Abstract
Purpose
Studies in exercise oncology are increasingly evaluating the implementation of cancer-specific exercise programming in real-world settings. Evaluating current implementation efforts and identifying current research gaps may inform future implementation. This scoping review explores studies implementing cancer-specific exercise programs to determine their pragmatic characteristics and evaluate potential for translation into practice.
Methods
A systematic literature search was conducted using five databases (up to July 2020) to identify implementation studies that used qualitative or quantitative methods. Program pragmatism was evaluated using the PRECIS/RE-AIM tool.
Results
Fourteen articles were included for review. While programs were moderately pragmatic (average: 3.4; range: 2.8–4.2), variability was observed between scoring domains. Programs scored higher (more pragmatic) in domains typical for effectiveness studies, including participant eligibility, follow-up intensity, primary trial outcome, and analysis of primary outcome. In contrast, programs scored lower (less pragmatic) in domains aligned with implementation science, including intervention flexibility, adoption, implementation, and maintenance. Limited information was reported regarding program fidelity, adaptations, and maintenance/sustainability.
Conclusion
Researchers should consider the pragmatism of interventions, the nuances of program adoption and implementation at the setting level, and the transition and integration of programming into the healthcare system. Future studies may benefit from the inclusion of decision-makers and implementation experts and shifting focus towards flexible programming. PRECIS/RE-AIM may facilitate the evaluation of programs throughout the study design and implementation process.
Implications for Cancer Survivors
The implementation of pragmatic exercise programs that are both scalable and sustainable is needed so that cancer survivors can experience exercise-related benefits beyond research settings.
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Data availability
A detailed extraction table was completed, and data are available through an open source data repository platform at https://dataverse.library.ualberta.ca/privateurl.xhtml?token=eb6a1bd9-6227-4e42-82a3-2f17b27e9360.
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
International Agency for Research on Cancer. GLOBOCAN Cancer Statistics 2020. December 2020. https://gco.iarc.fr/today/home.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. https://doi.org/10.3322/caac.21551.
Bower JE. Management of cancer-related fatigue. Clin Adv Hematol Oncol. 2006;4(11):828–9.
Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018;361:k1415. https://doi.org/10.1136/bmj.k1415.
Galvao DA, Taaffe DR, Spry N, Joseph D, Turner D, Newton RU. Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation. Prostate Cancer Prostatic Dis. 2009;12(2):198–203. https://doi.org/10.1038/pcan.2008.51.
Wefel JS, Witgert ME, Meyers CA. Neuropsychological sequelae of non-central nervous system cancer and cancer therapy. Neuropsychol Rev. 2008;18(2):121–31. https://doi.org/10.1007/s11065-008-9058-x.
Smith MR, Finkelstein JS, McGovern FJ, Zietman AL, Fallon MA, Schoenfeld DA, et al. Changes in body composition during androgen deprivation therapy for prostate cancer. J Clin Endocrinol Metab. 2002;87(2):599–603. https://doi.org/10.1210/jcem.87.2.8299.
Keating NL, O'Malley A, Freedland SJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of veterans with prostate cancer. J Natl Cancer Inst. 2012;104(19):1518–23. https://doi.org/10.1093/jnci/djs376.
Neo J, Fettes L, Gao W, Higginson IJ, Maddocks M. Disability in activities of daily living among adults with cancer: a systematic review and meta-analysis. Cancer Treat Rev. 2017;61:94–106. https://doi.org/10.1016/j.ctrv.2017.10.006.
Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–90. https://doi.org/10.1249/mss.0000000000002116.
Patel AV, Friedenreich CM, Moore SC, Hayes SC, Silver JK, Campbell KL, et al. American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Med Sci Sports Exerc. 2019;51(11):2391–402. https://doi.org/10.1249/mss.0000000000002117.
Mayer DK, Terrin NC, Menon U, Kreps GL, McCance K, Parsons SK, et al. Health behaviors in cancer survivors. Oncol Nurs Forum. 2007;34(3):643–51. https://doi.org/10.1188/07.onf.643-651.
Blanchard CM, Courneya KS, Stein K. Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol. 2008;26(13):2198–204. https://doi.org/10.1200/jco.2007.14.6217.
