Wellness for Special Populations: Benefits of Offering Wellness Programming to Cancer Patients During and After Treatment Kelly F. Roberts, MA, BSN Levine Cancer Institute Cancer Wellness Coordinator Levine Cancer Institute(LCI) Cancer Wellness Program(CWP) Partnership with Carolinas HealthCare System (LCI and Community Wellness) and the YMCA of Greater Charlotte and the Cannon Memorial YMCA locations Numerous, unique benefits to this 12 week physical exercise and wellness program The 3 P s of Cancer Survivorship 1. Palliation of ongoing symptoms 2. Prevention of late effects of cancer treatment or second cancers. 3. Promotion (Health Promotion) to maximize future wellness. Ganz: Q&A: The three P s of cancer survivorship care. BMC Medicine 2011 9:14. 1
Institute of Medicine, 2005 Designed for Survivors During Or After Treatment Survivors benefit whether actively going through treatments OR After treatments have already been completed Research According to the MacMillan Report, physical activity should be supported for cancer patients at all stages of the cancer care pathway. Maximizes the potential for physical activity to improve the health and quality of life for people living with cancer. Physical activity can improve or prevent the decline of physical functioning without increasing fatigue. Instead of recommending only rest, the advice should likely be avoid inactivity. Reference: www.macmillan.org.uk 2
Research Cancer Survivors want professional support in becoming more active. Ideally, research supports that an oncologist recommendation and referrals to a supervised gym-based exercise program yielded significantly greater exercise participation and increased total minutes of moderate to vigorous intensity aerobic exercise. Survivors need to be told why. We have one oncologist that tells his patients that exercise is as important as their chemotherapy and radiation treatments. Reference: www.macmillan.org.uk Research Moderate Exercise May Make Cancer Treatments More Effective. Moderate exercise (30-60% of aerobic capacity) on a regular basis may enhance tumor oxygenation and improve treatments in cancer patients. There aren t really any negative side effects of moderateintensity exercise. In fact, research shows that can help counteract some of the side effects of treatment such as low blood count, fatigue, cachexia, and decreased muscle mass. Reference: Benke, B. (2015, May 4). Moderate Exercise My Make Cancer Treatments More Effective. In Newswise. Retrieved May 27, 2015, from www.k-state.edu/media/newsrealeases/may15/behnke5415.html Research The Fitness Factor: To reduce the risk of cancer recurrence, exercise may be just what the doctor orders. Exercise appears to help prevent cancer and recurrence. Physical activity can also help to alleviate symptoms including fatigue, memory loss, sleep disturbances, weight gain, and breathing problems. Beil, L. (2014, December 4). The Fitness Factor. Cure, 13(4), 30-35. 3
Research More Benefits of Exercise for Cancer Survivors Colorectal cancer survivors exercising at least 150 minutes of moderate to vigorous physical activity per week experienced fewer neuropathy symptoms 2-11 years after diagnosis. Those who were less active had more neuropathy symptoms and a lower quality of life. Prostate Cancer Survivors who walked 3 or more hours per week improved hormone functioning and experienced fewer feelings of depression and body weight changes. Ford, S. (2015, April 20). Researchers Reiterate the Benefits of Exercise for Cancer Survivors. In Nursing Times. Retrieved May 27, 2015, from www.nursingtimes.net The Advice Is the Same. Exercise Program Components Cardiovascular Endurance (water options, group exercise) Strength (group exercise classes, free weights, bands) Balance Flexibility Mind-Body Opportunity (tai chi or yoga) 4
