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

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

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. THANK YOU