First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. EXCEL Exercise-Oncology Program
2.4. RE-AIM Outcomes
2.4.1. Reach
2.4.2. Adoption
Healthcare Provider Network
Qualified Exercise Professional Network
2.4.3. Implementation
2.5. Analysis
3. Results
3.1. Reach
3.1.1. Participant Demographics and Clinical Characteristics
3.1.2. EXCEL Study Enrolment, Study Refusal, Referral Type, and Referral Resources
3.2. Adoption
3.2.1. Healthcare Provider Network
3.2.2. Qualified Exercise Professional Network
3.3. Implementation
4. Discussion
4.1. Reach and Adoption
4.2. Implementation
4.3. Future Directions: EXCEL Implementation Strategies
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Participants (n = 236) |
---|---|
Age (years) † | 57.3 (12.5) |
Location | |
Rural/Remote | 199 (84.3) |
Urban | 37 (15.7) |
Sex | |
Female | 192 (82.1) |
Male | 42 (17.9) |
Ancestral Ethnicity | |
Aboriginal | 4 (1.7) |
Asian | 14 (5.9) |
British | 81 (34.3) |
Caribbean | 1 (0.4) |
European | 72 (30.5) |
Latin/Central and South America | 6 (2.5) |
Multi-ethnic | 38 (16.1) |
No information provided | 20 (8.5) |
Education | |
High school or less | 25 (10.7) |
More than high school | 209 (89.3) |
Employment Status | |
Full Time | 41 (17.5) |
Part Time | 31 (13.2) |
Retired | 85 (36.3) |
Homemaker | 8 (3.4) |
Disability | 56 (23.9) |
Temporarily Unemployed | 13 (5.6) |
Marital Status | |
Not Married | 55 (23.5) |
Married | 152 (65.0) |
Common Law | 27 (11.5) |
Cancer Type | |
Breast | 126 (53.4) |
Lung | 20 (8.5) |
Hematologic | 19 (8.1) |
Gynecological | 16 (6.8) |
Prostate | 16 (6.8) |
Skin | 6 (2.5) |
Brain | 6 (2.5) |
Colon | 6 (2.5) |
Head and Neck | 5 (2.1) |
Other ‡ | 16 (6.8) |
Advanced Cancer | |
Yes | 64 (27.4) |
No | 170 (72.6) |
Treatment Status | |
On | 128 (54.7) |
Off | 106 (45.3) |
Treatment Type for participants ‘On’ treatment | |
Chemotherapy | 33 (26.2) |
Radiation | 5 (4.0) |
Hormone Therapy | 52 (41.3) |
Combination * | 16 (12.7) |
Other ** | 20 (15.9) |
Variable (n, % of Year One Total) | Alberta | Nova Scotia | Ontario | Year One Total |
---|---|---|---|---|
Reach (n, % of Year one total) | ||||
Enrolled Participants | 113 | 60 | 63 | 236 |
Direct HCP Referral | 0 | 18 | 2 | 20 (8.5%) |
Indirect HCP Referral | 33 | 2 | 2 | 37 (15.7%) |
Self-Referral | 80 | 40 | 59 | 179 (75.8%) |
Adoption—QEP Network (n) | ||||
Fitness Professional Partnerships | 13 | 7 | 12 | 32 |
Health and Wellness Organizations | 4 | 6 | 9 | 19 |
Individual QEPs | 9 | 1 | 3 | 13 |
Trained QEPs | 17 | 12 | 16 | 45 |
QEPs Delivering EXCEL Classes | 9 | 6 | 7 | 22 |
Implementation (n or %) | ||||
Exercise Intervention Adherence | 76.7% | 82.3% | 77.0% | 78.2% |
Fitness-Assessment Completion | ||||
Baseline | 100.0% | 93.3% | 100.0% | 98.3% |
12-week | 92.0% | 90.0% | 85.7% | 89.8% |
Patient-Reported Outcome Completion | ||||
Baseline | 99.1% | 96.7% | 92.1% | 96.6% |
12-week | 92.0% | 90.0% | 77.8% | 87.7% |
Exercise Classes Implemented | 16 | 14 | 7 | 37 |
Referral Resource Descriptions | Number of Times Resources Were Indicated |
---|---|
Word of Mouth (57.7%) | |
Friend or Family Member | 3 |
Previous or Current Participant | 21 |
Support Group | 34 |
Health and Wellness Organizations and Programs | 77 |
EXCEL Team Outreach (20.1%) | |
Online Presentations | 1 |
Social Media or Websites | 19 |
Study Staff | 27 |
Healthcare Provider (18.8%) | |
Social Worker | 1 |
Lymphedema Specialist | 1 |
HCP provided brochure in clinic | 3 |
Patient Navigator | 3 |
Care Coordinator | 3 |
Primary Care Network | 5 |
Oncologist | 12 |
Nurse | 16 |
Print Materials (3.4%) | |
Posters | 3 |
Brochures | 5 |
HCP Organizations (n = 11) | Number of Presentations (n = 14) | Hub That Provided Presentation |
---|---|---|
Cancer Centres | ||
Tom Baker Cancer Centre | 3 | Alberta |
Allan Blair Cancer Centre | 1 | Alberta |
Margery E. Yuill Cancer Centre | 1 | Alberta |
Jack Ady Cancer Centre | 1 | Alberta |
Cancer Care Organizations | ||
Nova Scotia Health (Medical Oncology) | 1 | Nova Scotia |
Nova Scotia Cancer Care Clinic | 1 | Nova Scotia |
Canadian Association of General Practitioners in Oncology | 1 | Nova Scotia |
Canadian Association of Psychosocial Oncology | 1 | Alberta |
Cancer Care Ontario | 1 | Ontario |
Non-Profit Organizations | ||
Exercise is Medicine | 2 | Alberta |
Inpower | 1 | Alberta |
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Wagoner, C.W.; Dreger, J.; Keats, M.R.; Santa Mina, D.; McNeely, M.L.; Cuthbert, C.; Capozzi, L.C.; Francis, G.J.; Trinh, L.; Sibley, D.; et al. First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources. Int. J. Environ. Res. Public Health 2023, 20, 1930. https://doi.org/10.3390/ijerph20031930
Wagoner CW, Dreger J, Keats MR, Santa Mina D, McNeely ML, Cuthbert C, Capozzi LC, Francis GJ, Trinh L, Sibley D, et al. First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources. International Journal of Environmental Research and Public Health. 2023; 20(3):1930. https://doi.org/10.3390/ijerph20031930
Chicago/Turabian StyleWagoner, Chad W., Julianna Dreger, Melanie R. Keats, Daniel Santa Mina, Margaret L. McNeely, Colleen Cuthbert, Lauren C. Capozzi, George J. Francis, Linda Trinh, Daniel Sibley, and et al. 2023. "First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources" International Journal of Environmental Research and Public Health 20, no. 3: 1930. https://doi.org/10.3390/ijerph20031930
APA StyleWagoner, C. W., Dreger, J., Keats, M. R., Santa Mina, D., McNeely, M. L., Cuthbert, C., Capozzi, L. C., Francis, G. J., Trinh, L., Sibley, D., Langley, J., Chiekwe, J., Ester, M., Foucaut, A.-M., & Culos-Reed, S. N. (2023). First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources. International Journal of Environmental Research and Public Health, 20(3), 1930. https://doi.org/10.3390/ijerph20031930