Early research has established the benefits of PA and exercise in pediatric oncology [5]. However, this has led to only limited translation of research to community-based PA programs, such as the PEER program [4]. Earlier work on the PEER program evaluation has determined its feasibility and safety [3]. In order to assess the effectiveness of the PEER program, an evaluation of the program’s potential benefits is necessary. Given the community-based nature of PEER, consideration of the logistics and participant characteristics (age, cancer type, cancer treatment, cognitive ability and mobility) must be taken into account. The results of the interviews, along with the scoping review, guided the current work, the development of an evaluation toolkit and algorithm for implementation within the PEER program [9]. The final evaluation toolkit and algorithm (Appendix A) have important research and clinical implications.
First, from a research perspective, development and implementation of an evaluation toolkit can aid in understanding the effectiveness of community-based PA/exercise programming in childhood cancer. The toolkit provides a “starting point” to assess the PEER participants and corroborate the effectiveness of community-based programs, such as the PEER program. This allows for the necessary adaptations to the specific goals and logistics within a specific program to be considered. Additionally, while most evaluation tools selected have been widely used and accepted in childhood cancer, some evaluation tools have yet to be reported in the literature (healthy or cancer specific populations). For example, the PLAYTools have been developed by a panel of health and exercise experts, but have yet to be reported in the literature. Thus, continued application of the PLAYTools in the PEER program, may provide feedback regarding the validity of and reliability of the tools.
From a clinical perspective, the evaluation toolkit can provide objective assessment of key patient themes that can be provided to both the health care team and the families. Given the nature of community-based programs such as PEER, this clinical feedback is both valuable and extremely important in terms of both patient themes and maintaining the ongoing value of the program. Ongoing evaluation within the PEER program specifically ensures that each participant receives an assessment tailored to their needs and that will assess potential benefits from participation. Participants, parents and their HCPs will receive feedback from the evaluation, allowing tracking of progress/improvements over time. In addition, regularly seeing the impact of the PEER program participation on their patients may facilitate referral from HCPs into the program.
Limitations
There are a few important limitations to note regarding the evaluation tools selected. First, the evaluation toolkit and algorithm were specially designed for the PEER program and may not be applicable to all community-based PA/exercise programs for childhood cancer. For example, the evaluation tools were selected in alignment with available resources at the PEER program and the goals of the program. Implementation of the toolkit to any specific program must take into account that program’s unique needs. Second, given the limited number of interviews conducted, the results may not clearly represent the views of all HCPs and PEER program participants/families. Third, the algorithm does not account for individual limitations such as osteoporosis or peripheral neuropathy, thus a trained professional is required to use discretion to ensure any individual alterations are made. The evaluation tool should be applied in a manner that provides valuable feedback to the participant/family and provides substantive evidence to the HCP with regards to the potential role of PA/exercise in pediatric oncology. Lastly, the evaluation tools were selected based on a number of criteria (psychometric properties, cost, duration and personnel required) and thus there is a challenge in selecting tools that meet all criteria. For example, the PLAYTools best suited the needs of the PEER program, but have yet to be reported in childhood cancer. While we deemed the PLAYTools suitable for use, future research on physical literacy in childhood cancer may provide a more suitable measure.
Implications of Research Findings
Despite these limitations, there are also important strengths to be noted. To date, there is nothing in the literature specifically evaluating community-based PA/exercise programs in pediatric oncology. The generated toolkit and algorithm may provide a framework for programs to utilize, thus enhancing our knowledge about the effectiveness of such programs. Lastly, consistent application of the toolkit may provide further feedback regarding the reliability and validity of the evaluation tools.