Mary Ann Kennedy

Introduction: Exercise is a key part of cancer care, yet its integration into routine practice remains limited. This study explored the experiences of people living with and beyond cancer, with an updated, opt-out referral model embedded within a supportive oncology setting, focusing on initial engagement with exercise physiology appointments. Through this model, patients were automatically scheduled for a consultation with an in-house exercise professional during their cancer treatment. Methods: A qualitative descriptive design comprised of two focus groups with 13 participants was employed to explore views across pre-defined elements of the model: referral to exercise, appointments, counselling, and tailoring. Results: Participants valued the automatic appointment structure as it normalised exercise as being part of their treatment and reduced the burden from decision-making and arrangement of appointments. Trust in their treating doctors and nurses, together with consistent messaging, reinforced exercise as a medically endorsed intervention. Counselling on exercise addressed misinformation, highlighted the physiological rationale, and helped foster a sense of control and agency. The inclusive gym environment and tailored plans further supported engagement with exercise, from which the importance of collaborative but individualised care was noted. While the opt-out process facilitated initial uptake, sustained access to exercise services beyond the clinical setting remains a challenge. Conclusions: Findings support the feasibility and acceptability of integrated referral pathways and underscore the need for system-level changes and community partnerships to ensure long-term, equitable access to exercise in cancer care.

Purpose: Many people face multiple cancer- and treatment-related sequalae. Triage and referral to physical health services can manage such consequences, but a comprehensive understanding of available triage tools is lacking. This review (i) identifies tools used to triage to physical health services, (ii) maps tool characteristics and application outcomes and (iii) summarises existing gaps. Methods: A systematic search was conducted (three databases, April 2024). Articles were included if they used a tool to triage to physical health services. Tools were classified by triaged disciplines (i.e., diet, exercise, physical rehabilitation, multidisciplinary) and screened physical impairments (e.g., malnutrition). Tool characteristics (e.g., triage method) and application outcomes (i.e., reach, triage rates) were extracted. Results: Of 23,369 records retrieved, 67 studies were included. Studies comprised 78 instances of tool use (64 unique tools), where n = 33 triaged to dietetics (42%), n = 6 exercise (8%), n = 11 physical rehabilitation (14%), and n = 28 a combination of health disciplines (36%). Mean age was 65 years. Most tools were used during-treatment (45%), in hospital settings (62%), measured malnutrition/physical function (60%) and used single cut-off scores (68%). Reach and triage rates varied, with exercise (reach = 89%) and diet (triage = 63%) rates highest. Conclusion: Many physical health triage tools exist, most solely for dietetics, with heterogeneous characteristics and application outcomes. Updated tools are needed for triage to exercise/physical rehabilitation, multiple age cohorts across the cancer continuum, and that potentially use multiple cut-off scores. Cancer care professionals can use this compendium to identify which tool characteristics best suit their healthcare setting, for optimal outcomes.

Purpose: Survival after a cancer diagnosis is improving, increasing the importance of understanding and managing long-term treatment-related adverse effects. This study aimed to understand breast and prostate cancer survivors’ understanding of how cancer treatment may affect cardiovascular and musculoskeletal health. Methods: Australian breast and prostate cancer survivors treated with therapies with known cardiovascular adverse effects were recruited via a private cancer care provider. Participants completed an online background questionnaire, then participated in a focus group. Focus groups were recorded, transcribed, then analysed using reflexive thematic analysis. Results: In total, 26 cancer survivors (15 breast, 11 prostate; mean age 67 years) participated in one of seven focus groups. Three major themes were developed: 1) Focus is on the here and now, not the future—participants were infrequently told that their cancer treatment can have negative long-term effects; 2) Wanting individualised delivery of side-effect information—participants received varying types and amounts of information about side effects, but it was not delivered in a way that best suited them; and 3) Left wondering how to best manage side effects—few participants were provided with information about how to manage long term side effects, despite wanting this information. Conclusion: Important information about long-term side effects of cancer treatment, and how to manage them, was inconsistently provided to breast and prostate cancer survivors. Information about long-term treatment side effects should be delivered in a flexible, individualised way to better enable cancer survivors to understand the risk and engage in preventative health behaviours.

