Background: The Adem Crosby Centre provides holistic cancer care for patients within the Sunshine Coast, Queensland. As increasing evidence supports exercise for patients with cancer, our model of care integrates an exercise physiologist (EP) to help counteract many of the adverse physical and psychological effects of cancer and its treatment.
Aims: To describe the development and implementation of the integrated EP patient care model and pathway. To evaluate referral patterns and patients treated in the EP clinic from March 2017 to April 2018.
Development and implementation: Based on our model of care, our centre was committed to patient pre- and rehabilitation during all phases of cancer treatment. A framework was developed including referral pathways, clinical forms as well as clinic and exercise sessional templates. Business cases were developed to ensure optimal utilisation of resources. Fund-raising and grants permitted specialised equipment purchase and a dedicated gymnasium for supervised exercise. The EP service commenced with the opening of the cancer centre in April 2017.
EP patient care pathway: It is critical that patients be able to access EP services at any point during their care. Referrals are therefore accepted from physicians, nurses or any allied health provider. EP interventions include individualised exercise prescription, supervised training, pre- and rehabilitation around surgery or other therapies and are aligned with published physical activity guidelines for cancer patients. Following active treatment, ongoing care is provided by a variety of community providers who are linked with the service.
Referral patterns: Referrals primarily were generated from physicians (40.6%), cancer care coordinators (32.9%), nurses (21.9%) and allied health providers (4.6%). There was a median of 19 days between referral and clinic review. Tumour streams included: gastrointestinal (25.9%), breast (21.8%), urology (15.4%), lung (14.2%), haematological (13.7%) and other (9.0%). Most patients were undergoing active therapy at the time, with either curative or palliative-intent.
Conclusions: A defined model of care is critical to the successful development and implementation of an integrated EP service for cancer patients. Patient accessibility is enhanced by flexible referral pathways as reflected by the immediate widespread uptake and utility of the service. Future work will focus on evaluating outcomes including quality of life benefits.