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Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm

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Abstract

Purpose

Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm.

Methods

From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format.

Results

We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains.

Conclusions

The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.

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Data availability

Not applicable.

Notes

  1. https://www.livestrong.org/what-we-do/program/livestrong-at-the-ymca

  2. Exercise self-efficacy as defined in the EXCEEDS tool is an individual’s level of confidence in their ability to perform moderate intensity exercise at least 30 minutes per day, at least three times per week, for three months.

  3. Risk stratification is “the process of quantifying the probability of a harmful effect to individuals resulting from a range of internal and external factors.”[41]

  4. Health-care need is “the capacity to benefit from health care” [41]

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Acknowledgments

We would like to thank additional members of the American Congress of Rehabilitation Medicine’s Cancer Rehabilitation Networking Group for their contributions and support.

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Authors and Affiliations

  1. ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA

    Kelley R. Covington, Tiffany D. Kendig & Mackenzi Pergolotti

  2. Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA

    Kelley R. Covington & Mackenzi Pergolotti

  3. Ivy Rehab Network, NJ, White Plains, NY, USA

    Timothy Marshall

  4. Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA

    Grace Campbell

  5. Department of Occupational Therapy, University of Pittsburgh School of Health & Rehabilitation Sciences, Pittsburgh, PA, USA

    Grace Campbell

  6. UPMC Hillman Cancer Center at UPMC Magee Women’s Hospital, Pittsburgh, PA, USA

    Grace Campbell

  7. Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Grant R. Williams

  8. Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jack B. Fu

  9. Kessler Institute of Rehabilitation, West Orange, NJ, USA

    Tiffany D. Kendig

  10. Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA

    Nancy Howe

  11. Northwell Health Cancer Institute, New York, NY, USA

    Catherine M. Alfano

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Contributions

KC and TM led the initial conceptualization and methodology. KC led all data synthesis, algorithm development, and writing. The remaining authors served as the expert panel and participated in multiple rounds of analysis and synthesis for algorithm development. All authors reviewed and edited each draft of the manuscript.

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Correspondence to Kelley R. Covington.

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Conflict of interest

Authors Pergolotti, Covington, and Kendig received salaries from Select Medical. Author Williams is supported in part by the National Cancer Institute of the National Institutes of Health (K08CA234225 - GRW). 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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Covington, K.R., Marshall, T., Campbell, G. et al. Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. Support Care Cancer 29, 6469–6480 (2021). https://doi.org/10.1007/s00520-021-06208-7

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