Background: Current guidelines endorse the integration of exercise into cancer care. The diagnosis of cancer and its treatment, however, may introduce factors that make exercise engagement difficult, especially for individuals with advanced stages of disease. In this paper, we describe the baseline screening and triage process implemented for the Alberta Cancer Exercise (ACE) hybrid effectiveness-implementation study and share findings that highlight the multifaceted complexity of the process and the direct role of the clinical exercise physiologist (CEP). Methods: ACE was a hybrid effectiveness-implementation study examining the benefit of 12-week cancer-specific community-based exercise program. The ACE screening process was developed by integrating evidence-based guidelines with oncology rehabilitation expertise to ensure safe and standardized participation across cancer populations. The screening process involved four steps: (1) a pre-screen for high-risk cancers, (2) completion of a cancer-specific intake form and the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), (3) a CEP-led interview to further evaluate cancer status, cancer-related symptoms and other health issues (performed in-person or by phone), and (4) a baseline fitness assessment that included measurement of vital signs. Results: A total of 2596 individuals registered and underwent prescreening for ACE with 2570 (86.6%) consenting to participate. After full screening including the baseline fitness testing, 209 participants (8.1%) were identified as requiring further medical clearance. Of these, 191 (91.4%) had either a high-risk cancer, metastatic disease or were in the palliative end-stage of cancer, and 161 (84.3%) reported cancer-related symptoms potentially affecting their ability to exercise. In total, 806 (31.4%) participants were triaged to CEP-supervised in-person programming, 1754 (68.2%) participants to ACE community programming, and 8 (0.3%) specifically to virtual programming (post-COVID-19 option). Conclusions: The findings highlight the complexity and challenges of the screening and triage process, and the value of a highly trained CEP-led iterative approach that included the application of clinical reasoning.
背景：当前指南支持将运动纳入癌症治疗。然而，癌症诊断及其治疗可能带来阻碍患者参与运动的因素，尤其对于晚期癌症患者。本文描述了阿尔伯塔癌症运动（ACE）混合效果-实施研究中实施的基线筛查与分流流程，并分享了凸显该流程多层面复杂性及临床运动生理学家（CEP）直接作用的研究结果。方法：ACE是一项混合效果-实施研究，旨在检验为期12周、针对癌症患者的社区运动项目的效益。该筛查流程整合了循证指南与肿瘤康复专业知识，以确保不同癌症人群参与的安全性与标准化。筛查流程包含四个步骤：（1）高危癌症预筛查；（2）完成癌症专用登记表及全民运动准备问卷（PAR-Q+）；（3）由CEP主导的访谈，进一步评估癌症状态、癌症相关症状及其他健康问题（面对面或电话进行）；（4）包含生命体征测量的基线体能评估。结果：共有2596人注册并接受ACE预筛查，其中2570人（86.6%）同意参与研究。经过包含基线体能测试的完整筛查后，209名参与者（8.1%）被确认需要进一步医疗许可。其中191人（91.4%）患有高危癌症、转移性疾病或处于癌症终末期姑息治疗阶段，161人（84.3%）报告存在可能影响运动能力的癌症相关症状。最终，806名参与者（31.4%）被分流至CEP监督的现场项目，1754名参与者（68.2%）进入ACE社区项目，8名参与者（0.3%）被特别安排至虚拟项目（COVID-19疫情后的可选方案）。结论：研究结果揭示了筛查与分流流程的复杂性与挑战性，同时凸显了由训练有素的CEP主导、包含临床推理应用的迭代方法的重要价值。
肿瘤(癌症)患者之家