Why did you do this study?
Breast cancer is the most common cancer in women with one in three women diagnosed in their lifetime. In 2013, breast cancer is expected to account for 29% of all new cancer cases in women (Siegel et al., 2013). Due to earlier detection and improvements in treatment the five-year survival rate has steadily increased from 63% in the early 1960s to 90% in 2012 (ACS, 2011-2012).
In 2007, the Institute of Medicine identified shortfalls in cancer care and noted that survivors need increased access to services that improve both psychosocial and physical functioning. Addressing the post treatment concerns of survivors is critical because psychological distress and physical symptoms remain high for years post treatment (Bleker et al., 2000; Ganz, 2009; Wiel et al., 2007). Lingering psychological and physical symptoms often lead to decreased quality of life (Cordova et al., 1995) and is related to fatigue, depression, anxiety, and general decrease in performance in everyday activities (Duijts et al., 2010). Integrative therapies that address the psychosocial and physical needs of breast cancer survivors are needed to improve quality of life and well-being of breast cancer survivors (Block et al., 2009).
The purpose of the Get REAL & HEEL (GRH) program was to provide breast cancer survivors who have recently completed all major cancer therapies, with an opportunity to improve physical and psychosocial health through an integrative program consisting of recreation therapy and exercise.
What did you do and what did you find in this study?
The impact of GRH was measured using both quantitative and qualitative research methods. The results of two studies will be briefly highlighted.
Impact of GRH on Distress and Quality of Life
One study focused on the effect that the 20 week randomized controlled trial had on distress and quality of life. One hundred and twenty two women with stage I-III breast cander were randomly assigned to one of four groups: 1) integrated exercise and recreation therapy, 2) exercise only, 3) recreation therapy only, or 4) delayed treatment (control).
Participants completed the a) Impact of Event Scale to measure cancer related distress, and the b) Functional Assessment of Cancer Therapy – Breast (FACT-B) to measure quality of life. The questionnaires were completed during the initial assessment, at the completion of the eight-week randomized portion of the intervention, and at the 20 week conclusion of the trial.
Women in the Integrated Exercise + Recreation Therapy, Exercise Only, and Recreation Therapy Only groups had significantly reduced levels of distress compared to the control group at week 8. Women in the control group experienced comparable reductions in distress once they received the Integrated Exercise & Recreation Therapy intervention in weeks 8 – 20. Quality of life was not significantly different between groups over time.
Impact of GRH on Cancer Recovery
In addition to the results described above, narrative research was used to explore how participants used a challenge course to negotiate the meaning of their experiences with breast cancer. As a part of the Recreational Therapy the women participated in a series of challenge course programs. A challenge course consists of group activities that present physical and psychological problems that the group must solve. After completing the challenge, a facilitator leads the group in reflective conversations that allow participants to draw greater meaning from the experience. These reflective conversations served as the primary data source for this study, and we used a form of discourse analysis to analyze the data.
We identified three primary themes that illustrate the value of the challenge course experience. The women felt that it was critical that the Different Journeys that they were experiencing be acknowledged and valued. Cancer recovery is not identical for everyone despite typical perceptions of it being so, and recovery necessitates that women negotiate the way that they want to assign meaning to the experience. Secondly, the women valued the program for its ability to allow them to feel a sense of Mutual Support from the other program participants. They felt empowered and inspired to move beyond the experience of having cancer because of the other program participants. Lastly, the program offered them an opportunity to Re-Author Themselves and Identities. In a sense, the program was helping them to use cancer as a transformative experience that afforded them an opportunity to create a new sense of identity.
How do these findings impact the public?
Interventions that effectively decrease distress and facilitate effective coping are integral to overall health outcomes post cancer treatment (Movas et al., 2009). Yet treatment intended to reduce distress and facilitate healing remains a missing component of most cancer care. Particularly given that more women are surviving breast cancer, the development of the mental and emotional capacity to manage side effects and make choices that promote survivorship are critical (Weil, 2009). These two studies demonstrated that Recreational Therapy and Exercise are effective mechanisms to decrease the distress created by having breast cancer. Using novel therapies such as challenge course programming further facilitates the ability of survivors to develop effective coping mechanisms and engage in the reflective process needed to fully negotiate the meaning of their experiences with breast cancer.