Covington KR, Hidde MC, Pergolotti M, Leach HJ. Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence. Support Care Cancer. 2019;27(12):4435–50. https://doi.org/10.1007/s00520-019-05022-6.
Gaglio B, Phillips SM, Heurtin-Roberts S, Sanchez MA, Glasgow RE. How pragmatic is it? Lessons learned using PRECIS and RE-AIM for determining pragmatic characteristics of research. Implement Sci. 2014;9:96. https://doi.org/10.1186/s13012-014-0096-x.
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. https://doi.org/10.1080/1364557032000119616.
Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141–6. https://doi.org/10.1097/xeb.0000000000000050.
Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69.
Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https://doi.org/10.7326/M18-0850.
American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Tenth ed. Philadelphia: Wolters Kluwer; 2018.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276–82.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7. https://doi.org/10.2105/ajph.89.9.1322.
Holtrop JS, Rabin BA, Glasgow RE. Qualitative approaches to use of the RE-AIM framework: rationale and methods. BMC Health Serv Res. 2018;18(1):177. https://doi.org/10.1186/s12913-018-2938-8.
Santa Mina D, Sabiston CM, Au D, Fong AJ, Capozzi LC, Langelier D, et al. Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement. Curr Oncol. 2018;25(2):149–62. https://doi.org/10.3747/co.25.3977.
Pullen T, Sharp P, Bottorff JL, Sabiston CM, Campbell KL, Ellard SL, et al. Acceptability and satisfaction of project MOVE: a pragmatic feasibility trial aimed at increasing physical activity in female breast cancer survivors. Psychooncology. 2018;27(4):1251–6. https://doi.org/10.1002/pon.4662.
Pullen T, Bottorff JL, Sabiston CM, Campbell KL, Eves ND, Ellard SL, et al. Utilizing RE-AIM to examine the translational potential of Project MOVE, a novel intervention for increasing physical activity levels in breast cancer survivors. Transl Behav Med. 2019;9(4):646–55. https://doi.org/10.1093/tbm/iby081.
Conlon BA, Kahan M, Martinez M, Isaac K, Rossi A, Skyhart R, et al. Development and evaluation of the curriculum for BOLD (Bronx Oncology Living Daily) healthy living: a diabetes prevention and control program for underserved cancer survivors. J Cancer Educ. 2015;30(3):535–45. https://doi.org/10.1007/s13187-014-0750-7.
Hubbard G, Campbell A, Fisher A, Harvie M, Maltinsky W, Mullen R, et al. Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation. Pilot Feasib Stud. 2018;4:108. https://doi.org/10.1186/s40814-018-0297-1.
Kennedy MA, Bayes S, Galvão DA, Singh F, Spry NA, Davis M, et al. If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework. Eur J Cancer Care (Engl). 2020;2020:e13251. https://doi.org/10.1111/ecc.13251.
Culos-Reed SN, Dew M, Shank J, Langelier DM, McDonough M. Qualitative evaluation of a community-based physical activity and yoga program for men living with prostate cancer: survivor perspectives. Glob Adv Health Med. 2019;8:2164956119837487. https://doi.org/10.1177/2164956119837487.
Lanni TB, Brown E, Kuwajerwala N, Stromberg J, Gustafson G, Wood R, et al. Implementation of an oncology exercise and wellness rehabilitation program to enhance survivorship: the Beaumont Health System experience. J Commun Support Oncol. 2014;12(3):87–91. https://doi.org/10.12788/jcso.0024.
Dalzell MA, Smirnow N, Sateren W, Sintharaphone A, Ibrahim M, Mastroianni L, et al. Rehabilitation and exercise oncology program: translating research into a model of care. Curr Oncol. 2017;24(3):e191–e8. https://doi.org/10.3747/co.24.3498.
Heston AH, Schwartz AL, Justice-Gardiner H, Hohman KH. Addressing physical activity needs of survivors by developing a community-based exercise program: LIVESTRONG(R) at the YMCA. Clin J Oncol Nurs. 2015;19(2):213–7. https://doi.org/10.1188/15.cjon.213-217.
