Background: The incidence of cancer is increasing worldwide. Cancer and its treatments negatively affect patients’ physical condition, contributing to functional decline and frailty. Physical activity (PA) has demonstrated numerous benefits in counteracting these adverse effects, at all stages of the disease, with earlier initiation being associated with greater benefits. However, most patients with cancer do not meet the World Health Organization (WHO) recommendations for PA. Integrating PA programs into the cancer care pathway therefore appears essential to help patients reach these recommendations and benefit. Despite strong evidence supporting PA in oncology, its integration into routine cancer care remains heterogeneous across oncology centers in France, highlighting a gap between research evidence and clinical practice. Identifying multilevel determinants of PA integration and the strategies used to address them is essential to optimize implementation of PA programs in oncology.
Objectives: This study aimed to identify the determinants and strategies of PA integration across different French hospital organizations providing cancer care, across different levels of PA integration maturity.
Methods: Semi-structured interviews were conducted with professionals directly or indirectly involved in the cancer care pathway and in the development of PA, from centers both offering and not offering PA programs. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) frameworks.
Results: A total of 22 semi-structured interviews were conducted. Three levels of maturity in PA integration were identified: PA promotion (n=2); an emerging form of PA integration (n=6); and multiple well-developed, coordinated PA programs (n=4). Professionals interviewed held different roles in PA integration, including high-level leaders (n = 1), mid-level leaders (n = 3), opinion leaders (n=5), implementation leads (n = 4), implementation team members (n = 4), and PA program deliverers (n = 5).
A key PA integration is the knowledge, motivation, and engagement of mid-level leaders and opinion leaders, which contributes to a culture supportive of PA within services. Strategies to support this determinant included identifying and preparing champions, conducting educational meetings, and providing ongoing training. The capacity to access financial resources also emerged as a key determinant. To access new funding, some centers implemented day hospital initiatives or research projects, which not only supported program development but also generated evidence of innovation. This evidence, in turn, helped engage leaders and reinforce institutional commitment to PA integration.
The integration of PA into the care pathway depends on interprofessional coordination, facilitated by the establishment of multidisciplinary teams. Adaptability was identified as a key factor, with the flexibility of PA programs and the expertise of exercise professionals enabling interventions to be tailored to patients’ capacities and care pathways. Human, time, and physical space resources were key determinants of PA integration, addressed through strategies such as allocating dedicated staff, protected time, and adapted spaces.
Conclusions/Implications: These findings highlight the key determinants and strategies for integrating PA into cancer care pathways and provide guidance for implementing PA programs in hospital settings thereby facilitating the translation of research into practice.