Background: Clinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow. Methods: For this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed. Results: Initial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants’ performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility). Conclusions: Implementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment.

Nurse AMIE (Addressing Malignancies in Individuals Everyday) is a technology-enabled intervention developed to improve symptom self-management and quality of life in cancer patients. As the intervention was translated from earlier pilot trials for patients with metastatic breast cancer (NA-MBC) to a voice-activated version on Amazon Echo Show for women with metastatic breast cancer (NA-Echo), and finally to a rural advanced cancer population including all cancer types (NA-Rural), systematic documentation of adaptations was needed to ensure transparency and support future dissemination. To systematically describe and classify adaptations made in translating prior versions of Nurse AMIE using the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions (FRAME). A mixed-methods analysis was conducted documenting three Nurse AMIE iterations: NA-MBC, NA-Echo, and NA-Rural. Adaptations were documented from research team meeting notes, stakeholder interviews, protocol revisions, and prior trial usage data, then coded using FRAME domains. Nineteen planned adaptations were identified, all occurring during the pre-implementation phases of successive iterations. Adaptations were primarily contextual and content-related, targeting population eligibility, intervention duration, symptom assessment, interface design, and broader dissemination. Core intervention components were retained across all iterations. No training, evaluation, or fidelity-inconsistent adaptations were documented. FRAME-guided documentation revealed a coherent set of intentional, proactive adaptations that expanded Nurse AMIE's reach from metastatic breast cancer to rural adults with a broad range of advanced cancer types while preserving fidelity. Findings support informed scale-up and replication of the intervention in underserved oncology populations.

Background/Objectives: Obesity is a common comorbidity but there remains limited understanding on how higher obesity rates in rural areas may impact physical function decline and other health domains among cancer patients. This study addresses this gap by examining the association between body mass index (BMI) and physical function among a cohort of rural advanced cancer patients. Methods: This cross-sectional analysis uses baseline data from the Nurse AMIE trial (NCT04673019). Individuals were categorized as ‘normal weight’ (BMI ≤ 25 kg/m²), ‘overweight’ (BMI > 25 to 30 kg/m²), and ‘obese’ (BMI > 30 kg/m²). Objective physical function was measured by the Short Physical Performance Battery (SPPB) and subjective physical function and health domains were measured using surveys (PROMIS; SF-36). Results: Of 348 patients included, 88 (25.3%) were classified as ‘normal weight’, 107 (30.7%) as ‘overweight’, and 153 (44.0%) as ‘obese’. Average age was 64.8 years (SD = 12.2), 46% (n = 160) were female, 95% were white (n = 331), and 52% (n = 182) were Stage 4. Total SPPB scores revealed poorer functioning with higher BMI (M ± SD: BMI ≤ 25 kg/m²: 9.1 ± 2.3; BMI > 25–30 kg/m²: 8.3 ± 3.1; BMI > 30 kg/m²: 8.1 ± 2.8; p = 0.04). Similarly, scores from the SF-36 revealed subjective physical function was lower with higher BMI (BMI ≤ 25 kg/m²: 57.9 ± 29.1; BMI > 25–30 kg/m²: 53.7 ± 28.0; BMI > 30 kg/m²: 47.6 ± 27.6; p = 0.004). Participants reported lower levels of energy and greater fatigue with higher BMI (BMI ≤ 25 kg/m²: 49.8 ± 26.1; BMI > 25–30 kg/m²: 45.1 ± 24.6; BMI > 30 kg/m²: 40.7 ± 22.6; p = 0.01). Conclusions: Higher BMI is associated with poorer physical function and increased fatigue among rural advanced cancer patients, highlighting the need for supportive care related to physical function in this at-risk group.