Each year 13 million people are diagnosed with cancer worldwide (Moore, Durstine and Painter, 2016), writes Rob Williams, senior lecturer at Southampton Solent University. In 2014, 356,630 people in the UK were given a diagnosis of one form of cancer or another (Cancer Research, UK) and there are over 200 different types of cancer, the most common being cancers of the lung, breast, prostate and colon (National Foundation for Cancer, 2016).
Although cancer prevalence continues to rise, people survive now more than ever before due to advances in public awareness, diagnostics, surgery and treatment, with 2.5 million people currently living with cancer in the UK, which is projected to rise to 4 million by 2030, according to Macmillan. Ten-year survivorship following diagnosis is now predicted in at least 80% of people diagnosed with cancer of the skin, breast and prostate, an encouraging statistic due to the latter 2 sites being the most prevalent in women and men (Cancer research UK, 2016).
Cancer diagnosis is followed by an often long and traumatic journey of treatment; including surgery, radiotherapy, chemotherapy and in some cases years of hormone-altering drugs. There are physical, psychological and emotional effects which affect the patient and their family, and of course the legacy of surviving cancer is the fear and worry that it may come back. People often survive, but don’t flourish and instead become depressed, fatigued and withdrawn, struggling to cope with life after cancer, a concern voiced by cancer charities such as Macmillan.
This has seen a call for interventions to support the increasing number of survivors throughout and following their treatment and has been the catalyst for a body of evidence investigating the role of lifestyle and physical activity in cancer prevention and survivorship over the past 10 years or so.
Exercise and cancer rehabilitation
People who exercise regularly throughout their lives are seen in many population studies to reduce their risk of developing cancer. In many cancer sites, there seems to be a dose response, the more exercise the lower the risk (World Cancer Research Fund Expert Report, 2007).
Cancer Research UK suggest that about 40% of cancers are preventable and for bowel cancer the most physically active can reduce their risk by 40-50%. Indeed, there is strong evidence to support the benefits of exercise and weight control at significantly reducing risk in bowel, breast and endometrial cancers (Thomas et al., 2014). Exercise during treatment should be under the clearance of a physician and should be patient centred and individual to the person, taking into account fatigue, anaemia, mood status and severity of treatment side effects (Courneya and McNeely, 2016). The person should do what they feel able to comfortably do, but can see benefits in reduced fatigue and improving mood if they are able and willing (Shmitz et al., 2010).
Following treatment, a programme of rehabilitation should be supervised by a REPs level 4 Cancer Rehabilitation Specialist who should consider all the effects of past and current therapies. Effects of treatment on bone and connective tissue fragility must be considered as well as fatigue, low energy and psychological health status (Schmitz et al., 2010; Courneya and McNeely, 2016). Again, it is important to seek advice and referral from the client’s physician or cancer nurse specialist. It has been shown that a walking pace of 3mph for at least 3 hours a week can have beneficial impact on improving survivorship and a targeted programme of rehabilitation to improve the physical effects of surgery and radiotherapy/chemotherapy should be considered based on an individual health screen and functional assessment (Holmes et al., 2005; Thomas et al., 2014).
We have our education endorsed by PD:Approval, recognised by REPs and have been training REPs members to work with cancer survivors since 2012 in the UK, and many cancer rehabilitation schemes have taken off. The support of Macmillan cancer support and particularly their “Move More” programme has been most encouraging, however, work at the front-line needs to improve to encourage newly diagnosed individuals and those following successful treatment to appreciate the increasingly significant body of evidence that, at least in certain cancer sites, a referral to a well ran cancer rehabilitation scheme may be an effective way to control lasting anxieties and side effects, as well as improving survivorship likelihood.
Work in front line communication skills to encourage cancer patients to embrace lifestyle change and physical activity, of any appropriate mode, is warranted. And the community should continue to strive for an established, cardiac rehabilitation style, structure which helps practitioners at each level understand the diverse needs of cancer patients in striving to live an active, long and rewarding life.
Solent University Exercise Referral – cutting-edge real world learning
Last year saw the completion of another extremely successful Solent Exercise Referral Scheme. The scheme has been running for 3 years now in its current form and each year has seen the involvement of more clinicians and health charities from the surrounding area referring their patients into the exercise clinics for our students to work with.
The scheme offers students on the Health and Exercise Science programme the opportunity to gain invaluable experience in working with people living with long term chronic disease. The process involves thorough screening and risk assessment of safety to exercise, exercise rehabilitation, disease management and a large component of soft skills, i.e. building the students’ confidence and appreciation for forming relationships with older adults and referred clients.
We have seen an increase in volunteers joining the scheme this year and a wider spectrum of medical conditions including cancer, cardiac rehabilitation, respiratory disease, stroke, back complaints and Parkinson’s. An area which we are seeing growth in is mental health, a pleasing observation due to the need to bring the condition to the forefront of public awareness. New to the course this year is the inclusion of REPs level 4 Cancer Rehabilitation which is embedded into the units.
Organiser of the scheme and course leader for BSc (Hons) Health, Nutrition and Exercise Science, Rob Williams, said: “Another fantastic year for Solent Exercise Referral and another cohort of students gaining confidence and knowledge by working with referred patients. The scheme offers real world learning like which is provided nowhere else in the country. We work hard to form links with local hospitals and charities and this year we are proud to have collaborated with local Oncologists and MacMillan to develop the cancer rehabilitation programme.
"We have seen an increase in cancer referrals and we expect this to go from strength to strength. Students on the Health, and Exercise Science programme will benefit from cutting edge theory in health, exercise and nutrition, which is followed up by putting this theory into practice on real life clients and by working on public interventions such as the Community Innovation Programme.”
BSc (Hons) Health, Nutrition and Exercise Science student with her referred client, winner of most improved volunteer.
Students learn the how to safely and effectively programme exercise for referred patients. Students are supervised by staff who are experts in clinical exercise physiology and exercise programming for clinical populations.
Courneya, K., and McNeely, M. (2016). Exercise during cancer. ACSM direction. http://www.acsm.org/public-information/articles/2016/10/07/exercise-during-cancer-treatment
Macmillan cancer support. https://www.macmillan.org.uk/about-us/health-professionals/programmes-and-services/physical-activity.html
Meyerhardt J.A, Edward L. Giovannucci, MD, ScD; Shuji Ogino, MD, PhD; Gregory J. Kirkner, Andrew T. Chan, MD, MPH; Walter Willett, MD, DrPH; Charles S. Fuchs, MD, MPH (2009). Physical activity and male colorectal cancer survival. Arch Intern Med. 169: pp 2102-2108
MOORE, G.E., J.L. DURSTINE and P.L. PAINTER, 2009. ACSM's exercise management for persons with chronic diseases and disabilities. 3rd ed. ed. Leeds: Human Kinetics: Champaign ill.
National foundation for cancer (2007). https://www.nfcr.org/annual-reports/2007
Schmitz K.H, Courneya K.S, Matthews C, Denmark-Wahnefried W, Galveo D.A et al (2010). American college of sports medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sport and Exercise. 42: pp 1409-1424.
Schwartz A.L, Mori M and Gao R (2001). Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine and Science in Sport and Exrercise. 33: 713-723.
Schneider C.M, Dennehey C.A and Carter S.D (2003). Exercise and Cancer Recovery. Human Kinetics: Champaign Ill.
Thomas, R, J., Holm, M, Adhami, A., A., (2014). Physical activity after cancer: An evidence review of the international literature. BJMP 2014;7(1):a708.