The role of exercise and physical activity in cancer survivorship

Dr Lara Edbrooke

Abstract:

Allied health plays an important role in the management of cancer. Cancer is associated with high disease burden and physical hardship. People with cancer can experience complex symptoms including cancer-related fatigue, and these symptoms frequently lead to a cycle of inactivity and functional decline. There are well-established guidelines regarding physical activity for people with cancer, which are supported by research demonstrating that exercise is safe, and associated with improvements in many patient outcomes. Higher physical activity levels after diagnosis have also been shown to be associated with reduced cancer-specific and all-cause mortality in breast, colon and prostate cancer. Despite the evidence for exercise and physical activity, the majority of people with cancer do not meet the physical activity guidelines. Therefore many allied health disciplines play an important role through education regarding physical activity (to patients, carers and health care professionals) and / or with the delivery and prescription of exercise training to cancer survivors. This presentation will outline the rationale, role and evidence supporting exercise and physical activity for people with cancer. It will discuss issues including timing of exercise relative to treatment, including the topic of prehabilitation; and barriers to exercise from the perspective of patients and the healthcare system. Examples will be drawn from a number of difference cancer types.

Biography:

Lara is a physiotherapist, currently completing her PhD at the University of Melbourne. Her PhD research has involved conducting a multi-site (3 VCCC sites), multi-disciplinary randomised controlled trial of home-based exercise and symptom management for people with inoperable lung cancer during and following active treatment. Lara’s role at Peter MacCallum Cancer Centre involves research capacity building as the Grade 4 Allied Health Researcher for the seven Allied Health disciplines. Lara has previous research experience project managing several randomised controlled trials prior to undertaking her PhD and has completed a post-graduate diploma of epidemiology and biostatistics

 

Patients’ perspectives on what makes a better care experience while undergoing treatment for oropharyngeal dysphagia secondary to head and neck cancer

Ms Kate Lethbridge1, Ms Jessica Bain1, Mr Martin Checklin1, Ms Lucy Bath1

1Epworth Healthcare, Richmond, Australia

Abstract:

Aim:
To investigate patients’ perspectives on what makes a better care experience while undergoing rehabilitation for oropharyngeal dysphagia secondary to head and neck cancer.

Method:
Thematic analysis was conducted on data obtained from semi-structured interviews. A Symptoms Checklist was also used in order to identify which symptoms were managed well and which symptoms could have been managed better. Data was collected after active rehabilitation had ceased allowing a retrospective report on the patient’s experience.

Results:
Eight participants were interviewed who had a range of experiences with different allied health clinicians. Six themes were identified from the data; supportive network is essential (family, friends, workplace), reassurance from staff’s professionalism (empathy, clear communication and holistic care), access to services (timing and communication), using own motivation and resilience, receiving the right information (education and tailored information), shock and adjustment to diagnosis throughout rehabilitation phase (feeling fortunate, concerns regarding recurrence). Weight loss, difficulties swallowing, phlegm in throat and communication issues were the predominate difficulties experienced by over two thirds of participants.

Significance of the findings to allied health:
Allied Health clinicians play a key important role with supporting the person with head and neck cancer. Areas identified include providing relevant, tailored and timely information, offering specialist skills, screening for resilience, being able to detect and follow up on psychological distress, being compassionate and empathetic and providing the patient with a holistic approach.

Biography:

Lucy graduated from the University of Sydney with a Masters of Speech Pathology with honours in 2011, completing research in acoustic voice characteristics of radio broadcasters in Australia. She has worked across public and private health sectors in New South Wales and Victoria in acute, subacute and rehabilitation settings. Lucy has a particular interest in voice from her training as an actor, working in TV and stage after graduating from the Western Australian Academy of Performing Arts in 2003.

Functional pelvic floor muscle training before radical prostatectomy: A pilot study

Ms Alesha Sayner1,2, Dr Irmina Nahon2, Ms Sarah Davies1, Dr Kimberley Haines1, Dr Emily Karahalios3, Ms Cindy Ogluszko1

1Western Health, Sunshine, Australia, 2University of Canberra, Canberra, Australia, 3University of Melbourne, Melbourne, Australia

Abstract:

Aims:
To determine the feasibility of a study protocol comparing two modes of pre-operative Pelvic Floor Muscle Training (PFMT).

Method:
Western Health patients undergoing Radical Prostatectomy (RP) were included. Pre-operatively, participants were randomised to: Functional PFMT consisting of six functional activities with a pelvic floor muscle pre-contraction; or the standard care PFMT group, consisting of sustained static contractions. Post-operative Urinary Incontinence (UI) was measured using a three-day pad weight measure and the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UISF). Feasibility outcomes included recruitment and retention rates, outcome measure completion and program adherence.

Results:
Thirty participants were recruited within eighteen months. Sixteen men declined participation and fourteen Non- English-Speaking-Background (NESB) men were excluded. Twenty participants have completed the study. Program adherence was greater than 90%.  Over 90% of outcome measures were completed at 4 and 12 weeks post surgery and 80% of expected 26 week measures have been returned. Completion of data collection is anticipated by January 2019.