Exercise Program Highlights Free in 2014 Meets three times per week for 60-75 minutes Multiple support opportunities Initial consult and weekly health review by RN Pre and post fitness assessment with exercise physiologist (EP) Individualized exercise prescription (EP) Graduation: transitional assistance to next exercise opportunity Comprehensive Wellness Program Also Includes Weekly Education Basic Nutrition Stress Management Quality Sleep Quality of Life Goal Setting Managing the Side Effects of Treatment Positive Outlook/Affirmations/Dialogue Creating Connections Participants have more access than ever: Program has expanded to 13 different locations Participants receive access to the YMCA for 12 weeks Increased amenities Created more hours for availability to participate Pay for Fee Program (free prior) 5
YMCA s OF Greater Charlotte and the Cannon Memorial YMCAs Medical Referral Programming Comprehensive Wellness Program With Cross Referral Opportunities Acupuncture Healing Hands Music Therapy 6
2014 Charlotte Biz Journal Award finalist for Health Care! Smoking Cessation Opportunity for community, cancer survivors, and employees Unique 3 session opportunity that uses a combination of actively coping, brand switching, NRT, and support. 2014: 10 QuitSmart sessions 2015: 31 QuitSmart sessions Greater than 60% success rate for those that have remained smoke free > 6 months for two years. Smoking Cessation Benefits Surgery: Decreases surgery complications (oral mucositis, loss of taste, dry mouth, weight loss, fatigue, damaged voice quality, bone and soft issue damage Radiation Therapy: Improved effectiveness of radiation treatments and decreased risks of side effects of radiation Chemotherapy Improving chemotherapy treatments Increased Survival Rates and Better Prognosis Decreases treatment side effects and potentially improves the effectiveness of treatment QuitSmart Patient Comment: Just wanted to let you know that your program does work. Two pack a day for fifty years down to none. Thank you and please thank the sponsors who supported it. 7
Healing Arts and Community Writing Healing Arts and Community Writing Healing Arts and Community Writing 8
Nutritional Support **Healthy Cooking Club Breast Cancer Nutrition Nutrition for Survivors (English and Spanish) Meal Planning Plant Based Nutrition Wellness Classes (post treatment) (6 classes with 348 attendees) Virtual Capability **Most Popular Yoga and Deep Relaxation and Meditation Massage Therapy Massage Therapy Benefits: Decreased Pain Decreased Anxiety Decreased Depression, Decreased Sleep Disturbances Improved overall sense of well-being; 9
Improved Sense of Well Being General Patient Sense of Well-Being 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 July August September Pre-Class General Feeling Post-Class General Feeling Support Groups and Additional Fitness Classes Interns from UNC Charlotte Multiple Support Groups Strategic Partnerships: CHS and YMCA of Greater Charlotte Brings Together the Strengths of the Partners 1. Electronic Medical Record 2. Survivorship Care Planning 3. Amenities and Staff (exercise physiologists, fitness experts) of the participating 14 YMCA locations & CHS (nurses, dietitians) 10
Strategic Partnerships Benefits 1. Cross Referral Opportunities to LCI s Survivorship Program, Rehabilitation (Lymphedema Clinic), other Physicians (integrative), other YMCA opportunities, etc. 2. Satisfying appropriate care measures for the Medical Group 3. Satisfying certain internal Cancer Committee Goals 4. Marketing Positive Perception from the Community Strategic Partner: 24 Hours of Booty Provides invaluable funding to support scholarship opportunities for those who cannot afford to pay Provides all of the funding for QuitSmart smoking cessation program. This program is free. Offers staff, community and participants an avenue to give back in a fun, active challenging way. 24 Hours of Booty Race 2014 11
