Implementing exercise in cancer care: study protocol to evaluate a community-based exercise program for people with cancer

Background Clinical research has established the efficacy of exercise in reducing treatment-related side-effects and increasing wellbeing in people with cancer. Major oncology organisations have identified the importance of incorporating exercise in comprehensive cancer care but information regarding effective approaches to translating evidence into practice is lacking. This paper describes the implementation of a community-based exercise program for people with cancer and the protocol for program evaluation. Methods/Design The Life Now Exercise program is a community-based exercise intervention designed to mitigate and rehabilitate the adverse effects of cancer and its treatment and improve physical and psychosocial wellbeing in people with cancer. Involvement in the program is open to people with any diagnosis of cancer who are currently receiving treatment or within 2 years of completing treatment. The 3-month intervention consists of twice weekly group-based exercise sessions administered in community exercise clinics under the supervision of exercise physiologists trained to deliver the program. Evaluation of the program involves measures of uptake, safety, adherence and effectiveness (including cost effectiveness) as assessed at the completion of the program and 6 months follow-up. Discussion To bridge the gap between research and practice, the Life Now Exercise program was designed and implemented to provide people with cancer access to evidence-based exercise medicine. The framework for program implementation and evaluation offers insight into the development of feasible, generalizable and sustainable supportive care services involving exercise. Community-based exercise programs specifically designed for people with cancer are necessary to facilitate adherence to international guidelines advising patients to participate in high-quality exercise

Optimising the expansion of the national bowel cancer screening program - influencing the national policy agenda

Background and Context: The National Bowel Cancer Screening Program (NBCSP) has experienced a long and drawn-out expansion. Commenced in 2006, it invited just two age groups, those turning 55 and 65 years. Through the years, various commitments and extensions have been made. Finally, in the 2012–13 Budget, the Federal Government made an on-going commitment and agreed to fully implement biennial screening for 50–74 year-olds. While this commitment was welcomed, concerns were raised over the lengthy implementation time-line (2034) which could have serious implications on bowel cancer Aim: To estimate the impact and compare various expansion scenarios of the (NBSCP) in terms of bowel cancer deaths prevented due to early identification and prevention of bowel cancer. Strategy/Tactics: Using a well-established, validated computer simulation model for bowel cancer screening (MISCAN-Colon), adjusted to reflect the Australian situation, five implementation scenarios were developed and modelled. Their impact on bowel cancer mortality was compared. This is the first time Australian data has been used in internationally recognised cancer modelling software, allowing researchers to quantify the number of deaths prevented as a result of various screening scenarios for bowel cancer and enabling a comparison between the current adhoc screening program and the various simulated scenarios.Programme/Policy Process: The preliminary results of the modelling were made available for the Cancer Council Australia's election manifesto in July 2013. During the 2013 election campaign, the Shadow Health Minister, using information provided in the manifesto, announced that under a coalition government the NBCSP would be fully implemented by 2020. This commitment is expected to be translated into policy in the near future. Outcomes/What was Learned: Our results provided a strong argument to act with immediacy. The importance of relevant and timely evidence-based research to advocate for changes to public policy cannot be underestimated

Translating research into practice: outcomes from the Healthy Living after Cancer partnership project

Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program.In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6\ua0months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata.Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p

“Undressing” distress among cancer patients living in urban, regional, and remote locations in Western Australia

Purpose: People diagnosed with cancer from rural and remote locations may experience heightened distress because of distance from cancer treatment and support services. We examined whether remoteness and other factors are associated with psychosocial distress and explored commonly reported problems among cancer patients in Western Australia (WA). Methods: In a cross-sectional study, cancer patients newly referred to a Cancer Council WA Cancer Support Coordinator (CSC) were screened and assessed using the Distress Thermometer (DT) and Problem List (PL) and a standardized form, respectively. The index of remoteness was the Australian Standard Geographical Classification. The association between remoteness, demographic variables, and the frequency of problems endorsed on the PL was analyzed using bivariate analyses and a generalized linear mixed model (GLMM) regression. Results: Of 1032 patients referred to a CSC, 466 were screened (45.2 %) with complete data available for 441 patients. Patients from remote areas reported fewer problems than patients from urban and regional locations. Increasing remoteness was not associated with higher distress (r = -0.04, p = 0.43). Concerns reported differed by remoteness category and included worry, sadness, fears, finances, transportation, and physical symptoms. More emotional problems were independently associated with higher distress (ß = 0.47, p < 0.001), explaining 17.31 % of the variance. Conclusions: There is no evidence that increasing remoteness is associated with higher distress. Emotional concerns and physical problems appear to be prevalent among cancer patients irrespective of urban or rural location. Specific concerns detected by distress screening, particularly emotional concerns, may warrant further assessment and targeted referrals