Leach HJ, Gainforth HL, Culos-Reed SN. Delivery of an exercise program for breast cancer survivors on treatment in a community setting. Translat J Am Colleg Sports Med. 2017;2(24):153–61.
Moore J, Merchant Z, Rowlinson K, McEwan K, Evison M, Faulkner G, et al. Implementing a system-wide cancer prehabilitation programme: the journey of Greater Manchester's 'Prehab4cancer'. Eur J Surg Oncol. 2020;47:524–32. https://doi.org/10.1016/j.ejso.2020.04.042.
Faro JM, Arem H, Heston A-H, Hohman KH, Hodge H, Wang B, et al. A longitudinal implementation evaluation of a physical activity program for cancer survivors: LIVESTRONG® at the YMCA. Implem Sci Commun. 2020;1(1):63. https://doi.org/10.1186/s43058-020-00051-3.
McNeely ML, Sellar C, Williamson T, Shea-Budgell M, Joy AA, Lau HY, et al. Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study. BMJ Open. 2019;9(9):e029975. https://doi.org/10.1136/bmjopen-2019-029975.
Cormie P, Lamb S, Newton RU, Valentine L, McKiernan S, Spry N, et al. Implementing exercise in cancer care: study protocol to evaluate a community-based exercise program for people with cancer. BMC Cancer. 2017;17(1):103. https://doi.org/10.1186/s12885-017-3092-0.
Dennett AM, Peiris CL, Shields N, Morgan D, Taylor NF. Exercise therapy in oncology rehabilitation in Australia: a mixed-methods study. Asia Pac J Clin Oncol. 2017;13(5):e515–e27. https://doi.org/10.1111/ajco.12642.
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. 2011;38(2):65–76. https://doi.org/10.1007/s10488-010-0319-7.
Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3:32. https://doi.org/10.1186/s40359-015-0089-9.
Czosnek L, Rankin N, Zopf E, Richards J, Rosenbaum S, Cormie P. Implementing exercise in healthcare settings: the potential of implementation science. Sports Med. 2020;50(1):1–14. https://doi.org/10.1007/s40279-019-01228-0.
Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3-4):327–50. https://doi.org/10.1007/s10464-008-9165-0.
Chambers DA, Norton WE. The adaptome: advancing the science of intervention adaptation. Am J Prev Med. 2016;51(4 Suppl 2):S124–31. https://doi.org/10.1016/j.amepre.2016.05.011.
Brownson RC, Colditz GA, Proctor EK. Dissemination and implementation research in health translating science to practice. 2nd ed. Oxford: Oxford University Press; 2017.
Schell SF, Luke DA, Schooley MW, Elliott MB, Herbers SH, Mueller NB, et al. Public health program capacity for sustainability: a new framework. Implement Sci. 2013;8:15. https://doi.org/10.1186/1748-5908-8-15.
Stoutenberg M, Galaviz KI, Lobelo F, Joy E, Heath GW, Hutber A, et al. A pragmatic application of the RE-AIM framework for evaluating the implementation of physical activity as a standard of care in health systems. Prev Chronic Dis. 2018;15:E54. https://doi.org/10.5888/pcd15.170344.
Acknowledgements
The authors would like to acknowledge the assistance of the University of Alberta Health Sciences librarian Liz Dennett in developing the search strategies for this review.
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GP was supported by the Canadian Institutes for Health Research through the Sir Frederick Banting & Dr Charles Best Canada Graduate Scholarship – Master’s and by the University of Alberta through the Walter H Johns Graduate Fellowship.
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GP and MM created the concept of the study. GP, FS and MM created the search strategies. GP and FS performed searches and screened records. GP, FS and ND extracted data and evaluated the studies. All authors were involved in interpreting the results, drafting, and revising the manuscript. All authors read and approved the final manuscript.
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Purdy, G.M., Sobierajski, F.M., Dolgoy, N.D. et al. Evaluating implementation and pragmatism of cancer-specific exercise programs: a scoping review. J Cancer Surviv 16, 374–387 (2022). https://doi.org/10.1007/s11764-021-01032-8
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DOI: https://doi.org/10.1007/s11764-021-01032-8