Next Steps Research
Evaluation of the Next Steps cancer rehabilitation programme: Report to the New Zealand Breast Cancer Foundation
Written by Dr Judith Ansell, on behalf of the Pinc and Steel Cancer Rehabilitation Trust
Special thanks and awknowledgement must go to our funding partner The New Zealand Breast Cancer Foundation.
There is an increasing body of literature reporting improved outcomes for cancer patients who exercise, in terms of motality, morbidity and reduced fatigue. However, the cancer and treatments themselves make engagement in exercise difficult to access and undertake. Ideally, exercise programmes for cancer patients are offered by instructors who have specific training in the needs of this special population and can provide support for physical and social-emotional needs which may otherwise be barriers to participation.
The Next Steps programme was designed to provide ongoing exercise for women following cancer diagnosis and treatment. The programme combines pilates, yoga, and cardiovascular exercises into a series of ten 1 hour sessions to be delivered by physiotherapists with advanced training in oncology physiotherapy.
Data collected before and after attending a Next Steps course shows definite improvements in a sense of wellbeing, perceived fitness and cognitive skills such as memory. The number of women who thought their overall health and quality of life was very good or excellent doubled over the course of the programme. All of the women who attended Next Steps said they would recommend it to friend and most have said they have a renewed interest in exercise and would like to attend ongoing classes if they were available.
Data collection from the first 87 women through the programme was evaluated. Participant responses to the course were extremely positive with 93% indicating that they loved the whole course and 98% that they would recommend it to a friend. Of particular relevance is the fact 91% of the participants indicated that being part of a programme with other women who had experienced cancer allowed them to feel more comfortable. Most of the women who took part (81%) indicated that they would like to continue and this was reiterated as a major theme in the comments received in the evaluation.
Data collection before and after the programme indicated that course participants experienced substantial improvements in health measures such as perceived fitness, strength and flexibility and being able to relax. In addition, measures of reduced wellbeing including fatigue, body confidence, general confidence, feeling down and difficulty sleeping all showed considerable improvement after 10 weeks.
Daily function is often seriously affected by cancer and cancer treatment. Data collected from the Next Steps programme indicates that an appropriately designed exercise programme can substantially ameliorate some of these effects. Numbers of participants reporting problems with aspects of daily function including feeling tired, weak and experiencing limitations in activity were substantially reduced. Numbers reporting emotional concerns such as feeling worried, irritable and depressed also decreased by approximately 50%. However, the largest improvement in measures of daily function was a decrease in the numbers of participants who reported having memory difficulties, which reduced from 38% to 13%. The role that exercise appears to have in reducing fatigue and improving cognitive function is an aspect of cancer rehabilitation deserving of more attention.
The holistic nature of health and well-being appears to have bee addressed well by the Next Steps programme. Participants have commented on the importance of support from their physiotherapists and other participants who have some understanding of the cancer experience. The chance to relax at the end of the class was seen as an important part of the programme. In addition, the Word of the Day was discussed and appears to have been a positive and inspiring aspect of the course.
The high rate of satisfaction and reported benefits is of particular note as the data was obtained from women who ranged in age between 34 and 77 years and had a range of cancer treatment and medical issues. The positive results reported in the evaluation report suggest that Next Steps is flexible and can address a comprehensive range of reported issues for patients after cancer treatment.
Many Next Steps participants, in commenting on the value of the programme to their physical, emotional and mental health, have voiced a desire to continue with Next Steps or a similar programme, and to see it available to other cancer patients. Given our current knowledge of the importance of exercise for cancer patients, the primary recommendation arising from the evaluation report is to support this request from the Next Steps participants and to emphasise the importance of targeted health improvement programmes for patients who have experience cancer and are seeking to return to a good quality of life.