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Karen Hock and Cari Utendorf
Cari Utendorf, Tiffany Stump, Sara Wolfe, Lynne Brophy, Jennie Gerardi, and Karen Hock
Background: Research has consistently demonstrated the benefits of exercise in the oncology patient (Blaney et al, Psychooncology 2013; Garcia and Thomson, Nutr Clin Pract 2014; Rock et al, CA Cancer J Clin 2012). Despite the benefits of exercise for cancer survivors, only 20%–30% of them will be active after cancer treatment (Rock et al, CA Cancer J Clin 2012). The known barriers to exercise in oncology are lack of patient education, lack of knowledge, fatigue, decreased motivation, and comorbidities (Blaney et al, Psychooncology 2013). Objectives: This quality initiative program between oncology rehabilitation physical therapy department and surgical oncology nursing aims to improve the quality of care provided to our patients by reducing the barriers to exercise. One main barrier for the patients is their lack of knowledge of how to begin an exercise program. This is overcome by prescribing physical therapy and designing an individualized exercise program that can be performed in their home. Secondary objectives are to determine a change in fatigue, compliance, and/or any barriers after physical therapy. Methods: Patients are identified by the breast surgical oncology team, and a referral for physical therapy is placed. A comprehensive evaluation is completed, including: past exercise preferences, 2-minute walk test, a fatigue questionnaire, and a 30-second sit to stand test, with these same outcome measures obtained at discharge. The James Exercise Program is provided via 4 1-hour sessions. A nurse from surgical oncology calls the patient, administers the fatigue questionnaire, and determines any barriers to exercise that the patient is facing at the 8- and 12-week mark. Results: The preliminary results of the program demonstrate compliance with exercise, reduction in fatigue, improvement in endurance and strength. Conclusion: This innovative quality initiative between physical therapy and surgical oncology nursing has benefitted our patients. We leverage the expertise of the physical therapists to provide personalized exercise regimens and the professional clearance/recommendation for physical therapy from oncology team, to minimize barriers to exercise in the oncology population. Limitations to this program are that some participants fail to arrive at the initial session, lack of support and resources in the participants hometown to allow adherence to the exercise program (despite all efforts to encourage the fact that the program can be completed in their own home), and the low number of participants.