Updates from EIM

Developing a Grassroots Physical Activity Referral Network for Cancer Patients: Rising Above + Beyond Cancer

September 29, 2023 by Luann Larson

The American Cancer Society projects that there will be over 1.9 million new cancer cases in the U.S. in 2023. Of that number, 20,460 will be in Iowa. The Iowa Cancer Registry estimates that there will be 360 new cancers in Clinton County, 110 new deaths, and 2,760 individuals living with cancer in Clinton, a county with a population of just under 50,000 residents. The question becomes, how can we improve the lives of those living with cancer?

To address this question, the YWCA in Clinton, Iowa began offering “Above + Beyond Cancer (A+BC)”, an evidence-based program that focuses on recovery and prevention. A + BC was founded in 2011 by Dr. Richard Deming, an oncologist in Des Moines, Iowa. As part of the program, the Des Moines YMCA offers fitness classes, yoga, meditation, cycling, nutrition classes, a book club, outdoor adventures, and cancer education. Since its inception, the program steadily spread to other centers in the Des Moines area. YWCA Clinton, wanting to offer the A + BC program, reached out to Program Director Mary Van Heukelom in fall 2021. With much of the groundwork already in place (e.g., several staff with the ACSM Cancer Exercise Trainer certification), Mary felt that YWCA Clinton had the proper foundation to become a remote branch of the A + BC family. The next challenge was getting buy-in from the local health system.

Healthcare Provider Referral

The A + BC Cancer program is a free program for any cancer survivor referred by a medical professional. The challenge was establishing partnerships to generate awareness and initiate patient referrals with medical professionals in the Clinton area. Fortunately, the hospital serving the greater Clinton area was affiliated with the health system where A + BC founder, Dr. Deming, practiced medicine. Early outreach and awareness efforts included setting up appointments to visit both the radiation and medical oncology groups to introduce the program. Unfortunately, these initial efforts resulted in only a small number of referrals. A review revealed that many of those affected by cancer often did not spend a significant amount of time with their oncologists at the end of their treatment. The Clinton YWCA team realized that the last stop for patients before being released from cancer treatment was physical therapy. Thus, information about A + BC was sent to all the physical therapy teams in town, followed up with a call, and, in some cases, a personal visit to their offices to speak about the program. Informational packets were also sent to all medical professionals and regional oncology departments in the area at the end of 2022. Altogether, these efforts resulted in a slow uptick of patient referrals. A key lesson learned along the way is that constant turnover at the medical facilities requires consistent, ongoing efforts to train new physicians, nurses, and physical therapists on the local resources available to their patients.

The Above + Beyond Cancer Program

When survivors are referred to the A + BC program, they are invited to participate in a baseline assessment that includes questions about the survivor’s quality of life, their goals, and assessing their ability to join either a group training session, Total Training, or if they are better suited to one-on-one sessions with a certified cancer exercise trainer. The Total Training sessions, led by a certified cancer exercise trainer, include strength, flexibility, balance, and aerobic training, as well as a brief discussion section focusing on different health-related topics, such as gratitude, nutrition, and goal setting. At the end of the three months, another assessment is completed to evaluate changes in strength, body fat, and aerobic endurance. To eliminate financial barriers, survivors have access to scholarships, which provide three months of full access membership YWCA Clinton. Additionally, YWCA Clinton partners with Gilda’s Club of the Quad Cities to offer additional monthly support sessions for cancer survivors and their caregivers.

Initial Impact

In only its first year, 18 cancer survivors (15 breast cancer survivors, 3 survivors with other types of cancer) have enrolled in the A + BC program. The largest improvement experienced by the Clinton participants is their aerobic endurance with an average improvement of 30% in the 30-Second Chair Stand and the 2-Minute Step Test. Survivors also experience large improvements in balance, assessed through the 4-Stage Balance test. One A + BC breast cancer survivor, who participated in both the one-on-one and Total Training group sessions, stated, “Each training session feels as though it is tailored to my needs. I can get out of chairs more easily, go up and down stairs, and, most notably, I can mow my lawn in one session, rather than three. I wouldn’t trade the strength that I’ve gained back for anything.” The physical therapist for this participant commented, “Whatever you are doing, keep doing it!”

While the program is still in its early development and growth stages, there is great enthusiasm for the continued growth of the program and helping program participants “Rise Above + Beyond Cancer.”

For more information about the A + BC program, email Luann Larson, Health & Wellness Manager at the YWCA Clinton.

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