Telerehabilitation was safe, feasible and increased exercise uptake in cancer survivors: A process evaluation (Preprint)

BACKGROUND Access to exercise for cancer survivors is poor despite global recognition about its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. OBJECTIVE Following rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff and the health service with the aim of informing future program development. METHODS A mixed methods evaluation of a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referral, admissions, wait-time, attendance, physical activity and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data coded and mapped to the Proctor Model for Implementation Research. RESULTS The telerehabilitation program received 175 new referrals over 8-months. Of those eligible, 123/150 (82%) commenced. There were no major adverse events. Adherence to health coaching was high (80% scheduled sessions), but participation in online group exercise classes was low (n=36, 29%). Patients improved their self-reported physical activity levels (+110 minutes per week, IQR 90 to 401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was AUD $1,104. CONCLUSIONS Telerehabilitation is safe, feasible and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation. CLINICALTRIAL Not applicable.