The benefits of multidisciplinary involvement in an exercise referral service; early detection of the consequences of cancer treatment

Purpose

Active Against Cancer is a unique health and wellbeing service with exercise at its core. The service delivers prehabilitation, in treatment and rehabilitation group exercise classes to patients, who attend 2 to 3 times a week and are assessed regularly throughout. Consequently, service staff are well placed to identify, in some cases treat and in some cases signpost patients experiencing any consequences of cancer or cancer treatment, to the appropriate service or specialist. The aim of this study is to demonstrate the impact of 1) embedding a service of this kind providing a framework for regular and early patient contact and 2) having a cancer specialist physiotherapist as part of the multidisciplinary delivery team.

Approach

All patients have a 1:1 assessment on entering the service. Patients attend exercise classes weekly and can access specialist physiotherapy assessment/treatments at anytime. Patients that attend AAC are from a general population demographic. A questionnaire was designed and approved by the quality assurance team. This was distributed to all patients who had received treatment from the physiotherapist including scar therapy, MSK advice/treatment and lymphoedema taping. Patients were asked to complete the questionnaire confidentially and include comments. Patient notes were also used to assess the effectiveness of treatment comparing pre and post treatment objective and subjective measurements including ROM, function and arm measurements in the case of lymphoedema.

Outcomes

Results: To date 400 patients have been assessed on entering the service. Of those 17 patients had issues that required further input. 1 patient was referred directly from a physiotherapist for scar therapy, 4 patients self referred after experiencing musculoskeletal problems and 8 patients were identified on initial assessment for scar therapy due to loss of function and/or pain. Of those 8, one patient went on to be diagnosed with early stage lymphoedema as identified by the cancer specialist physiotherapist. An additional one patient was also identified and referred early for lymphoedema assessment. The questionnaires state all patients were very satisfied with the effectiveness of the treatment they received, their ability to do everyday tasks and general mobility of the affected limb.

Conclusion(s): The presence of a cancer specialist physiotherapist within a cancer exercise referral gives the patients a more in depth assessment and more timely access to specialist advice and treatment through regular contact. This helps to improve their function to carry out their daily tasks with less limitation and improve their levels of fitness through attending exercise classes. This improves recovery outcomes, reduces treatment burden and risk of recurrence. Suggestions for future work would be to continue this project increasing numbers over a longer period of time and measure the impact on other services – does it lessen the burden?

Cost and savings

No further information. 

Implications

The potential impact of this shared activity is to demonstrate the role of a cancer specialist in a service of this kind and the need for this service which positively impacts patient outcomes through timely response. A holistic approach to patient care within an exercise service helps to address concerns, enhance well being and signpost patients to appropriate services.

Top three learning points

No further information. 

Funding acknowledgements

Not funded. 

Additional notes

www.activeagainstcancer.org.uk (service website) NHS England » Winners of the NHS Parliamentary Awards 2020 (highly commended at NHS Parliamentary Awards 2021)

Attachment