Translating research into practice: outcomes from the Healthy Living after Cancer partnership project.

BACKGROUND: Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. METHODS: In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. RESULTS: Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor. CONCLUSIONS: This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors' health and quality-of-life at a relatively low cost. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Factors influencing non-participation in an exercise program and attitudes towards physical activity amongst cancer survivors.

PURPOSE: The purposes of this study are to investigate factors influencing non-participation in a structured exercise program for cancer survivors and to explore survivors' experiences and attitudes in relation to physical activity participation. METHODS: Face-to-face or telephone interviews were conducted with individuals who had registered for, or engaged in, the 'Life Now' exercise program run by Cancer Council Western Australia. Participants were 20 cancer survivors (mean age 63.90 years, SD 15.29) who had either cancelled their registration or withdrawn from the exercise program during the preceding 2 years. Interview transcripts were analysed using thematic analysis. RESULTS: Seven main themes emerged: availability of the program; access, time and cost; lack of motivation or confidence; unwell or fatigued; physical activity preferences; knowledge of physical activity guidelines; and lack of referral or advice. The main barriers were contextual and included availability of, and access to, the program. Participants expressed a preference for home-based physical activity. CONCLUSIONS: Interventions aimed at promoting physical activity in cancer survivors should offer home-based programs and include referral and advice from oncologists. IMPLICATIONS FOR CANCER SURVIVORS: Increasing cancer survivors' participation in, and compliance with, exercise programs may require home-based strategies and referrals from oncologists to allied health professionals to individualise care.

Healthy Living after Cancer: a dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors.

BACKGROUND: Given evidence shows physical activity, a healthful diet and weight management can improve cancer outcomes and reduce chronic disease risk, the major cancer organisations and health authorities have endorsed related guidelines for cancer survivors. Despite these, and a growing evidence base on effective lifestyle interventions, there is limited uptake into survivorship care. METHODS/DESIGN: Healthy Living after Cancer (HLaC) is a national dissemination and implementation study that will evaluate the integration of an evidence-based lifestyle intervention for cancer survivors into an existing telephone cancer information and support service delivered by Australian state-based Cancer Councils. Eligible participants (adults having completed cancer treatment with curative intent) will receive 12 health coaching calls over 6 months from Cancer Council nurses/allied health professionals targeting national guidelines for physical activity, healthy eating and weight control. Using the RE-AIM evaluation framework, primary outcomes are service-level indicators of program reach, adoption, implementation/costs and maintenance, with secondary (effectiveness) outcomes of patient-reported anthropometric, behavioural and psychosocial variables collected at pre- and post-program completion. The total participant accrual target across four participating Cancer Councils is 900 over 3 years. DISCUSSION: The national scope of the project and broad inclusion of cancer survivors, alongside evaluation of service-level indicators, associated costs and patient-reported outcomes, will provide the necessary practice-based evidence needed to inform future allocation of resources to support healthy living among cancer survivors. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR)--ACTRN12615000882527 (registered on 24/08/2015).

'Nothing beats the doctor's face to impart trust in their judgement': the role of telehealth in cancer care.

Despite Western Australia having low COVID-19 case numbers and limited community transmission, cancer service delivery changes were introduced early in the pandemic, including adoption of telehealth. Patients attending telehealth appointments during COVID-19 between 11 May 2020 and 7 August 2020 reported that telehealth lessened their concerns and met their needs to varying degrees. Despite this, 56% of patients still preferred in-person appointments.