Abstract
BackgroundHealthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program.MethodsIn this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata.ResultsFour of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor.ConclusionsThis telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors’ health and quality-of-life at a relatively low cost.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).
Highlights
Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors
Eakin et al BMC Cancer (2020) 20:963 (Continued from previous page). This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors’ health and qualityof-life at a relatively low cost
The Healthy Living after Cancer (HLaC) Partnership Project is a dissemination and implementation trial evaluating the effect of a 6-month, telephone-based lifestyle intervention for cancer survivors delivered by four Australian state-based Cancer Councils as part of their Cancer Information and Support Service
Summary
Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The number of cancer survivors is rapidly increasing worldwide [1] This is largely due to improved screening and treatments leading to increased survival rates for the majority of cancers. Engagement in regular physical activity, improvement in diet and keeping within a healthy weight range are recognised as evidence-based methods of mitigating these long-term risks and are recommended by most national cancer organisations [7,8,9]. These recommendations are supported by a strong body of evidence showing they lead to improved survivorship outcomes; yet, adherence to these recommendations is poor [10]. While most cancer survivors desire guidance regarding healthy lifestyles [15, 16], and there is increased recognition of the importance of improving healthy lifestyle behaviours in models of survivorship care [17], cancer care does not routinely include such assistance [15, 18, 19]
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