A Telehealth Cancer-Related Fatigue Clinic Model for Cancer Survivors: A Pilot Randomised Controlled Trial (The T-CRF Trial)

Group 1 (The T-CRF group) Group 1 will be offered 3 x telehealth clinics (up to one-hour each) led by a trained nurse from the Cancer Council Queensland (CCQ) at week 2, week 14 and week 26 post-baseline to: 1) conduct a cancer-related fatigue (CRF) assessment; 2) provide verbal patient education on fatigue management addressing: physical activity, current symptoms and/or general coping plus a written 3-page booklet on “Fatigue and Cancer” published by Cancer Council Australia; 3) co-develop a CRF Management Plan (FMP) including SMART goals (using motivational interviewing and self-efficacy techniques); and 4) facilitate referrals (including to the hospital physiotherapist), as required. Patient participants will be provided with an emailed/mailed copy of their CRF Management Plan. The CCQ nurse will action any referrals to other health professionals agreed upon during the consultation (e.g., e.g. pharmacist, dietitian, social work, physiotherapist, occupational therapist, psychologist, psychiatrist, palliative care, GP for blood tests) including one to the intervention physiotherapist, if indicated. Where referral pathways at Princess Alexandra Hospital are not available/not appropriate, participants will be referred to community organisations or to their GP to coordinate community referrals (e.g. chronic disease management plan referral to access community dietitian). CCQ nurses will also provide 10-20min follow-up phone calls to participants at three time points between the nurse led clinics (approximately once per month) to check-in with the participant and ask about their progress and offer support. Adherence to the intervention will be monitored using clinic and phone review checklists. Patients who are referred to the hospital physiotherapist will be stratified to an exercise intervention of varying exercise intensity levels and supervision based on an adapted algorithm. This framework for clinical decision making enables personalized condition assessment, risk stratification and referral to optimal settings for exercise promotion in cancer survivors. Consideration will also be given to patient preference and availability of cancer physiotherapy resources. A thorough assessment will be conducted by the intervention physiotherapist to ensure all participants are safe to exercise. All participants referred to the Physiotherapy Cancer Exercise Classes at PAH require medical clearance from treating specialists. Contraindications to the exercise class include: unstable diabetes, unstable angina, chest discomfort and shortness of breath on low activity, uncontrolled cardiac failure, severe aortic stenosis, uncontrolled hypertension (i.e. Systole > 160 and Diastole > 90 mm Hg), acute infection/fever/ feeling unwell, resting tachycardia with or without arrhythmias, and change in clinical status (e.g. symptoms occurring at lower levels of exertion or at rest). Additional contradictions to exercise relate to weight gain with signs of fluid overload, low haemoglobin, white blood cells, platelets and blood sugar, as well as low oxygen saturation. Criteria also exists for stopping exercise and when to call for rapid response. Interventions with the physiotherapist will depend on outcomes from the initial assessment (in Physiotherapy Outpatients at PAH) and patients will either attend PAH Physiotherapy exercise interventions or be referred to a community exercise program. Face-to-face (at PAH Physiotherapy Outpatients) or telehealth individual/group exercise sessions with PAH Physiotherapists will be offered over 12 weeks (once weekly) or 6 weeks (twice weekly) and may include , for example, treadmill, exercise bike, leg press, shoulder press, bicep curls or boxing depending on individual need and available equipment (if telehealth). Group exercise allows for eight participants supervised by two physiotherapists. Attendance at supervised exercise sessions or referrals to community exercise will be recorded as a measure of adherence to the intervention.