Cancer Survivorship
Every year, more people are surviving cancer.21
However, side effects from acute and ongoing treatments continue to diminish
physical function and quality of life (QOL) for years after treatment
completion.46,67,78 These complications often lead to a restriction
of physical activity. Recent research found that as many as 70% of cancer
survivors do not perform sufficient physical activity to achieve the basic
health guidelines.6 It has also been found that the majority of
cancer survivors significantly decrease their level of physical activity after
diagnosis, with a return to pre-diagnosis physical activity levels to be highly
unlikely.55
Side Effects of
Treatment
Direct side effects of cancer treatments,
especially chemotherapy, radiation therapy, and hormone therapy, include
cardiotoxicity, loss of bone mineral density, loss of muscle mass, and
increases in fat mass and fatigue.18,35,53,67,75 The reduction in
physical activity exacerbates these side effects, especially fatigue, which
creates a vicious cycle between continued loss of physical function and decreasing
exercise.4 This puts cancer survivors at a huge risk for developing
secondary diseases, such as cardiovascular disease, osteoporosis, diabetes, and
chronic fatigue; having a reoccurrence of their cancer; or developing another
cancer.
Health Burden of
Cancer
Cancer is Australia’s leading burden of
disease, accounting for 19% of the total burden2 and costing the
country $16 million per year in health care for breast cancer alone.72
Currently, there are over 300,000 cancer survivors in Australia, with 20,000
more men being diagnosed each year just with prostate cancer.21 With
the growing population of survivors needing further medical treatment for secondary
diseases, the health burden on these patients and subsequently the health care
system is becoming astronomical. The main reason there are more survivors are
improvements in cancer screening and treatment. However, the improvements in
medical treatment to keep people alive does not necessarily mean that people
are living well. Studies have shown that cancer treatment severely diminishes
cancer survivors’ QOL.37,76 As this evidence has become more widely
known, improving cancer survivors’ QOL has become as important an outcome as physical
rehabilitation. Quality of life is defined as the combination of a persons’
physical, psychological, and social well being.51
Interventions to Help
Cancer Survivors
Exercise has been proven effective at improving
cancer survivors’ health and QOL.23,35,67 Beyond diminishing the
physiological impact of treatment side effects, cancer survivors can improve
their fitness to a greater level than they enjoyed before treatment. Exercise
has been shown to improve the psychological dimension of QOL, and group
exercise classes provide social support for cancer survivors.12,13,16,38,44,48,49
However, some researchers have called into question the validity of these
findings, citing that the measured improvement in these areas may be more
superficial, and not dealing with deeper psychological issues.30 To
address these issues, psychological interventions are needed, and have had
great success at helping with depression, anxiety, and QOL.62,63,69
Despite the success of both approaches, few studies have employed a multi-modal
design to optimally improve cancer survivors’ QOL.13,45,50,78 These
studies have many limitations, including poorly delivered exercise, limited
sample sizes, and not following up the participants to determine the long term
impact of their interventions.
An additional limiting feature of exercise
oncology research to date is that it has been biased toward breast cancer survivors,23
though there is still a large body of research into exercise amongst male
cancer survivors. However, there is a lack of research on psychological
interventions amongst men. A recent systematic literature review on
psychological interventions for prostate cancer survivors identified 21 studies
total, all of which were poor quality, and few which included psychotherapy components.11
There is a general belief and stigmata, supported by research, that men are not
interested in participating in psychotherapy based interventions.20,34,40,52,56,68,70,74
Approach to the
Problem
The intervention tested in the present study
aimed to improve the health and QOL of Western Australian breast and prostate
cancer survivors. This is a novel intervention, which combined group exercise
and supportive group psychotherapy (SGP), grounded within the transtheoretical
model of behaviour change (TTM) to help improve exercise behaviour and adherence.59
The same intervention was delivered to both breast and prostate cancer
survivors to determine if it would be suitable for both populations, and
therefore more economically feasible to roll out into the larger community.
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