Level 4 Cancer Rehabilitation
Assessment Guidance & Documentation
The key email address is Case Studies for anything associated with externally delivered courses. Please note: For extension requests or queries regarding assessments please contact Case Studies.
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Additionally, lecturing staff is not permitted to preliminary grade papers prior to submission. All communication should be made directly to the WRIGHT Foundation Office and any requests to review students' work will be declined.
Submission Dates
Case-study report: post-course written assessment.
To be completed post-course and is based on a ‘hypothetical’ client. Candidates have 12 weeks to complete this assessment and return it to the office. Pass Mark = 70%. per section.
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Task - Complete the Online Course
On Course Resources
Additional Cancer Referral Resources
Cancer Rehabilitation Exercise Scheme Health Professionals' Information
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Solihull - Cancer Rehabilitation Exercise Scheme - Link
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The GM Cancer Prehab4Cancer and recovery program - Link
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Developing High-Quality Cancer Rehabilitation Programs: A Timely Need - Link
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Cancer Rehabilitation Pathways (MacMillian) - Link
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Public Health Scotland Waiting List Times - Link
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NHS England Cancer Waiting Times - Link
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Cancer: summary of statistics (England) 2021 - Link
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British Medical Association NHS backlog data analysis (August 2022) - Link
Organisations & Qualifications Links
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Cancer Key Terms > Link
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Day 1 On Course Notes > Link​
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Human Cancer: Known Causes and Prevention by Organ Site > Link
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A Cancer Strategy for Northern Ireland 2022-2032 > Link
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Day 2 On Course Notes > Link​
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Day 2 [Section 5 & 6] - Exercise Prescription Notes > Link
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Getting ‘match fit’ before chemotherapy keeps tumors in check > Link
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Day 3 On Course Notes > Link
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Escape Pain Education > Link
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“Move it or Lose it" > Link ​
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The Stages of Grief: Accepting the Unacceptable > Link
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PowerPoint Notes
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About Cancer > Link
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Assessment and testing > Link
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Benefits of exercise in cancer prevention and rehabilitation > Link
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Co-morbidities > Link
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Exercise Programming > Link
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Exercise Programming 2 > Link
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Fundamental Physiology of the Neuromuscular > Link and Muscular System > Link
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Click the image to access the (ACSM 2018) textbook. [Case Study Section 5]
Click the image to access the (ACSM 2018) textbook. [Case Study Section 5]
Click the image to access (ACSM 2010)
[Case Study Section 5]
Click the image to access the textbook [Case Study Section 5]
Click the image to access textbook
Click the image to access textbook
Click the image to access
[Case Study Section 5]
Click the image to access textbook
Roscoe, C.M., Pringle, A., Chandler, C., Faghy, M.A. and Barratt, B., 2022. The Role of Physical Activity in Cancer Recovery: An Exercise Practitioner’s Perspective. International Journal of Environmental Research and Public Health, 19(6), p.3600.
Nieman, D.C., 1994. Exercise, infection, and immunity. International journal of sports medicine, 15(S 3), pp.S131-S141. [Inverted J Model]
UK Cancer Tools and Intelligence
UK Cancer Tools and Intelligence
Some of these sites will require a login which you will need to request.
Local Cancer Intelligence - LCI England is an online tool that gives visual and analytical identification of cancer information in England by the Clinical Commissioning Group (CCG) as well as some data groupings and comparisons within Cancer Alliances. > Link
Articles of Interest
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Public Health Profiles Fingertips is a large public health data collection. Data is organized into themed profiles. > Link
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Public Health Outcomes Framework The Public Health Outcomes Framework sets out a vision for public health, to improve and protect the nation's health, and to improve the health of the poorest fastest. > Link
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Tobacco Control Profiles The Local Tobacco Control Profiles for England provides a snapshot of the extent of tobacco use, tobacco-related harm, and measures being taken to reduce this harm at a local level. > Link
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Longer Lives This tool brings together a selection of mortality indicators from other PHE public health profiles, in order to make it easier to assess outcomes across a range of causes of death. > Link
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PHE data and analysis tools Data and analysis tools from across Public Health England. > Link
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Office for National Statistics Our main responsibilities are collecting, analyzing, and disseminating statistics about the UK's economy, society, and population. > Link
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Systemic Anti-Cancer Therapy (SACT) The SACT dataset collects systemic anti-cancer therapy activity from all NHS England providers. It is a mandatory collection and the world’s first comprehensive database, allowing us to understand treatment patterns and outcomes on a national scale. > Link
Task - Case Study Instructions
Case Study Summary Guidance
You MUST complete the following:
​Section 1 - Create a summary statement of your client explaining his/her medical diagnosis.
