Aims: To establish the feasibility of embedding exercise-based rehabilitation in a cancer treatment unit to allow cancer survivors early access to exercise support.
Method: A mixed-methods, pre-post study was conducted using Bowen’s Framework to describe key domains of feasibility: demand (referrals), acceptability (uptake, attendance, satisfaction), implementation (resources), practicality (adverse events, costs) and limited-efficacy (function, quality of life, self-efficacy). Patients and clinicians involved in service delivery were included. Patients were medically stable, adult cancer survivors receiving curative or palliative treatment for any cancer at the health service. Patients completed an 8-week home or hospital-based exercise program. Clinicians included doctors, nurses and allied health professionals involved with referring to or delivering the rehabilitation service. Quantitative data were analysed descriptively. Effect sizes (Hedge’s g) and mean differences were calculated to determine effect size and clinical significance. Qualitative data were analysed thematically using a phenomenological approach.
Results: The exercise-based rehabilitation service received 155 referrals over a 6-month recruitment period (of which 73 commenced). Patients attended 40% to 56% of scheduled sessions and reported high satisfaction. There were no major adverse events. The program utilised existing resources, with the predominant cost being staff. The average cost per participant was AUD $1,104. Participants made moderate to large, clinically significant gains in function (6-minute walk distance; +73m, 95% confidence interval 49 to 96) and quality of life (EORTC QLQ-C30 Global quality of life; +8 units, 95% confidence interval 3 to 13). The service was well accepted by patients and staff. The main themes that arose from qualitative data were the importance of visibility and culture change.
Conclusion: Implementation of exercise-based rehabilitation in an acute cancer setting was safe and feasible. Important considerations for implementation are flexible access, visibility, patient and staff education and establishing funding streams to sustain programs.