Your recent systematic review sought to estimate the effects of multidisciplinary, exercise-based, group oncology rehabilitation programs. Are they a widely used approach?

This approach, similar to cardiac or pulmonary rehabilitation, is the most common way of delivering exercise rehabilitation to people with cancer.

In health services, group-based rehabilitation usually comprises a set period of exercise supervised by physiotherapists or exercise physiologists.

This is often complemented by education sessions or individual therapy with multidisciplinary staff, such as nurses, dietitians, occupational  therapists and social workers or psychologists, to deliver a comprehensive package of care to address a range of cancer and treatment-related issues, such as fatigue, treatment side-effects, psychosocial wellbeing, deconditioning and preventing cancer recurrence and other chronic disease, such as cardiovascular disease and osteoporosis.

You found plenty of evidence about personal benefits that cancer survivors might obtain from participating in one of these programs. Can you summarise those benefits?

Findings from our review support other research and recently published guidelines for people with cancer that multidisciplinary, exercise-based oncology rehabilitation improves muscle strength, functional strength, and reduces  depression. 

There  is also some evidence these programs may improve quality of life, particularly in people with early-stage cancer.

Surprisingly, our findings contradict previous research in exercise-only studies that show rehabilitation reduces fatigue and improves fitness.

However, this may be related to issues with exercise reporting, dose and the baseline status of participants.

You would hope that those benefits would carry over into benefits for the healthcare service (like fewer admissions or lower costs of healthcare for these patients). Did you find that?

Unfortunately, our review highlighted this as a major gap in the literature.

Just one trial looked at hospital length of stay for unplanned hospital admissions, which was inconclusive for demonstrating benefit from oncology rehabilitation.

Other trials of exercise-only oncology rehabilitation also show conflicting evidence about their effect at a health service level.

There is an increasing push from the oncology community to integrate these programs into health services.

However, with increasing pressures on public health services, it is difficult to implement these much-needed programs in the absence of cost- effectiveness data.

What about early versus late delivery of these programs. Does that impact the amount of benefit achieved?

This is a burning question to many clinicians, particularly in light  of recent guidelines recommending the implementation of prehabilitation.

In practice though, it can be quite challenging to engage people to participate in  exercise  rehabilitation early in the treatment continuum.

Again, this review found only two studies comparing different time periods of rehabilitation.

One study found less reduction in FEV1 but no improvements in any other outcome in people receiving early rehabilitation for lung cancer.

It is also important to note those who received early rehabilitation in this trial had high rates of dropout and more postoperative pulmonary complications in the early rehabilitation group.

Another trial of early rehabilitation during radiotherapy for head and neck cancer also found little difference between early and late rehabilitation for improving outcomes.

These findings suggest that timing is not as important as having any access to oncology rehabilitation programs.

Are there trials of these multidisciplinary, exercise-based, group oncology rehabilitation programs that have been registered and that plan to look at these ‘missing’ outcomes?

While there are a number of implementation studies registered relating to oncology prehabilitation and health service endpoints, randomised controlled trials evaluating supervised, multidisciplinary oncology rehabilitation or prehabilitation are scarce.

Our team will be initiating a trial this year to evaluate the effect of prehabilitation comprising a supervised nutrition and exercise intervention for people preparing for autologous stem cell transplant, as this is a population that is particularly vulnerable to deconditioning and prolonged hospital length of stay.

We will be evaluating the effect of rehabilitation on physical capacity as well as hospital length of stay, post- transplant complications, three-month unplanned hospital readmissions, and emergency department presentations.

What about your personal plans for future research?

My research interests currently align with how we can translate oncology exercise and rehabilitation research to practice.

I am interested in evaluating different models of care to help improve access  to rehabilitation for cancer survivors.

COVID-19 has presented us a great opportunity to try innovative ways of delivering oncology rehabilitation via telehealth so we plan to evaluate this in more depth in the coming year.

I am also passionate about upskilling physiotherapists in the area of oncology rehabilitation and look forward to completing the evaluation of our website, the Cancer Exercise Toolkit, funded via the Pat Cosh Trust during our project, ‘Taking Oncology Rehabilitation Online.’

>> Dr Amy Dennett is a Research and Translation Fellow, Victorian Cancer Agency Fellow and physiotherapist in the Eastern Health Oncology Rehabilitation Program. Amy’s research spans the boundaries of clinical practice and research to optimise outcomes and improve access to rehabilitation services for people with cancer.