Wellness and Life after Cancer (WALAC)

Innovating Survivorship Care for Rural and Regional Victorians

In line with international best practice, there is significant work being done by Australian researchers and health services to investigate and address the issues, difficulties and needs of post-treatment cancer survivors. Similarly, there is an aim to understand the support and resources that survivors feel is needed to better assist them as they transition from the treatment to recovery phases (1)

A 2008 qualitative study of survivors, conducted by Jefford et al (2) showed that participants reported a multitude of significant cancer impacts on everyday functioning, interpersonal relationships, self-confidence and psychological wellbeing, in addition to impacts on their physical health and vitality.

Post-treatment issues or unmet needs, identified by survivors as being of primary concern were analysed and themed into the following groups:

  • Managing everyday routines and responsibilities
  • Managing treatment side effects and medications
  • Coping with changes to self-identity and support
  • Fear, anxiety, lacking confidence, sadness and loneliness
  • Information needs
  • Coping with the behaviour of others
  • Relating to others and positive experiences
  • Health services: feelings of abandonment and uncertainty after treatment
  • Practical and financial challenges including retirement, returning to work and unexpected costs for post treatment support such as prosthesis, dental or life-long medication.
  • Development of second cancers due to genetic susceptibilities, shared etiologic exposures and mutagenic effects of cancer treatments.

Evidence shows that psycho-educational interventions are the beneficial for cancer survivors as they provide both informational and psychological support. A comprehensive meta-analysis of 56 interventions compared the effect of four types of interventions in breast cancer survivors – psycho-educational, cognitive- behavioural therapy, supportive and relaxation (3). Results showed that psycho-educational interventions had positive effects on survivors. Facilitators and presenters in the small group environment that encourage peer support are well positioned to use specific communication techniques and language which can encourage behaviour changes for participants. A number of theories of health-behaviour change have highlighted the factors or processes that prompt behaviour change (4). These processes have been identified as self-efficacy, social support, decisional processes and perceived relevance or vulnerability. The stages of readiness have also been identified as an important process to facilitating health-behaviour change.

Based on this evidence, Cancer Council Victoria’s ‘Wellness and Life after Cancer’ (WALAC) program was first established in 2015, to support the growing numbers in survivors living with and beyond a cancer diagnosis. The program has been developed to assist survivors, families and friends with this time of transition and enables those moving from treatment to recovery to build resilience and increase their capacity to self-manage their own health and wellbeing.

Three key survivorship themes are the focus of the program:

  1. Finding a new normal
  2. Transition from clinical care to supported self-management
  3. Healthy lifestyle behaviours

In recent years, exercise as a medicine has become increasingly recognised as an important element in cancer treatment and recovery. The recent position statement from the Clinical Oncology Society of Australia (5) recommends exercise to be embedded as part of standard practice in cancer care and be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment. All members of the multidisciplinary cancer team should promote physical activity and recommend people with cancer adhere to exercise guidelines. Best practice cancer care to include referral to an accredited exercise physiologist and/or physiotherapist with experience in cancer care.

It has also been established that those living in rural and regional Victoria, Australia, face additional cancer survivorship challenges, including distance and limited transport options required to access treatments and supports, impacting on cancer outcomes (6). Telehealth is defined as the use of telecommunication techniques to exchange health information and provide healthcare and health education over a distance (7). The investment in infrastructure and models of delivery by the Victorian government to enable telehealth to be incorporated into models of care in Victoria has led to innovative use of telehealth to support cancer patients in regional and rural Victoria. However, there are few examples featuring both education and allied health interventions for patients.

In 2016, Cancer Council Victoria was successful in receiving grant funding to innovate the current WALAC program delivery, to include practical exercise and wellness sessions for survivors and carers. The program is currently being piloted in two Victorian regions, consisting of four, 8-week programs in each region (8 in total).

Group exercise sessions run for one hour each week and are delivered by trained Exercise Physiologists at each regional health service. Following exercise, participants then move to another room for 1hr weekly education, based on the original WALAC education program. The education is delivered by synchronous (real time) telehealth video conferencing, to link multiple sites together and remove the barrier of distance by enabling participants to remain as close to home as practicable while accessing the program.

The project is being evaluated via action research methodology, to enable continual learnings to be embedded into practice. The final project evaluation will be completed in June 2019, with aim to embed the exercise and education program as a standard service offering post pilot.

References

  1. Jefford M KE, Pollard A, Baravelli C, Carey M, Franklin J, Aranda S, Schofield P. Survivorship issues following treatment completion—results from focus groups with Australian cancer survivors and health professionals. Journal of Cancer Survivorship. 2008;2(1):20-32.
  2. Jefford M, Karahalios E, Pollard A, et al. Survivorship issues following treatment completion: Results from focus groups with Australian cancer survivors and health professionals. Journal of Cancer Survivorship 2008;2:20–32.
  3. Meyer TJ, Mark MM. Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology 1995; 14 (2); 101-8.
  4. Emmons, K, Rollnick S. ‘Motivational Interviewing in Health Settings – Opportunities and limitations’. American Journal of Preventive Medicine 2001; 20 (1).
  5. Clinical Oncology Society of Australia: COSA position statement on exercise in cancer care. April 2018. [cited 2018 May 20th] available from: https://www.cosa.org.au/media/332488/cosa-position-statement-v4-web-final.pdf
  6. George, M. Rural Oncology: Overcoming the Tyranny of Distance for Improved Cancer Care. American Society of Clinical Oncology. 2014: 1 – 4.
  7. Australian Government Cancer Australia Cancer Learning – Cancer Survivorship 2013 [cited 2015 March 18th ]. Available from: http://cancerlearning.gov.au/topics/survivorship/cancer-survivorship-fundamentals-OLD