One step forward, two steps back: a qualitative study of clinical perspectives on implementing exercise in neuro-oncology care.

BACKGROUND: Neuro-oncology care lacks an exercise referral pathway and tailored exercise programming. The Alberta Cancer Exercise-Neuro-Oncology (i.e., ACE-Neuro) study was implemented and evaluated for feasibility and effectiveness to address this lack of resources. The purpose of the present study was to understand healthcare provider, exercise specialist, and cancer care administrator perspectives on the role of exercise in neuro-oncology. METHODS: A qualitative study design using interpretive description was conducted. Clinical team members involved in the referral to and delivery of ACE-Neuro were invited for a semi-structured interview. Interviews were scheduled either in-person or remotely. Analysis was conducted by a transdisciplinary team including collaboration with a neuro-oncology clinical partner. RESULTS: A total of n = 10 clinical team members participated. Mean interview length was 35:44 ± 17.49 min. Three themes were created during analyses: (1) The Gateway: Optimizing Exercise Referral in Neuro-Oncology, (2) The Building Blocks: Championing a Tailored Neuro-Oncology Exercise Model, and (3) Beyond the Short-Term: Neuro-Oncology Needs a Stronger Voice in Funding and Policy. These themes highlight that the clinical team perceived an electronic medical record referral pathway as feasible, tailored exercise is non-negotiable for neuro-oncology patients, and funding and policy were identified as major barriers to sustainable exercise programming. CONCLUSION: This study offers new insights into how exercise is implemented within neuro-oncology care from the clinical perspective. A systematic focus on optimizing referral pathways, championing the delivery of personalized programming, and bridging policy and system-level strategies for long-term program sustainability are key to advancing the field of neuro-oncology. IMPLICATIONS FOR CANCER SURVIVORS: From the perspective of clinicians, integrating exercise into routine neuro-oncology care requires methodical referral pathways and tailored exercise program delivery. Clinicians also believe that long-term sustainability will require administrative and policy support to ensure access to supportive care resources for those living with brain cancer. These implementation strategies have the potential to improve patient access to evidence-based and individualized neuro-oncology exercise resources. CLINICAL TRIALS REGISTRATION: NCT04831190 ( https://clinicaltrials.gov/study/NCT04831190 ).