Abstract
Background: Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and provided practical recommendations to inform evidence-based practice, policymaking, and further investigations. Methods: Studies that recruited cancer patients, assessed the co-location of exercise services and cancer treatment units and reported findings on service implementation were included. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis. Results: Exercise service implementation was relatively modest across the included studies. These services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events. Conclusion: Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise medicine for individuals on cancer treatment. While this model appears feasible for patients/clinicians, calculated efforts are required to drive uptake. There is no one-size-fits-all approach; hence, sustainable service integration remains a product of many factors, including structures and strategies that reflect the organizational dynamics of the clinical service environment housing the exercise unit.
Service Integration of the Job Service: A Comparative Analysis of the One-stop Shop in the UK, USA, and Australia
