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Australian cancer survivors can access exercise as ‘standard of care’

Note: This post is written by the team of The ONE Group (Oncology – Nutrition – Exercise) at Penn State College of Medicine as part of a first-person blog about their work. Learn more about the group here.

G’day mates! I’m Dr. David Mizrahi from Australia, a Fulbright Postdoctoral Researcher visiting the U.S. for three months from The Daffodil Centre at The University of Sydney. I’m based at St. Jude Children’s Research Hospital in Memphis and am honored to visit Dr. Kathryn Schmitz and the ONE team in Pennsylvania during my travels. My research focuses on physical activity in adult and childhood cancer survivors. I also have a strong interest advocating to embed exercise-medicine into standard of care for cancer survivors in my role as the Chair of the Clinical Oncology Society of Australia (COSA) Exercise and Cancer Committee.

In this blog post, I will highlight the current landscape for ‘exercise-oncology’ in Australia, and discuss potential for integrating exercise into routine cancer care. I believe that Australia’s public health system is one of the leading countries to clinically deliver exercise-medicine for cancer survivors, and many other countries would benefit by replicating our system.

To begin, Australia’s public health system, called Medicare, offers a range of free/subsided services to all residents, without need for private insurance. If you break your leg, or are diagnosed with cancer, you’d likely receive treatment under Medicare without needing to pay. I’ll come back to this in a moment.

Now let’s discuss the role of exercise physiologists in the public health setting, which we term Accredited Exercise Physiologists (AEPs). In Australia, you can become an AEP by completing a University course, normally 4 years and includes 500 hours of clinical placements. Once AEPs become accredited with Exercise and Sport Science Australia (ESSA), they can then deliver rebatable services to people with all different types of chronic conditions, including cancer. Since 2006, there are a range of completely or partially subsidized initiatives where exercise services can be accessed by the community. These include:

  • Medicare: All Australians with a chronic disease can receive five subsidized sessions per year with an AEP, which needs to be activated by a Primary Care Physician (PCP). Typically, these are spaced out over 8-12 weeks, and can help survivors get active with the aim to transition to self-management. These sessions split across other allied health professionals including physiotherapists and dietitians. All cancer survivors will be eligible for this. People with diabetes can receive an additional eight sessions annually. Telehealth/video sessions and home-visits have been added under this scheme, meaning regional patients or patients with difficulty commuting can receive these services. Medicare by far has the largest potential to embed exercise-medicine into cancer care. However, there currently is a disconnect between cancer centres, PCPs and community AEPs, with services not yet embedded (although usage is rising). This presents a huge opportunity to implement referral pathways between these health providers and allow survivors to receive tailored exercise-medicine interventions as part of their management.
  • Private insurance: Many extras plans from the majority of private insurance companies will include AEP services, which can be accessed in addition to the five Medicare sessions.
  • Department of Veteran Affairs: Defense force veterans can receive an addition 12 sessions with an AEP.
  • AEPs in hospital settings: There are currently a small number, but rising, of AEPs in working Australian hospital (around 110). Of this, there are 12 AEPs that work uniquely in cancer centres, meaning that patients have access to this specialized service, while another 18 AEPs see cancer survivors in addition to other chronic conditions as part of their role. Embedding more AEPs into treating cancer centres is a critical step in getting cancer survivors more active throughout treatment, and can assist in transitioning them to community AEPs in survivorship.

We have made a great start including:

  • The public health funding initiatives
  • The endorsement for exercise from our peak oncology organization COSA
  • Some AEPs in cancer centres
  • Increasing number of community AEPs with cancer experience

Our next steps to truly embed exercise-medicine into cancer care include:

  • Achieving top-down support for exercise from the treating clinical teams
  • Establishing referral pathways between cancer centers and community AEPs
  • Appointing more AEPs in cancer centers
  • Increasing the number of Medicare sessions/year for cancer survivors (at least equivalent to the additional eight sessions that diabetic patients receive)
  • Establishing national partnerships between cancer centers  and universities to conduct larger exercise-oncology studies.

One way or another, we will work toward embedding exercise-medicine into cancer care, and improve the lives of those affected by cancer.

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