IN THE INTERIM BLOG

Cancer and Recurrence; winning the battles

My blog today has been inspired by a story in the BBC News earlier this week. http://www.bbc.co.uk/news/health-36455818

A major trial is about to commence in the US and Canada to discover the potential link between cancer recurrence and obesity. It reminded me of my own, much smaller, trial in 2010-2011 in England when I was a Service Improvement Facilitator at the Dorset Cancer Network. I co-managed a survivorship project with the aim of introducing an exercise and dietary management programme for women after diagnosis and treatment of breast cancer that would lead to a lasting beneficial change in health behaviour, weight reduction and improvement in quality of life. Drawing on the many national and international studies on healthy lifestyle choices and breast cancer at that time, a breast cancer unit at a Dorset hospital was chosen to expand on this body of work by exploring the impact of a specific physical and dietary intervention. At that time there were no exercise/dietary rehabilitation programmes available to patients following breast cancer treatment yet, increasingly, evidence suggested that physical rehabilitation could lead to patients returning to normal lifestyle more quickly and that exercise and weight reduction (by following a low fat diet) may have a role in reducing recurrence of breast cancer. Furthermore, there was evidence to suggest that exercise may reduce symptoms such as depression, arthralgia, hot flushes, low bone mineral density and other side effects of treatment. We introduced a four week introductory Nordic walking exercise programme under instructor supervision together with a weight management programme under the care of community dietetics. At both the beginning and end of the project patients were weighed and measured (BMI and waist circumference). A visual analogue scale was completed in terms of symptoms of arthralgia (bone pain) and hot flushes. A HAD scale to assess psychological status was also completed as were qualitative dietary changes assessed by food frequency questionnaires and/or food diaries before and after intervention. Finally, a patient questionnaire survey assessed satisfaction with the intervention.

The results were fantastic; the cohort of patients either maintained or reduced their BMI over the period of the programme. One patient in particular, lost a total of 4.5st with greatly improved lymphoedema. The work with the dietician was particularly appreciated by the patients as this had not been previously available in such depth. Reduction in medication for conditions such as depression were also reported as were less tangible benefits such as feelings of “a return to society” as opposed to being in “patient mode”. Follow up clinics were also felt to be more positive in terms of a more individualised approach to each patient – assessing and meeting their needs more accurately. The patient and clinician relationship was also felt to be more of a partnership in making decisions regarding future treatment. There was also the benefit of more relaxed carers and families. Patients gained an understanding of the principles of a healthy low fat diet whilst not compromising Vitamin D and Calcium intake. They felt empowered to self-care in terms of exercise and following a healthy, low fat diet. Patients reported improved satisfaction with their post treatment and quality of life was improved for all patients post intervention.

And, of course, good health and the reduction in recurrence isn’t just good for the patient, it’s also good for their families, for the economy and for the NHS.

I hope this trial in the US and Canada brings about similar results – I feel sure that it will – and I cannot wait to hear how patients’ lives have been improved.

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