DISCUSSION
cancer, melanoma
DISEASE PROGRESSION, TRANSIENT ISCHAEMIC ATTACK, MELANOMA, ADVERSE EVENTS, CANCER, EVENT, ADVANCED CANCER, RECRUITMENT, METASTATIC CANCER
The present study examined the feasibility, safety and preliminary efficacy of an 8‐week telehealth supervised exercise programme in patients with melanoma receiving checkpoint inhibitor therapy. The telehealth exercise intervention was feasible, tolerable and safe for patients with melanoma receiving checkpoint inhibitors. In addition, physical function measures were significantly improved while QoL was preserved despite patients undergoing checkpoint inhibitor therapy, well‐known to cause reductions in QoL.This is the first study to report on supervised telehealth exercise in advanced melanoma patients or those undertaking checkpoint inhibitor therapy. Except for the recruitment rate which was just below the target of 50%, all the feasibility outcomes indicate that telehealth exercise is a feasible and safe intervention for this patient group. The telehealth exercise intervention exceeded the pre‐determined criteria for study outcomes (>3) with a completion rate of 91%, programme attendance of 88%, median exercise compliance of 82.1% (resistance exercise) and 84.9% (aerobic exercise), and tolerance at 88%, without causing any severe or life‐threatening adverse events. While two participants self‐reported experiencing a transient ischaemic attack, neither occurred during exercise and neither participant's GP attributed the event to the intervention.It has been consistently reported that patients with advanced or metastatic cancer are under‐represented in survivorship research and services, given the complexity of their supportive care needs.Moreover, delivering exercise through telehealth is also a novel aspect of the study. A number of health‐related services have had to be changed during the COVID‐19 pandemic,Our findings on preliminary efficacy may be important given the association between cardiorespiratory fitness and muscle strength with independent living and survival in older patients and those living with cancer.Since advanced melanoma patients receiving checkpoint inhibitor therapy can have lower QoL than matched controls,The strength of the present study is that it comprised a structured multimodal design (i.e. aerobic, resistance and balance activities) for patients with advanced melanoma receiving checkpoint inhibitor therapy. In addition, the utilisation of telehealth to provide supervised exercise is particularly relevant for individuals with advanced cancer (potentially immuno‐compromised), enabling access to exercise services for patients in metropolitan, rural and remote settings. The information provided regarding exercise metrics such as attendance, exercise compliance and tolerance enables the replication of this study on a larger scale. However, some limitations are worthy of comment. Changes to hospital recruitment procedures (following COVID‐19) and disease progression among many patients with advanced melanoma made recruitment difficult; consequently, our sample size was small, and a control group was not utilised. Moreover, due to the COVID‐19 pandemic and patients advanced melanoma status, assessments were undertaken via telehealth. As a result, the learning effect within the physiological testing outcomes could not be measured without a non‐exercise control group, potentially contributing to the changes in physical function observed. Given the number of comparisons/analyses undertaken, we cannot discount that at least one of the significant findings may be due to chance. Future studies should utilise a randomised controlled design to further investigate the effects on QoL and other patient‐reported symptoms during a longer exercise intervention. Additionally, we recommend that future studies examine the effect of exercise on muscle mass/body composition during checkpoint inhibitor treatment using techniques such as dual X‐ray absorptiometry. Finally, monitoring treatment compliance/tolerance during an exercise intervention will provide important clinical insights.In conclusion, an 8‐week online telehealth exercise intervention is feasible and well tolerated by patients with melanoma receiving checkpoint inhibitor therapy with no major adverse events. Further, the intervention appeared to improve physical function in this group of patients while preserving QoL. These are important findings to inform the design of future randomised trials, which should include larger patient numbers, a usual care control group, a longer exercise intervention, and objective measures of body composition.