outcomes such as fatigue, pain, anxiety, depression, quality of life, function, sleep, bone health and breast cancer-related lymphedema.

However, research has also shown that most patients receiving chemotherapy don’t get any guidance on the benefits of exercise. And, it is estimated that only 9% to 23% of oncologists refer exercise programs to patients receiving chemotherapy.

As a result, Kathryn H. Schmitz, associate director of population sciences at Penn State Cancer Institute in Hershey, Pennsylvania, and colleagues conducted a trial to investigate the feasibility of integrating an exercise trainer directly into the chemotherapy infusion suite at Penn State Cancer Institute.

Between April 2017 and October 2018, 807 patients (all ages 18 and over) were deemed eligible to enroll into the Exercise in All Chemotherapy (ENACT) trial. Of those considered eligible, 114 completed the trial. Patients with all stages of cancer were included in the trial.

“We excluded pregnant women and those with any diagnosis that would make unsupervised exercise unsafe as deemed by the oncologist or the exercise trainer,” the study authors wrote “We also excluded patients for whom there was evidence in the medical record of an absolute contraindication for exercise according to the American Heart Association.”

Each patient enrolled onto the trial was given a brief evaluation (isometric grip strength, 30-second chair stand and the tandem balance test) before being prescribed with their individualized exercise program.

All the patients were advised to rest when needed; 90.62% were prescribed aerobic exercise; 93% resistance exercise; 40% balance exercise; and 80% flexibility exercise. Patients took part in the exercise intervention program for an average of 15 weeks. Of note, there were no side effects related to the exercise intervention.

At the end of the trial, Schmitz and colleagues interviewed staff members and 10 patients on the location, communications, program safety, funding, willingness to recommend the program to others and patient experiences.

Each patient agreed that it was ideal to have the exercise unit on-site and most were concerned that an off-site location would discourage patients from exercising. The nurse practitioners that were surveyed believed the on-site program encouraged patients to think of exercise as a part of their cancer treatment; and physicians felt that there would be less participation if the unit was moved off-site. According to the study authors, one physician said, “streamlining is the key for any success of anything,” in response to the trial.

All interviewees thought that the program was safe. Additionally, most of the survey respondents recommended the ENACT program be covered by insurance due to the potential for the exercise intervention to reduce costly complications as well as the similarity of the intervention to other services already covered by insurance (nutrition, mental health care, physical therapy, etc.).

Each participant recommended the program to other patients and thought that it should be standard.

Having a clear and personalized program was important to the patients’ ability to successfully participate, according to survey responses. “Patients reported multiple benefits, including distraction from cancer and cancer treatments, an increased sense of control, emotional support, and physical benefits,” the authors wrote.

Patients reported that symptoms, depression, other life demands, weather and needing to heal from surgery were sometimes barriers to performing their exercises.

Depending on what home exercise equipment was prescribed to patients, the intervention cost between $190.68 and $382.40 per patient. This was less than a specific physical therapy-based program ($866) and less than a specific community-based program ($500).

Based on the evidence, the study authors encourage other cancer centers to create an exercise intervention space within their chemotherapy units to offer patients easier access to exercise.

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