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​Section 2 - Provide additional details regarding other information from the client and/or her specialist, giving a rationale for each [minimum of 4]. You should ensure the information provides greater clarification for the case study.
​Section 3 - Which physical and psychological tests/assessments [see above resources] would you select for ALL stated conditions.? [Section 3 blank template]
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Provide a reason for your selection i.e., Berg Balance, Piper Fatigue, GAD-7, mood/diet diary, blood pressure, % body fat, VO2 etc. Additional Reading has been provided here > Link
and what methods you would apply of ensuring documentation is secured/stored/transmitted information or accessed. (GDPR/Data protection)
​Section 4 - ​ Design a proposed 12-week programme of exercise/physical activity, which is safe, appropriate and effective for your client.
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Note: This should be a minimum of a 12-week overview [Monday to Sunday] showing the progression of Frequency, Time, Type & Intensity)
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​Section 5 - Provide a detailed exercise session from your exercise programme, assuming that the client is feeling motivated for the particular session.
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Note: This should be based on the information you used for the practical assessment
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​Section 6 - Provide justification for your exercise programme regarding safety, appropriateness and effectiveness.
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​Note: This should be a minimum of 12 paragraphs, one week per paragraph
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​Section 7 - Explain what considerations you would have when ensuring the referral location (i.e., gym, etc.) is suitable for your client; ensure you consider physiological and psychosocial components.
​Section 8 - Create a detailed agreed programme for continued intervention/engagement with your client.
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Note: This may be signposting or development of other services. (Short/Medium/Long term goals of SMART and signposting support specialists, support groups)
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Step 9. Design an information/promotional leaflet about the benefits of a cancer rehabilitation exercise referral scheme. [Example 'real world' poster]
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Note: Design it so it aims at the patients and the medical professional from whom you wish to receive referrals. (A4 Leaflet, target audience AND referrers with who, how, why, what, where, when)
See the YouTube digital media above for a detailed breakdown of how to complete the practical assessment.
Additional Case Study Resources
Below is a range of resources and guidance notes that will help you to complete the case study assessment
About this Section
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NHS Medication Resource [Case Study Relevant, Section 2]
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Exercise Recommendations & Executive Summary Reports
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Components and Effects of Exercise on the Immune Handout - Link
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ACSM (2021) Guidelines for Exercise Testing and Prescription, 11th Edition: Contraindications for Starting Exercise, Stopping Exercise, and Injury Risk for Cancer Survivors [Table] - Link
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[Case Study Section 5] Campbell et al., 2019. An executive summary of reports from an international multidisciplinary roundtable on exercise and Cancer: evidence, guidelines, and implementation. Rehabilitation Oncology, 37(4), pp.144-152. Link
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[Case Study Section 5] NSCA Recommendations on Exercise & Cancer - Link
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NSCA Recommendations on Exercise & Cancer Table Only - Link
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[Case Study Section 5] Example of a RAG Progression Circuit [Red, Amber & Green] - Link
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Example Presentations/ Case Study Presentations ​
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Presentation Evidence Case Study 1 [ Example September 2021 Course] - Link
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Presentation Evidence Case Study 1 [ Example January 2022 Course] - Link
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Presentation Evidence Case Study 1 [ Example April 2022 Course] - Link
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Presentation Evidence Case Study 1 [Example November 2022 Course] - Link
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Presentation Evidence Case Study 2 [ Example September 2021 Course] - Link
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Presentation Evidence Case Study 2 [ Example January 2022 Course] - Link
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Presentation Evidence Case Study 2 [ Example April 2022 Course] - Link
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Presentation Evidence Case Study 2 [ Example August 2022 Course] - Link
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Presentation Evidence Case Study 2 [Example November 2022 Course] -Link
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Presentation Evidence Case Study 3 [ Example September 2021 Course] - Link
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Presentation Evidence Case Study 3 [ Example January 2022 Course] - Link
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Presentation Evidence Case Study 3 [ Example April 2022 Course] - Link
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Presentation Evidence Case Study 3 [Example November 2022 Course] - Link
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Presentation Evidence Case Study 4 [ Example January 2022 Course] - Link
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Presentation Evidence Case Study 4 [ Example April 2022 Course] - Link
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Mental Health and Fatigue-Related Measurements & Tools [Case Study Relevant, Section 3]
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GAD-7 [Anxiety] - Link
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About this resource - The Generalised Anxiety Disorder Assessment (GAD-7) is a seven-item instrument that is used to measure or assess the severity of generalized anxiety disorder (GAD). Each item asks the individual to rate the severity of his or her symptoms over the past two weeks. Response options include “not at all”, “several days”, “more than half the days” and “nearly every day”
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Original Study - Spitzer, R.L., Kroenke, K., Williams, J.B. and Löwe, B., 2006. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), pp.1092-1097. Link
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PHQ-9 [Depression] - Link
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About this resource - The PHQ-9 is the nine-item depression scale of the patient health questionnaire. The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV. The PHQ-9 can function as a screening tool, an aid in the diagnosis, and a symptom-tracking tool that can help track a patient's overall depression severity as well as track the improvement of specific symptoms with treatment.