Purpose: The Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care encourages all healthcare professionals to discuss, recommend, and refer people with cancer to exercise; however, use of these recommendations in practice is unknown. Methods: Oncology healthcare professionals working in Australia were invited to complete a cross-sectional online survey that assessed contextual factors that influence implementation of COSA exercise guidance in cancer care, based on the Consolidated Framework for Implementation Research. Results: We received 133 survey responses. Most were women (74%), nurses (35%), or oncologists (26%), involved in cancer care for > 10 years (63%), and in a public hospital setting (69%). Most participants agreed that exercise is beneficial (94%) and the COSA recommendations would positively influence patients’ exercise behaviours (94%). However, only 35% routinely apply COSA recommendations in practice, and only 35% believe they are the best person to provide exercise support. Patient-level barriers included needing additional support to access exercise (92%), most commonly financial (74%). Organisational-level barriers included a lack of dedicated resources to support delivering exercise guidance (69%), and not believing providing exercise guidance is an important part of their role (51%). Only 24% agreed their organisation revised practice based on the COSA recommendations. Conclusion: Despite most oncology healthcare professionals agreeing that exercise is beneficial, and that the COSA recommendations are important for patients, only a minority actually apply the recommendations in their practice. Targeted implementation efforts are needed to facilitate use of COSA exercise guidance in clinical practice.

Background: Cancer rehabilitation and exercise oncology (CR/EO) have documented benefits for people living with and beyond cancer. The authors examined proximity to CR/EO programs across the United States with respect to population density, race and ethnicity, socioeconomic status, and cancer incidence and mortality rates.Methods: This cross‐sectional study was conducted in 2022–2023. Online searches were initiated to identify CR/EO programs. Geocoding was used to obtain latitudinal and longitudinal geospatial coordinates. Demographic data were abstracted from the 2020 5‐year American Community Survey. Cancer incidence and mortality data were obtained from the Centers for Disease Control and Prevention. US 2013 Rural‐Urban Continuum Code (RUCC) classification was used to define counties as either urban (RUCC 1–3) or rural (RUCC 4–9). Multivariable logistic regression was used to evaluate the association between being far from a program and census‐tract level factors.Results: In total, 2133 CR/EO programs were identified nationwide. The distance from a program increased with decreasing population density: rural tracts were 17.68 ± 0.24 miles farther from a program compared with urban tracts (p < .001). Program proximity decreased as the neighborhood deprivation index increased (p < .001). Exercise oncology programs were less common than cancer rehabilitation programs in tracts with a larger proportion of minority residents (p < .001).Conclusions: Prior research has documented that underrepresented populations have worse cancer‐related symptoms and higher cancer mortality. Herein, the authors document their findings that these same populations are less likely to have proximity to CR/EO programs, which are associated with improved cancer‐related symptoms and cancer mortality outcomes. To realize the positive outcomes from CR/EO programming, efforts must focus on supporting expanded programming and sustainable payment for these services.

Introduction: Integration of exercise into standard oncology care requires a highly skilled workforce of exercise professionals; however, competency requirements have not kept pace with advancements in the field. Therefore, the aim of this study was to obtain consensus on core competencies required for an exercise professional to be qualified to work with adults undergoing active cancer treatment.Materials and Methods: A three‐round modified electronic Delphi process was used. In Round 1, an international group of 64 exercise oncology stakeholders (i.e., exercise oncology professionals (n = 29), clinical referrers (n = 21), and people with lived experience (n = 14)) responded to open‐ended prompts eliciting perspectives regarding competencies needed for an exercise oncology professional to work with adults receiving active cancer treatment. Subsequently, only exercise oncology professionals participated, ranking the importance of competencies. In Round 2, professionals received summary feedback, ranked new competencies generated from open‐ended responses, and reranked competencies not reaching consensus. In the final round, professionals finalized consensus ranking and rated frequency and mastery level for each.Results: Consensus was reached on 103 core competencies required for exercise professionals to be qualified to deliver care to adults undergoing active cancer treatment. The core competencies represent 10 content areas and reflect the needs of clinical referrers and people with lived experience of receiving cancer treatment.Conclusions: The core competencies identified reflect significant advancements in the field of exercise oncology. Results will underpin the development of education, certification, and employment requirements for exercise oncology professionals, providing a critical step toward achieving routine integration of exercise into standard oncology care.

