Macmillan Next Steps Cancer Rehabilitation Jo Pain Macmillan Specialist Dietitian Clare Lait Macmillan Specialist Physiotherapist

AIMS & OBJECTIVES Current challenges in Cancer Survivorship Case Study Introduction to Macmillan Next Step Rehabilitation

CHALLENGE By 2020 nearly 1 in 2 people will receive a cancer diagnosis 70% of people with a cancer diagnosis have at least one other long term condition Estimated by 2030, there will be 37,400 people living with and beyond cancer in Gloucestershire 25% of people with cancer suffer from long term poor health or disability following treatment

CASE STUDY Reduced Activity/fitness Low mood Erectile dysfunction Weight gain Sleep disturbances Change in body image 69 year old man diagnosed with Prostate Cancer. Treated with radiotherapy followed by hormone treatment Fear of recurrence Hot flushes

BARRIERS TO CHANGE Friends & family Social stigma Embarrassment Unhelpful conversations - acceptance or cost of ‘living’ post cancer Fatigue Loss of motivation & empowerment Loss of identity

IMPACT Increase in Long term health conditions such as diabetes, osteoporosis Increase in risk of cancer recurrence (due to weight, activity, health behaviours) Social isolation & challenges with relationships Increase use of GP appointments Increased pressure on staffing Financial impact More than 3x as many people aged over 65 will be living with cancer by 2040 Increased use of benefits 37% of those who survive cancer do not return to work We have strong evidence that being overwt increases the risk of 11 different cancers. That makes it the biggest lifestyle risk factor for cancer, secondary to smoking. We could prevent about 1 in 6 of these cases (that’s 25,000 cases a year). An estimated 5% of cancer cases in the UK each year are linked to excess body weight Scientist estimate that 2 in 5 of breast cancer cases in the UK could be prevented by maintaining a healthy wt, being physically active & not drinking alcohol – that’s 20,000 fewer cases a year Scientists now think that 1 in 11 cases of advanced prostate cancers in the UK could be prevented by maintaining a healthy weight Systematic review of 71 prospective cohort studies: leisure time physical activity linked to national guidelines of 150 minutes is associated with a 30% reduced risk of breast cancer mortality. (British Medical Journal) Results of 2 studies suggested that risk of disease recurrence & cancer mortality was reduced by about 50%, by performing the equivalent of 6 hours of moderate intensity physical activity per week (brisk walking). (Meyerhardt et al 2006)

WHERE DO THESE PATIENTS CURRENTLY GO? GP Service Suffer in silence Charitable care i.e. Maggies, Charlies (limited localities and limited AHP input) Secondary care - A&E, inappropriate admissions, consultant clinics

ADDITIONAL PROBLEMS Lack of AHP Cancer specialists – Country & county wide Lack of knowledge of role of AHP’s for patients & professionals or how to refer

SOLUTION Macmillan Next Steps Cancer rehabilitation Aims to ensure people in Gloucestershire with Breast, Colorectal and Prostate Cancer can feel supported to live well, with and beyond cancer, by offering: Patient group education and information programmes 1:1 Cancer Rehabilitation Education to Health care professionals

CASE STUDY PATIENT 1:1 with Dietitian for weight management +/- referral onto Recipe for Health: Healthy Weight group for long term maintenance 1:1 with Physio +/- referral onto Active Everyday exercise programme Take Control/HOPE courses for management of anxiety, sleep disturbances, fatigue management and dealing with fear of recurrence

OUTCOME FOR PATIENT Management of weight & improved body image Improved knowledge of healthy eating and dispelling myths regarding diet & cancer Improved fitness and knowledge of how to maintain Socialisation and support from other cancer survivors Regained identity and empowerment Improved relationships Improved sexual function - Pelvic floor/Strengthening/relaxation Improved sleep Management of anxieties and use of Mindfulness Improved fatigue

HEALTH, SOCIAL & FINANCIAL OUTCOMES More appropriate use of secondary care resources Better long term health outcomes Reduced risk of cancer recurrence Reduced financial impact

I have learnt to have a more positive attitude & feel less lonely. I would never have had the confidence to return to exercise without the help of Next Steps. Since I started Active Everyday I feel so much better about myself, my energy levels have increased and I have been able to move on I have learnt to have a more positive attitude & feel less lonely. I felt very alone since my cancer diagnosis. I now know that I am not. Macmillan Next Steps has made a real difference to my life, enabling me to rediscover my core, increase my confidence and move on. Macmillan Next Steps has been invaluable to getting me going again

THANK YOU