Significance of the findings to allied health:
This study explores a novel area of pre-operative PFMT. It identifies issues around intervention application. Feasibility may be enhanced by multi-linguistic validation of the pad weight measure to enable inclusion of people from NESB and multi-site recruitment. The protocol appears to be feasible based on single site recruitment and data collection. Assessment of prostate cancer patient needs and preferences would compliment these findings to facilitate multi-site inclusivity and wider protocol adaptability.

Biography:

Alesha is an APA titled Women’s and Men’s Pelvic Health Physiotherapist working between Western Health and the Australian Prostate Centre. She is completing her PhD in the area of patient experience with prostate cancer and physiotherapy. She is currently in a project management role involving the implementation of a prehabilitation program for prostate cancer patients using experience based co-design methodology. She feels extremely privileged to work with the population of men with prostate cancer.

Exploring nutrition knowledge, practice and education needs in regards to cancer malnutrition in the primary care and community sector

Ms Jane  Stewart1, Ms B Steer1, Ms Jenelle Loeliger1

1Peter Maccallum Cancer Centre, Melbourne, Australia

Abstract:

Aim:
Cancer malnutrition remains a prevalent issue across a patient’s continuum of care and is under-detected and under-treated in primary care. This study aimed to investigate current nutrition knowledge, practice and education needs in the primary care and community sector in regards to cancer malnutrition.

Method:
Victorian general practitioners (GPs), general practice nurses (GPNs) and dietitians in acute cancer services, community health services/rehabilitation and private practice were invited to complete surveys.

Results:
The survey was completed by 152 dietitians, 22 GPs and 10 GPNs. One-third of acute oncology dietitians rarely/never refer their cancer patients to primary care/community dietitians and 2/3 never/rarely provide a discharge summary to a patients’ GP. GPs/GPNs and dietitians working in primary care/community settings (78%, 63% respectively) believe patients with cancer malnutrition are going unrecognised in their service. Only ¼ community health services complete nutrition risk screening routinely on initial presentation and only 35% of GPs/GPNs very often/always weigh their cancer patients. GPs/GPNs (88%) believe they should have primary responsibility for screening patients for malnutrition and 94% see benefit in having access to a malnutrition screening tool. Additional education and resources on cancer malnutrition are wanted by all surveyed clinicians.

Significance of the findings to allied health:
Efforts should be made to improve clinical practice across the continuum of care, in particular for the identification of cancer malnutrition in primary/community care and the transition of nutrition care between sectors. Increased awareness and targeted education resources in regards to cancer malnutrition for the primary care/community sector are required.

Biography:

Jenelle Loeliger is an Advanced Accredited Practising Dietitian and currently the Interim Director of Allied Health at Peter MacCallum Cancer Centre. She is passionate about implementing evidence based practice into usual care and ensuring patients with cancer have access to high quality allied health services. Jenelle conducts projects/research across various areas within cancer and provides state-wide leadership to the Victorian Cancer Malnutrition Collaborative program of work which helps to reduce the burden of malnutrition on patients with cancer.

Driving Improvement for Head and Neck Cancer Patients with Gastrostomy Tubes through Advanced Practice in Dietetics

Mrs Kim  Lunardi1, Ms Natalie  Simmance1

1St Vincent’s Public Hospital, Melbourne , Fitzroy, Australia

Abstract:

Title:
Driving Improvement for Head and Neck Cancer Patients with Gastrostomy Tubes through Advanced Practice in Dietetics

Aim:
Many patients with head and neck (HN) cancer require gastrostomy feeding tubes (G-tubes) during their treatment.  Poor consumer experience and model of care mapping identified opportunities to improve service provision. This project aims to describe the development of an advanced  scope of practice (ASP) dietitian role to improve patient experience and outcomes.

Method:
An ASP credentialing program in G-tube management for HN Dietitians was developed, informed by a literature search and key stakeholder engagement to meet local clinical governance requirements. Service and patient events were measured and patient feedback obtained via staff logbooks and surveys.

Results:
Up until October 2018, four Dietitians have been credentialed, enabling provision of stoma site care and procedures to change G-tubes, activities historically undertaken by other professions. Of the 50 G-tube changes completed by ASP Dietitians, 26 (52%) were for patients from the HN unit.  A dietitian-led hospital “Gastrostomy Consult” service has provide 97 service events, of which 64 (66%) were for patients from the HN unit. Patient outcomes include reduced wait time to care (2 months to 0-2 days) and reduction in unnecessary appointments, with no adverse events recorded.  For consumers, satisfaction with the new service model is high.

Significance of the findings to Allied Health:
This novel ASP Dietitian role has been successfully imbedded into the hospital workforce and enables comprehensive, timely, safe and patient-centred care for patients with HN cancer.

Biography:

Kim Lunardi is an Accredited Practicing Dietitian with more than 10 years experience, specialising in Head and Neck surgical oncology and Advanced Nutrition Support. She leads the St Vincent’s Hospital Melbourne Advanced scope of practice and competency development portfolio and has work published in this area.