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Warwick-Edinburgh Mental Well-being Scale (WEMWBS) - Link
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About this resource - WEMWBS is a 14-item scale of mental well-being covering subjective well-being and psychological functioning, in which all items are worded positively and address aspects of positive mental health. The scale is scored by summing responses to each item answered on a 1 to 5 Likert scale. The minimum scale score is 14 and the maximum is 70. WEMWBS has been validated for use in the UK with those aged 16 and above. Validation involved both student and general population samples, and focus groups.
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The Fatigue Severity Scale (FSS) - Link
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About this resource -The Fatigue Severity Scale (FSS) is designed to differentiate fatigue from clinical depression since both share some of the same symptoms. Essentially, the FSS consists of answering a short questionnaire that requires the subject to rate his or her own level of fatigue. The obvious problem with this measure is its subjectivity. Here is an example FSS questionnaire containing nine statements that attempt to explore the severity of fatigue symptoms. The subject is asked to read each statement and circle a number from 1 to 7, depending on how appropriate they felt the statement applied to them over the preceding week. A low value indicates that the statement is not very appropriate whereas a high value indicates agreement. Additional information - Link
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Multidimensional Fatigue Inventory (MFI) - Link
About this resource - The MFI is a 20-item scale designed to evaluate five dimensions of fatigue: general fatigue, physical fatigue, reduced motivation, reduced activity, and mental fatigue. By limiting the length of the questionnaire, developers hoped to accommodate those individuals who might find larger measures especially tiring while still obtaining enough detailed information to examine multiple facets of fatigue.
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Fear Avoidance Belief Questionaire - Link
About this resource - The FABQ was developed by Waddell to investigate fear-avoidance beliefs among LBP patients in the clinical setting. This survey can help predict those that have a high pain avoidance behavior. Clinically, these people may need to be supervised more than those that confront their pain.
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Physical Resources & Tools [Case Study, Section 3/ Practical Assessment Relevant]
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PARQ+ (2021) - Link
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About this resource - The PAR-Q+ is a 7-step questionnaire for use with persons of all ages. It screens for evidence of risk factors during moderate physical activity and reviews the family history and disease severity. If a person answers yes to one or more questions, the individual should complete a thorough follow-up of medical questions and consult a physician about beginning physical activity. An interactive online version for medical follow-up questions is provided by the e-PARmed-X+ (Jamnik, et al, 2011; Bredin, et al, 2013).
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The Functional Assessment of Cancer Therapy - General (FACT-G) - Link; Scoring Document - Link
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About this resource - FACT-G is a 27-item questionnaire designed to measure four domains of HRQOL in cancer patients: Physical, social, emotional, and functional well-being. Original development and validation involved 854 patients with cancer and 15 oncology specialists. An initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interviews with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 27-item FACT-General (FACT-G). Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR) and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time.
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The Functional Assessment of Cancer Therapy – General – 7 Item Version (FACT-G7) - Link; Scoring Document - Link
About this resource - FACT-G7 is a shortened, 7-item version of the FACT-G designed to quickly and effectively capture the most relevant issues to cancer patients in a valid and reliable manner. Development included oncology patients with advanced cancer from 11 disease sites who ranked the symptoms and concerns they viewed as ‘the very most important when undergoing cancer treatment and completed the FACT-G. Of the highest priority, cancer-related symptoms and concerns endorsed by patients for inclusion in the FACT-G7, fatigue, and the ability to enjoy life were ranked the most highly. The FACT-G7 can be used to rapidly assess top-rated symptoms and concerns for a broad spectrum of advanced cancers in clinical practice and research, as well as for quality reporting in cancer chemotherapy and radiation.
