The evidence is clear: exercise improves health outcomes for people living with cancer. Physical activity is associated with a 26-69% reduction in cancer-related mortality, and a 35% reduction in cancer recurrence.
The problem: over 90% of cancer survivors are physically inactive and often struggle to connect with rehabilitation programs that could help them to reach the recommended activity levels.
“Eastern Health established the first oncology rehabilitation program in Australia over ten years ago,” explains physiotherapist and research fellow, Dr Amy Dennett, “but only one in 200 cancer survivors in Australia has access to an equivalent service.”
Dennett and a team of researchers from La Trobe University and Eastern Health are working to change that. They have developed the Cancer Rehabilitation to Recreation (CaReR) Framework, a tailored approach to help health services embed physical activity into cancer care.
“The framework is based on idea that cancer survivors might require support to be physically active,” Dennett says, “and that they may need different types of support based on their symptoms, physical function and confidence.”
CaReR adopts a three-phase approach – rehabilitation, fitness and recreation – with counselling offered as a core element throughout all phases.
The rehabilitation phase provides intensive support, with a focus on restoring function and preventing disability. “It spans bed-based rehabilitation to one-hour exercise sessions led by a physiotherapist,” she explains. Counselling emphasises goalsetting, and a focus on reducing sedentary behaviour and ‘returning to normal’.
The fitness phase focuses on establishing good exercise habits, while the recreation phase aims to maintain physical activity for good long-term health. In both phases, the aims of counselling shifts to target confidence and motivation for increasing physical activity.
Cancer survivors may enter the framework at any phase depending on their symptoms, functional status and self-efficacy. They may transition between the three phases or within each phase as their care needs are addressed or their health status changes.
“The framework offers a cost-effective solution to oncology rehabilitation,” adds Dennett. “Not everybody requires intensive rehabilitation. If we can intervene early, then we can determine what level of service is needed, and what phase is the most appropriate starting-point for the patient.”
“We hope that CaReR will assist clinicians to help cancer survivors access the right care, at the right time, to improve health and wellbeing.”
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