Technology supported self-guided nutrition and physical activity interventions in adults with cancer: a systematic review

Dr Nicole Kiss1,2,3, Mr Brenton Baguley4,5, Professor Kylie Ball1, Professor Robin Daly1, Associate Professor Steve Fraser1, Dr Catherine Granger3,6, Dr Anna Ugalde7

1Deakin University, Burwood, Australia, 2Peter MacCallum Cancer Centre, Melbourne, Australia, 3Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia, 4School of Psychology, Faculty of Health, Deakin University, Burwood, Australia, 5School of Human Movement and Nutrition Sciences, St Lucia, Australia, 6Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Australia, 7School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Australia

Abstract:

Background:
Nutrition and physical activity interventions are important components of cancer care, and with increasing demand for services there is a need to consider flexible, easily accessible and tailored models of care whilst maintaining optimal outcomes. This systematic review describes and appraises the efficacy of technology supported self-guided nutrition and physical activity interventions for people with cancer.

Methods:
A systematic search of multiple databases through to July 2018 was conducted for randomised and non-randomised trials investigating technology supported self-guided nutrition and physical activity interventions. Risk of bias was assessed using the Cochrane Risk of Bias tool. Outcomes included behavioural, health-related, clinical, health service or financial measures.

Results:
Sixteen randomised controlled trials representing 2,684 participants were included. Most studies were web-based interventions (n=9) and 12-week follow-up duration (n=8). Seven studies assessed dietary behaviour with two reporting a significant benefit on diet quality or fruit and vegetable intake. Fifteen studies measured physical activity behaviour with eight finding significant improvement in muscle strength and/or moderate-to-vigorous physical activity. Four of nine studies assessing health-related quality of life (HRQoL) reported a significant improvement in global HRQoL or a domain subscale. A significant improvement in fatigue was found in four of six studies. Interpretation of findings was influenced by inadequate reporting of intervention description and compliance.

Conclusion:
This review identified short-term benefits of technology supported self-guided interventions for people with cancer on physical activity level and fatigue, and some benefit for dietary behaviour and HRQoL. However, current literature demonstrates a lack of evidence for long-term benefit.

Biography:

Dr Nicole Kiss is an advanced APD with more than 18 years’ experience in cancer nutrition and is Chair of the Nutrition Group of the Clinical Oncology Society of Australia. Nicole is co-lead of the Exercise and Nutrition for Cancer research group in the Institute for Physical Activity and Nutrition at Deakin University. Nicole holds honorary research positions with the Department of Cancer Experiences Research at Peter Mac and the University of Melbourne.

 

The development of a nutrition care pathway for patients undergoing surgery for upper gastrointestinal cancer

Ms Irene Deftereos1,2, Ms Vanessa Carter1, Ms  Jasmine Everist1, Ms Kathryn Pierce1

1Western Health, Gordon St Footscray, Australia, 2The University of Melbourne, Melbourne, Australia

Abstract:

Aim:
Malnutrition is a significant problem for Upper Gastrointestinal (UGI) cancer patients, and guidelines recommend perioperative nutritional intervention. In 2016, Western Health Dietetics Department established a UGI Nutrition Clinic alongside UGI surgical oncology clinics, with a Nutrition Care Pathway (NCP) aiming to address service gaps. Appointments link with pre-existing surgical appointments, minimising patient burden and providing multi-discplipinary care.

Methods:
A retrospective audit of 12 months pre (group 1) and post (group 2) implementation was conducted.

Results:
Age, BMI, gender and tumour types were similar in Group 1 (n=32) versus Group 2 (n=30). 60% in Group 2 received nutrition assessment at time of diagnosis, compared to 25% in Group 1. Dietitian input in radiotherapy/chemotherapy increased from 78% to 100%. 78% of patients received review post neoadjuvant therapy, previously not provided. Average dietetic outpatient time pre surgery increased from 2 minutes pre implementation to 35 minutes. Average occasions of service (OOS) pre surgery increased from 1.7 to 4.5. 93% received nutrition follow up within 3 weeks post discharge, compared to 15% pre implementation. 4 hospital admissions for feeding tube issues were avoided. Percentage weight loss was not different, contributed to by low yield from missing data.

Significance to allied health:
Patients now have access to coordinated, consistent, timely, effective nutrition care reflecting best practice.  A process driven, pathway approach linking with pre-existing appointments can ensure a patient centred, multi disciplinary and sustainable model of care.

Biography:

Irene is a Senior Dietitian at Western Health.  She specialises in Upper Gastrointestinal Surgical Oncology. Irene has worked as a Clinical Dietitian since 2009 in surgical, ICU and oncology settings. Irene is currently undertaking her PhD titled ‘The investigation of preoperative nutritional status and intervention in patients with Gastrointestinal Cancers.’ Irene is passionate about the role of the Dietitian for the nutritional optimisation of surgical patients in the pre and postoperative periods.