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Original PFS - Link The Revised Piper Fatigue Scale (PFS) Authors Original Copy -Link
User-Friendly Version - Link
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About this resource - PFS is one of the popular instruments to assess the perceived fatigue of patients with chronic diseases such as cancer. This instrument consists of 22 items and four subscales to assess multidimensional fatigue. The scale was originally developed with 42 items in 1989, and then it was revised to 22 items based on a study of women with breast cancer in 1998. The final version of the PFS consists of four dimensions of subjective fatigue, and the subscales are behavioral/severity (six items), affective meaning (five items), sensory (five items), and cognitive/mood (six items). 1) The behavioral/severity subscale consists of items related to the impact and distress on activities of daily living, 2) the affective meaning subscale consists of items related to the emotional attributes of fatigue, 3) the sensory subscale consists of items related to physical symptoms of fatigue, 4) and the cognitive/mood subscale consists of items related to mental and mood status.
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Berg Balance Test - Link
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Original Study - Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992; 83 Suppl 2:S7-11. [Abstract] - Link
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About this resource - The Berg Balance Scale (BBS) is used to objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks. It is a 14-item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function and takes approximately 20 minutes to complete. It does not include the assessment of gait.
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Tinetti POMA Test - Link
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About this resource - Tinetti's Performance-Oriented Mobility Assessment (POMA) is a commonly used clinical measure of both gait and balance that was developed specifically for use with older adults. This instrument consists of 16 items, 7 related to gait and 9 related to balance. The POMA examines step length and height, gait initiation, step symmetry and continuity, straightness of the path of travel while trying to walk in a straight line, trunk position, and base of support during the period of double support. Performance on all items is scored from 0-1 or 2 for a maximum score of 28, with a higher score indicating better gait and balance. Low scores on the instrument have been shown to correlate with fall risk in elderly adults. A total score of 19 or less indicates a high risk of falling and a score between 19 and 24 indicates a moderate risk.
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Original Study - Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for elderly patients based on a number of chronic disabilities. Am J Med 1986:80:429-434. - Link
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Various Online Calculators - Link
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1RM Estimate Calculator - Link
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RPE Chart - Link
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Talk Test Chart - Link
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Task - Complete Your Practical
Practical Assessment Submission Guidelines
See the YouTube digital media above for a detailed breakdown of how to complete the practical assessment.
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Recording Guidance
You MUST complete the following:
Plan for a 60-minute practical session for your case study client. Due to COVID, you will deliver an absolute minimum of 20 minutes of this [5-minute warm-up; 10-minute main section; and 5-minute cool-down].
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The digital media [video] should have no more than three breaks [warm-up; main component; cool-down] with the client and instructor [yourself] in view at all times during the recording.
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The sound quality must be sufficient to enable assessment (minimal noise in the background).
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Note: The session should follow the program design you have completed on the course.
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Practical Instruction Overview
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You Must demonstrate the following:
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Pre-Warm up Health & Safety - Showing the instructor [yourself]taking a client through the health and safety issues, verbal PARQ, medication check, including any comorbidity checks and concerns relating to exercise prescription.
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Warm-up - Show and explain to the client duration, mobilization, pulse raiser, stretches, or replicant movement patterns.
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Use two measures of intensity required for warm-up (RPE, Talk test, observation, heart rate reserve, heart rate maximum, or METS)
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Demonstrate/verbalize safe use of equipment, training suggestions, and health and safety advice throughout the warm-up.
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Main Section - Demonstrate/verbalize safe use of equipment.
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Demonstrate/verbalize - CV type, workload, intensity. Additionally, explain the reason for the client using this equipment or performing the movement action and where it fits with the client's goals.
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Demonstrate/verbalize -Resistance machines, free weights, bands, bodyweight exercise, reps, sets, weight, time. Additionally, explain the reason for the client using this equipment or performing the movement action and where it fits with the client's goals
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Demonstrate/verbalize - Explain the reason for the client's exercise or movement action either progressing and/or any modifications required throughout the main section.
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Cool Down - Demonstrate and explain duration, rewarm to cv cool down, structural work (stretches whether maintenance or developmental)
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Apply two measures of Intensity for the cool-down (RPE, Talk test, observation, heart rate reserve, heart rate maximum, or METS)
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Demonstrate/verbalize- safe standing to floor transitions. Highlight any concerns post-exercise.
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Please Note: All evidence or questions should be sent to the following address and NOT the Lecturers.