Exercise during and after cancer therapy is associated with a reduction in cancer-related deaths and may reduce the risk of cancer recurrence.

It also plays a role in treating side effects, including fatigue, depression and lymphoedema, as well as helping patients regain fitness and strength after treatment.

However, the important role of exercise in cancer recovery is not as well known as it should be, says Dr Amy Dennett, an APA Cancer Physiotherapist working with Eastern Health in Melbourne and a researcher at La Trobe University’s Sport and Exercise Medicine Research Centre.

While the Clinical Oncology Society of Australia released a position statement in 2018 (Cormie et al 2018) outlining the need to embed physical activity and exercise in cancer care, many oncologists do not routinely refer patients to physiotherapists and exercise physiologists as part of their care plan.

And while some patients are referred by their cancer centre to an exercise program, most hospital systems and cancer centres don’t have dedicated programs for cancer patients, who then have to look elsewhere.

‘The first port of call is a local physio, but then the issue is finding a physio with the expertise or at least the confidence to manage someone with or recovering from cancer, even if they don’t have specialist qualifications in that area,’ Amy says.

‘We need to give people more confidence that they can go to a physio for an exercise program.

'Often they will go to a physio if they’ve got lymphoedema or they’ve got a shoulder problem or some other impairment, but we need to do a little bit better at letting people know that a physio can help with exercise as well.

'That’s where this toolkit comes in, to try to fill that gap.’

As a physiotherapist working in the cancer rehabilitation space, Amy found that other clinicians were asking her for resources on treating cancer survivors.

‘It’s a relatively new space for physios to be working in—exercise and cancer—compared to some of the other areas that we work in,’ she says.

‘I was being asked, “How do I set up a program? Where do I find programs?” and this fit really well with my research interest in enhancing access to services for people with cancer.

'So the next logical step was to develop some resources to help physios to set up and prescribe evidence-based exercise programs to people with cancer.’

Amy and her colleagues started developing the Cancer Exercise Toolkit in 2020 and launched it in 2021.

A research paper outlining the development process and evaluation results was published earlier this year (Dennett et al 2022).

What’s in the toolkit?

The Cancer Exercise Toolkit is a website designed for exercise professionals, including educational resources and a location map for exercise rehabilitation programs.

The main focus is providing clinicians with the information and the confidence they need to work with cancer patients and survivors, although there are also resources for patients and survivors themselves.

‘There’s already a lot out there for consumers in terms of fact sheets and things like that.

'We didn’t want to reinvent the wheel and the gap was really in clinician education and training.

'That’s what we’ve tried to fill.’

The Cancer Exercise Toolkit includes:

• overviews of the evidence supporting exercise in cancer, with links to key publications and other resources
• practical advice on setting up and delivering exercise programs, including resources
• guidance for safely prescribing exercise to people with cancer
• patient resources, including educational videos and exercise instructional videos
• a location map for cancer-specific exercise programs across Australia.

The evidence base

The development of the toolkit was supported by a 2020 grant from the Pat Cosh Trust.

The researchers used a co-design process involving a group of physiotherapists and other exercise professionals to identify the key elements that the website would need in order to cover the learning needs of the end users.

Importantly, a group of patients was included in the co-design process as well, providing a perspective on what they needed from physiotherapists and others.

‘In the first two workshops, we had an expert group of physios with more advanced training in exercise and cancer and we had a group of generalist physios as well.

'We did that quite intentionally, because the skill sets are quite different in both of those groups.

'We wanted to be able to appeal to a broad audience of physiotherapists, while making sure that we had really accurate knowledge from the experts contributing to the process,’ Amy says.

‘We brought them together in a third workshop to bounce those ideas off each other and refine different elements of the proposed website.’

A final workshop focused on the prototype website, allowing participants to provide feedback on what was working and what needed more information.

The pilot website was initially launched in February 2021, with more than 320 users completing an initial survey and almost 60 completing a follow-up evaluation after using it for three months.

‘The surveys provided us with data showing that this website was user-friendly and that many users were recommending it to their colleagues.

'Importantly, it improved their confidence, knowledge and skills in being able to deliver exercise programs to people with cancer, which is really promising, as it goes back to why we set up the website in the first place,’ Amy says.

Results of the co-design process and the evaluation of the website have recently been published (Dennett et al 2022) and the website continues to be updated as new research is published on exercise and cancer.

Who should use it

The Cancer Exercise Toolkit has continued to be accessed regularly, with an average of 866 views in the first six months after it was launched.

Amy and the team behind it are keen to get the word out to physiotherapists and cancer centres.

‘It just gives clinicians, who might not have any cancer experience at all, a little bit of reassurance and a starting point of where they can go, what they can do.

'It has been really helpful to have all the evidence in the one spot so clinicians can look up a specific cancer with a specific treatment and have an idea of what that involves.

'The precautions and the safety aspect pages are among the most commonly accessed pages because often that’s where the questions lie,’ Amy says.

‘Ultimately, we’d like it to become the go-to resource for exercise and cancer, like the Pulmonary Rehabilitation Toolkit, which is now synonymous with pulmonary rehab and endorsed by Lung Foundation Australia.’

Click here to access the Cancer Exercise Toolkit. 

References

Cormie, P., Atkinson, M., Bucci, L., Cust, A., Eakin, E., Hayes, S., McCarthy, S., Murnane, A., Patchell, S., Adams, D. ‘Clinical Oncology Society of Australia position statement on exercise in cancer care.’ Med J Aust. Aug 20; 209(4), 2018, 184–187. DOI: 10.5694/mja18.00199. Epub 7 May 2018. PMID: 29719196.
Dennett, A., Tang, C., Chiu, A., Osadnik, C., Granger, C., Taylor, N., Campbell, K., Barton, C. ‘A Cancer Exercise Toolkit Developed Using Co-Design: Mixed Methods Study.’ JMIR Cancer, 8(2):e34903, 2022. cancer.jmir.org/2022/2/e34903, DOI: 10.2196/34903.