Healthy Living after Cancer A telephone delivered health coaching program psychosocial outcomes

Okay, good afternoon everyone my name's Liz Hing and I work at Cancer Council New South Wales I'm a health coach on the healthy living after cancer program and this is actually my first conference presentation so bear with me, with the slides

Oh, wrong way, there we go on I'm going to start with a bit of background on the project Um, healthy living after cancer is an NHMRC project, their partner organizations: the Cancer Council New South Wales, Victoria, WA, South Australia and the University of Queensland We're evaluating the integration of an evidence-based telephone delivered health coaching intervention for cancer patients, cancer survivors actually, into cancer councils 13 11 20 information and support service Come a long way sorry

The program is supported by a team of Australian and international investigators with expertise in a, variety of cancer survivorship areas and on the ground there's a number of staff that work in various cancer councils in the New South Wales, Victoria, South Australia and WA and we were supported by project coordinator Aaron in University of Queensland Now, as you can see by the red line, cancer survival rates for the majority of cancers have been steadily improving in Australia over the past decades and this trend is expected to continue So you can see that going up and you can see that the number of deaths which is the grey line is not rising and this is obviously great news Cancer survivorship however is associated with an increased risk of cancer recurrence, development of new cancers, persistent side effects you know, such as fatigue and some comorbid conditions for example, cardiovascular disease, type 2 diabetes and actually as Jane Turner said in the plenary speech, she said these patients aren't as good as new and and that's right and that's why they, they that you know why they welcomed and like a wellness focus program such as this So to improve the longer term wellbeing national cancer organizations recommend the cancer survivors engage in regular physical activity, eat a healthy diet, keep their weight within a healthy range and although cancer survivors actually do express a strong desire you know, to do this and to make these lifestyle changes, many do struggle without support and advice

So there's also a large body of evidence supporting healthy lifestyle interventions for cancer survivors and and those that use broad-reaching mobility such as the telephone but such programs are routinely available or offered in survivorship care that's why this is where healthy living field The gap: so quick overview of the program healthy living after cancer is available to any adult who's been treated with curative intent for any type of cancer, who finished their treatment, their active treatment, those who take part received six months of telephone health coaching delivered by a Cancer Council health coach or nurses focusing on healthy lifestyle changes and they are of course you know engaging in regular you know, physical activity, eating a healthy diet and maintaining a healthy weight and I just want to add you know as as as, a as in the panel earlier today they were talking about, you know other stuff that comes up, the other stuff and of course you know we do get people talking about the other stuff as well and that's really important so we're also seen sometimes or you know people talk to us about about other concerns, the base and they say I don't want to bother my family, I don't bother my doctor with this part So apart from the health side, I do see this other side creeping in quite a lot as well So participants completed telephone survey at the beginning of the program and at the end of the program and again six months later were asked, to self-report their weight as well as the height so we can calculate their BMI, their waist circumference and also a range of questions around the physical activity, their diet, quality of life, treatment related symptoms, side effects cancer, fear of cancer recurrence, distress and a range of demographic questions and the items that are in bold on there, and they're the ones that we're going to focus on today and discussing preliminary results The healthy living after cancer intervention is based on the following evidence-based guidelines for cancer survivors

These are in line with the national guidelines around maintaining a healthy body weight, doing 30 minutes or more of moderate-intensity physical activity and the national guidelines in diet around, especially around eating the five servings of vegetables, the two of fruit and limiting alcohol consumption Our target group as I've mentioned before, adults have completed treatment for any cancer with curative intent and they've completed treatment although they can be on hormonal therapy such as the Septon Participants are screened for eligibility by healthy living after cancer staff members at one of cancer, at one of the cancer councils before commencing the program and look, if there are concerns about eligibility the cancer survivor may be asked to speak to their GP or their specialists we can also contact the project coordinator in UQ and ask for guidance and she can take our questions to the clinical investigators that are on the project and we've also got a project if a cue that's constantly being updated and circulated regularly which details interesting or challenging cases So, so we've got a lot of support around people that we're looking after we anticipate that approximately 50 completions per year per Cancer Council and over three years service delivery that will be approximately 600 completing the program

