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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.

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Brittany Unthank, Lynne Laurence Brophy, Lindsey Radcliff, Heidi Basinger, and Sabrenna Bourque

Background: Scalp cooling is a useful technique for decreasing hair loss and reducing the stigma patients feel when they experience alopecia. It was used for a period of time in the U.S. more than 20 years ago and then was removed from the market while use continued in Europe. Recently, better equipment has been developed and approved by the FDA for use with patients who have solid tumors. Current evidence supports this technology and will be summarized in this presentation. Discussion: Setting up scalp cooling as an offered service at any setting presents many challenges and changes in workflow affecting physicians and nursing staff. The purpose of this presentation is to prepare oncology providers who wish to implement scalp cooling using a machine based system at their setting. Our implementation process will be used as a teaching case study. Product support, logistics, patient satisfaction, equipment, and education needs will be discussed. This project description will highlight the steps taken to implement scalp cooling at a comprehensive cancer center for breast and gynecology oncology patients. Initial efforts to review the literature, investigate equipment choices, and compare use with other centers will be reviewed. The management aspects of setting up a new service, eg, business plan, physical plan considerations, informed consent, costs, staffing, workflow, clinic schedules, safety, and staff education will be shared. Important tips for keeping patients safe and comfortable while achieving maximum therapeutic benefit will be discussed. Evaluation will be presented in the form of lessons learned during implementation resulting in more efficient work flow and greater patient comfort during scalp cooling. Patient satisfaction data will be disseminated. Conclusion: The oncology community is eager to provide patients with scalp cooling, but no literature to date has described the management aspects of implementation. This presentation will offer comprehensive information to assist in addressing anticipated needs when initiating scalp cooling.