Benefits and Outcomes General: Improved Self Esteem and Confidence Improved Quality of Sleep Improved Quality of Life Decreased Fatigue Symptoms Decreased Intensity of the Side Effects of Treatments (neuropathy, decreased cognitive function) Benefits and Outcomes General: Improved Nutrition (Weight Gain, Loss, Maintenance) Improved Strength and Cardiovascular Endurance Improved Balance and Flexibility Improved Ability to Carry Out ADL s Increased Support Opportunities Decreased Risk of Other Co-Morbidities Decreased risk of anxiety and depression Decreased risk of recurrence 2014 LCI CWP Outcomes 12
LCI CWP Fitness Outcomes 2014 LCI CWP Fitness Outcomes 2014 LCI CWP Fitness Outcomes 2014 13
LCI CWP Fitness Outcomes 2014 LCI CWP Fitness Outcomes 2014 QuitSmart Outcomes 2013 Date of Class # of employees # of community Total # of Participants Total Completed Success Rate - Success Rate 3 months 6 months 1/18/2013 1 0 1 1 100% 100% 2/20/2013 2 5 7 6 83% 83% 4/17/2013 1 11 12 6 66% 50% 8/7/2013 (Union) 5 3 8 4 50% 50% 8/21/2013 0 6 6 6 67% 67% 8/22/2013 1 0 1 1 100% 100% 10/16/2013 4 4 8 7 57% 43% 11/22/2013 2 0 2 2 100% 100% 11/27/2013 (Union) 2 2 4 2 50% 50% 11/27/2013 2 6 8 3 67% 33% Totals 20 37 57 38 68% 60% 14
QuitSmart 2014 Outcomes Date of Class Location # of employees # of community Total # of Participants Total Completed Success Rate Success Rate -3 months 6 months 3/4/2014 LCI Main 3 5 8 6 of 8 6/6 =100% 5/6 = 83% 2/19/2014 LCI Concord 1 6 7 6 of 7 3/6 = 50% 4/6 = 67% 5/7/2014 LCI Union 1 3 4 1 of 4 0/1 =0% 0/1 = 0% 5/7/2014 LCI Main 1 5 6 5 of 6 3/5 = 60% 3/5 = 50% 5/7/2014 HFFC Concord 0 7 7 7 of 7 5/7 = 71% 5/7 = 71% 6/3/2014 LCI Main 1 10 11 9 of 11 7/9 = 77% 6/9 = 67% 6/3/2014 LCI Main (Hispanic) 0 9 9 7 of 9 6/7 = 86% 4/7 = 57% 8/4/2014 LCI Union** 0 2 2 0 of 2 N/A N/A 9/9/2014 LCI Main 1 11 12 8 of 12 6/8 = 75% 5/8=63% 9/11/2014 Concord 0 4 4 3 of 4 2/3 = 66% 2/3 = 66% 9/4/2014 Cleveland 1 1 2 1 of 2 1/1 = 100% 1/1 = 100% 11/1/2014 Union** 1 0 1 1 of 1 1/1 = 100% 1/1 = 100% 10/7/2014 Pineville 0 7 7 5 of 7 3/5 = 60% 2/5 = 40% 10/30/14 Lincoln** 0 2 2 0 of 2 N/A N/A 11/13/14 Concord HFFC 1 6 7 4 of 7 4/4 = 100% 4/4 = 100% 12/1/14 LCI Main 1 7 8 5 of 8 5/5 =100% 4/5 =80% Totals 12 85 97 68/97 = 70% 52/68 = 76% 46/68 = 67% Positive Comments: LCI Cancer Wellness Program Everything. I just love being here. Best thing that ever happened to me. One of the best things I have ever done for myself. This has been a wonderful opportunity to improve my physical well being and gave me the right outlook for my healthy future. Maryanne Kelly Started Program in June 2014 LCI CWP Success! Program: LCI Cancer Wellness Program Start Date: June 2014 Initial Weight: 178.8 BMI: 30.6 BP: 116/84 HR: 72 Waist: 38 Hip: 42 Pre-Program Health: Prior Lung CA (one lung removed); Brain Mass (CA) Program End Date: September 2014 Weight: 154.6 BMI: 26.5 BP: 124/76 HR: 68 Waist: 36 Hip: 40 Accomplishments: Completed the Survivor Lap at 24 Hours of Booty; Lost 23.4 pounds and improved in all physical aspects tested; Exercising with her husband (riding bikes at the beach) 45 15
LCI CWP Success! From Leukemia Patient to Half-Marathoner March 7 Corporate Cup Half-Marathon April 11 Charlotte RaceFest Half- Marathon 46 Benefits of a Comprehensive Cancer Wellness Program Value of strategic partnerships cannot be measured. Benefits and opportunities for Survivors are undeniable. Opportunities are available from the time of diagnosis. Survivorship Care Planning efforts are important for long term quality of life. Survivors have better odds than ever and their quality of life is dependent on comprehensive programming opportunities. 16