Participants are referred to the program through a range of referral pathways, we're aiming to promote the program to regional and remote areas as much as we can because we, we know that from telephone delivered programs particularly beneficial here and especially as there isn't as we know, a lot of other stuff available in regional areas and this is looking and nationally so far across all of the cancer councils We've got 334 referrals with eighty-one percent eligible and ninety-four percent consenting to take part in the program The main referral pathway has been out 13 11 telephone service, the main reason for ineligibility and and refusal are disinterest in the program or we've been unable to contact them for screening or consent, and so far 287 participants have completed the pre program assessment and convince, and commenced to the intervention calls and here's a bit of a summary of New South Wales, New South Wales is actually the lead state for healthy living after cancer at the moment, with 132 referrals, 85% screened eligible, 91% consenting The average age of our participants is 55, the majority of female with an average BMI of 28 and the average number of years since their diagnosis is at or treatment, sorry, is three years and here's some interesting statistics on just New South Wales and eighty percent of our participants our from metro areas and we have actually a disproportionately more participants from most disadvantaged or lease disadvantaged areas The majority of our participants as you can see have had breast cancer, we do also have a small number of participants who were diagnosed with rare forms of cancer

I'll be talking in a moment about our preliminary results of the psychosocial outcomes, but it's interesting to note that many of our participants during their pre assessment report struggling with anxiety and depression today we have a completion rate of sixty-two percent with 27 completers from Cancer Council New South Wales Participants receive on average ten intervention calls, the main reason for withdrawal are feeling like they're not benefiting from the program or we've been unable to contact them for the intervention In the results this graph shows some of our preliminary results and as you can see the results are very promising and the results are on your right hand side down there and the ones are in bold of the ones obviously that are doing the best are going to the psychosocial outcomes in a minute but I just wanted to highlight a couple of results that we're particularly pleased to see If you look at the fruit and veg has increased and that's actually particularly hard to get people to increase that to increase the amount of fruit and veg, especially veg that they ate, so we're really pleased about that and also very pleased about physical quality of life because again it's, it's really hard and complex to get people to make, you know long-term changes or any sort of changes around increasing their activity in and around exercise so we're very excited by the results were seeing so far So now give you more detailed information on our psychosocial outcomes so the quality of life was measured using the sf-12 health survey and our preliminary results show a significant improvement in physical health quality of life from pre to post program however although it's trending in the right direction there's no significant improvement in mental health quality of life, cancer and treatment related symptoms and side-effects was measured using the MD Anderson Symptom inventory

Our preliminary results show a significant improvement in symptoms severity from pre to post there was a corresponding significant improvement in symptoms interference from pre to post distress or description distress was measured using the National Comprehensive Cancer Network distress thermometer our preliminary results show no significant reduction in level of distress on impact of level of distress from pre to post program but as you can see our participants reported an overall low level of of distress to begin with, 29 at pre-program on a 10-point scale and as I mentioned previously the average number of years from cancer diagnosis and treatment of our participants is three years and so it may be that our participants are simply no longer feeling that distressed and that's why we're not seeing that improvement in now from pre to post Fear of cancer recurrence was measured using the concerns about recurrence questionnaire preliminary results show a significant reduction in fear of cancer recurrence from pre to post now this is what I really like doing the post program telephone survey participants have been asked to range of questions on the satisfaction with the program and he's a little word crap cloud that showing some of the most frequently used words we've received wonderful feedback really positive about about the program and it's you know as you can imagine yes it is helping them increase their fruit and veg and physical activity but it's really also helping their mental well-being and they're feeling so much more like getting on with life and so finally, I'd like to leave with some quotes I like the last quote, I felt more supported especially after my treatment even though people thought I was okay after my treatment I actually wasn't, so it was so beneficial for me and participating in this program I felt so supported and this one again you know people ring 13 11 20 , there are ringing the program not about fight, they don't know this program exists the ring the program because they that they're feeling like they need support, they're feeling down, so I like the last one here, I didn't join because I wanted to get healthier or improve myself, I rang Cancer Council because i was feeling very down after finishing my treatment and the program is offered to me even though it wasn't it, was even though it was being a bit depressed that was my reason for contacting the Cancer Council During this program helped to get me out of that, to get me do it, to get me out and get fitter and doing things

So how do you find out more? At lunchtime come and see me or if you're from interstate, call 13 11 20 and speak to your Cancer Council New South Wales, and you can email us directly at that email address We've also got a web page with our referral forms on it, and questions, first and also like to thank you U Queensland who gave us all the employees, sent me down all the figures, especially Aaron Robson and Liz Aiken and all my Cancer Council staff across across Australia and my Cancer Council New South Wales buddies out there

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