Feasibility of implementing an exercise intervention in older adults with hematologic malignancy
Introduction
Hematological malignances (HM) affect a disproportionate number of older adults (≥65 years) and account for an estimated 178,500 new cases and 56,840 estimated deaths in the United States in 2020 [1]. Survival probability of older adults with HM is dependent upon patient and disease characteristics with highly variable treatment modalities. Notably, maintaining quality of life (QoL) and functional status while receiving treatment is an important metric in recovery from both diagnosis and treatment toxicities.
Interventions for disease management and physical functioning in vulnerable older adults with HM are limited. Older adults with HM are vulnerable to functional decline and physical deconditioning due to both disease and treatment resulting in organ impairment and/or malignancy-induced cachexia [2]. In adults with HM, exercise increases cardiorespiratory fitness, muscle strength, and physical well-being, and reduces fatigue and depression [[3], [4], [5]]. Older adults who are long-term cancer survivors especially benefit from exercise to reduce functional decline and improve QoL [6]. However, exercise interventions have logistical challenges and identifying implementation barriers can facilitate dissemination of exercise programs across oncology centers
The Otago Exercise Program (OEP) is an evidence-based, individually tailored strength and balance training program designed to be carried out by physical therapists and includes prescribed in-person and home-based exercise [7]. The OEP has been found to be an effective exercise regimen to improve functional balance and muscle strength, and prevent fall-related injury and mortality [[8], [9], [10]]. OEP has been implemented among a diverse groups of older adults, including community-dwelling older adults with chronic diseases [[11], [12], [13], [14]] and residents in assisted living facilities [15]. Despite its record of effectiveness in a variety of older adults, the OEP has not been implemented among older cancer populations. We aimed to implement an exercise intervention for a higher risk population, identifying patients who are older, at risk for functional impairment, and actively receiving treatment for HM. Here we report the feasibility (recruitment and retention), acceptability (OEP implementation) and preliminary outcomes (e.g., self-efficacy and motivation) of implementing a structured exercise program for older adults with HM.
Section snippets
Recruitment
Potential participants were recruited from the hematology clinics at The Ohio State University Comprehensive Cancer Center. Patients who did not enroll in the OEP program were asked to complete a non-enrollment survey. The survey was abstracted [16] to identify protocol-related barriers, patient-related barriers, and physician/provider-related barriers (Supplement). Complete enrollment criteria are previously described [17]. The Institutional Review Board at The Ohio State University approved
Results
Sixty-three patients were approached from August 2016 to January 2018; 18 patients declined to participate and 45 consented to enrollment. A declined-enrollment survey was utilized to identify obstacles for abstained enrollment including protocol-related barriers, patient-related barriers and physician-related barriers. Obstacles to trial enrollment included transportation/travel concerns (n = 15), followed by uncertainty about exercise (n = 5), cost to insurance (n = 4), lack of support (n
Discussion
The study sought to examine the feasibility (recruitment and retention), acceptability (OEP implementation) and preliminary outcomes (e.g., self-efficacy and motivation) of implementing a structured exercise program among high-risk older adults with HMs. Our analysis identifies that in-person, PT-led OEP intervention (79% adherence), where patients met with a therapist regularly, had higher adhearance than the patient at-home, independent exercise portion of the program (66.7% adherence).
Conclusion
Implementing the OEP in older adults with HM has logistical challenges, yet our data suggest that participants found the OEP and exercise, in general, important and relevant during their treatment High satisfaction ratings with acceptable adherence rates indicate that the OEP is a well-accepted and enjoyable strategy to intervene on the physical function of older adults with HM undergoing therapy. Examination into long-term adherence is warranted to identify if adherence to physical activity
Funding
Dr. Rosko reports grants from NCI K23 Award, during the conduct of the study; other from accc, outside the submitted work; Dr. Presley reports other from consulting Onclive, other from Pontentia, consulting from Yale University, outside the submitted work.
Author contribution
A.R. Y.H. M.N. Designed research; A.R. D.J. R.O Enrollment of patients, A.R. Y.H. J.J. J.K-S. analyzed data; A.R. Y.H. D.J.C·P R.O. M.N. J.K-S. wrote, revised and edited the manuscript.
Support
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under the Award Number UG1CA189823 (Alliance for Clinical Trials in Oncology NCORP Grant), K23 CA208010-01 (PI Rosko), and UG1CA233331. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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