Purpose: Cancer survival is improving, making optimal management of long-term treatment-related adverse effects increasingly important. Exercise and a healthy diet are beneficial and regularly recommended in cancer survivorship guidelines; however, few cancer survivors meet these recommendations so there is a need to explore why. This study aimed to understand experiences receiving exercise and diet support among Australian breast and prostate cancer survivors during and following treatment, and to explore what support they would like to receive. Methods: Adults who completed active treatment for breast or prostate cancer were recruited via a private cancer care centre. Using a qualitative descriptive study design, participants attended in-person focus groups that were recorded, transcribed, then analysed using reflexive thematic analysis. Results: In total, 26 cancer survivors (15 breast, 11 prostate) participated in one of seven focus groups (4 breast, 3 prostate). Two themes were developed: 1) It was just brushed over, and 2) Wanting more. Theme 1 reports that exercise, and especially diet, were rarely discussed. If they were, it was often limited to general recommendations. Theme 2 shows that participants wanted more specific and personalised support, and information about how exercise and/or diet could benefit their cancer treatment. Conclusion: Despite strong interest in receiving personalised exercise and diet support, neither are routinely provided to Western Australian breast and prostate cancer survivors. If support was provided, there was inconsistency in the level and type of support provided. These findings identify important gaps in exercise and diet support provision to cancer survivors and will inform future strategies aiming to improve cancer survivorship care.

Objective: The aim in this study was to quantify the number, nature, and severity of injuries sustained by male and female high school students who took part in a running training program that culminated in the completion of a half or full marathon. Design: This study is a retrospective clinical audit. Methods: Injury reports from high school students (grades 9–12) who participated in a half or full marathon 30-week progressive training program comprising four training days per week (three running days and one cross-training day) were reviewed. The number of runners completing a marathon, together with the number, nature, severity of injuries, and treatment types, as reported to the program physiotherapist, were the main outcome measures. Results: Program completion was 96% (n = 448/469). Of all participants, 186 (39.6%) were injured, with 14 withdrawing from the program due to injury. For those who completed a marathon, 172 (38%) reported 205 musculoskeletal injuries (age of injured runners: 16.3 ± 1.1 years; 88 girls (51.2%) and 84 boys (48.8%)). More than half (n = 113, 55.1%) of the reported injuries were soft tissue injuries. Most injuries were localized to the lower leg (n = 88, 42.9%) and were of a minor nature (n = 181, 90%), requiring only 1–2 treatments. Conclusions: There was a low number of relatively minor injuries for high school participants taking part in a graduated and supervised marathon training program. The injury definition was conservative (i.e., any attendance to physiotherapist) and the relative severity of injuries was minor (i.e., requiring 1–2 treatment sessions). Overall, these results do not support a need to restrict high school students from taking part in marathon running, though continued emphasis on graduated program development and close supervision of young participants is recommended.

Background: Despite its therapeutic role during cancer treatment, exercise is not routinely integrated into care and implementation efforts are largely absent from the literature. The aim of this study was to evaluate a strategy to integrate the workflow of a co-located exercise clinic into routine care within a private oncology setting in two clinics in the metropolitan region of Western Australia. Methods: This prospective evaluation utilised a mixed methods approach to summarise lessons learned during the implementation of an integrated exercise workflow and supporting implementation plan. Data collection was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Reports detailing utilisation of the exercise service and its referral pathways, as well as patient surveys and meeting minutes documenting the implementation process informed the evaluation. Results: The co-located exercise service achieved integration into routine care within the clinical oncology setting. Patient utilisation was near capacity (reach) and 100% of clinicians referred to the service during the 13-month evaluation period (adoption). Moreover, ongoing adaptations were made to improve the program (implementation) and workflows were integrated into standard operating practices at the clinic (maintenance). The workflow performed as intended for ~70% of exercise participants (effectiveness); however, gaps were identified in utilisation of the workflow by both patients and clinicians. Conclusion: Integration of exercise into standard oncology care is possible, but it requires the ongoing commitment of multiple stakeholders across an organisation. The integrated workflow and supporting implementation plan greatly improved utilisation of the co-located exercise service, demonstrating the importance of targeted implementation planning. However, challenges regarding workflow fidelity within and across sites limited its success highlighting the complexities inherent in integrating exercise into clinical oncology care in a real-world setting.