An evidence-based intervention (“Fit for Treatment”) to prevent cancer treatment-induced toxicities in cancer patients: An effectiveness-implementation hybrid study

This study involves two components. The first, an interventional study which will compare the effects of a 12-week exercise intervention to usual care in individuals with cancer undertaking treatment. The second, a situational appraisal of this exercise intervention. 1. Exercise Intervention The intervention will be a structured and individualised 12-week exercise program with the following components: 1) Participants will aim to complete 36 exercise sessions during this 12-week period (averaging 3 exercise sessions per week). If participants are unable to reach the target 36 sessions during these 12 weeks (i.e. they miss sessions due to excess treatment-related side effects), then they will be provided with the option of performing make-up sessions during this 12-week period (i.e. a participant may complete 2 sessions one week, then 4 sessions the following week). Alternatively, participants will be provided with the option of completing as many of the remaining sessions as possible during one additional week, making the intervention 13 weeks in duration (at most) for these participants. 2) For twelve (or thirteen) weeks, an accredited exercise physiologist (AEP) will directly supervise three hour-long gym-based sessions per week at the School of Human Movement and Nutrition Sciences gymnasium, UQ Healthy Living Clinic, Princess Alexandra Hospital, or an accredited exercise physiology clinic. 3) After six weeks, participants will then be given the option to be provided prescription for one of these three sessions as a self-managed home session, from weeks 7-12(13). 4) The AEP will individually tailor exercises for patients whose arm movement is restricted as a result of prior surgery and individualised to enhance neuromuscular strength, endurance, balance, cardiorespiratory fitness and flexibility. The AEP will be cognisant of neutropenic risks (e.g. no swimming will be prescribed for those on chemotherapy). 5) High-intensity aerobic exercise will be prescribed during the intervention, individualised to the participants’ cardiorespiratory fitness and closely monitored by the AEP. 6) If participants decide to, and are deemed capable of, completing the second exercise session unsupervised at home from weeks 7-12(13) of the intervention, exercise maintenance strategies will be utilised to enhance adherence to the home-based exercise program. 2. Situational Appraisal Princess Alexandra Hospital and Wesley Hospital clinicians (oncology nurses, physiotherapists, medical oncologists and service managers) and intervention participants will be invited to attend focus groups. Participants will be required to attend one of two focus groups, lasting no longer than 90 minutes in duration. Participants will be asked questions regarding resource utilisation, the knowledge and skills needed to implement the intervention, as well as cultural and structure barriers and facilitators.