Exercise and nutrition routine improving cancer health (ENRICH): the protocol for a randomized efficacy trial of a nutrition and physical activity program for adult cancer survivors and carers.

BACKGROUND: The Exercise and Nutrition Routine Improving Cancer Health (ENRICH) study is investigating a novel lifestyle intervention aimed at improving the health behaviors of adult cancer survivors and their carers. The main purpose of the study is to determine the efficacy of lifestyle education and skill development delivered via group-based sessions on the physical activity and dietary behaviors of participants. This article describes the intervention development, study design, and participant recruitment. METHODS/DESIGN: ENRICH is a randomized controlled trial, conducted in Australia, with two arms: an intervention group participating in six, two-hour face-to-face sessions held over eight weeks, and a wait-list control group. Intervention sessions are co-facilitated by an exercise physiologist and dietician. Content includes healthy eating education, and a home-based walking (utilizing a pedometer) and resistance training program (utilizing elastic tubing resistance devices). The program was developed with reference to social cognitive theory and chronic disease self-management models. The study population consists of cancer survivors (post active-treatment) and their carers recruited through community-based advertising and referral from health professionals. The primary outcome is seven-days of sealed pedometry. Secondary outcomes include: self-reported physical activity levels, dietary intake, sedentary behavior, waist circumference, body mass index, quality of life, and perceived social support. The outcomes will be measured at baseline (one week prior to attending the program), eight-weeks (at completion of intervention sessions), and 20-weeks. The intervention group will also be invited to complete 12-month follow-up data collection. Process evaluation data will be obtained from participants by questionnaire and attendance records. DISCUSSION: No trials are yet available that have evaluated the efficacy of group-based lifestyle education and skill development amongst mixed groups of cancer survivors and their carers. The results will have implications for the planning and provision of health and support services during the cancer survivorship phase. CLINICAL TRIALS REGISTRATION: Australian New Zealand Clinical Trials Register identifier: ANZCTRN12609001086257.

Exploring the impact of training on the experience of Australian support group leaders: current practices and implications for research.

BACKGROUND: Existing literature suggests that the effectiveness of a support group is linked to the qualifications, skills and experience of the group leader. Yet, little research has been conducted into the experiences of trained vs. untrained support group leaders of chronic-illness support groups. The current study aimed to compare the experience of leaders, trained vs. untrained in group facilitation, in terms of challenges, rewards and psychological wellbeing. METHODS: A total of 358 Australian leaders of cancer and multiple sclerosis (MS) support groups, recruited through State Cancer Councils and the MS society (response rate of 66%), completed a mailed survey. RESULTS: Compared with untrained leaders, those with training were significantly younger, leading smaller groups and facilitating more groups, more frequently (all P < 0.05). Trained leaders were more likely to be female, educated beyond high school, paid to facilitate, a recipient of formal supervision and more experienced (in years) (all P < 0.01). Untrained leaders reported more challenges than trained leaders (P < 0.03), particularly struggling with being contacted outside of group meetings (52%) and a lack of leadership training (47%). Regardless of level of training, leaders identified a number of unmet support and training needs. Overwhelmingly, leaders found their facilitation role rewarding and the majority reported a high level of psychological wellbeing. CONCLUSIONS: Group facilitator training has the potential to reduce the burden of support group leadership. Developing interventions to assist support group leaders will be particularly beneficial for leaders with minimal or no training group facilitation training.

Changes in sexuality and intimacy after the diagnosis and treatment of cancer: the experience of partners in a sexual relationship with a person with cancer.

Changes in sexuality and intimacy after cancer were examined using open-ended questionnaire responses with 156 informal carers who were partners of a person with cancer. Interviews were conducted with 20 participants to examine changes in depth. Seventy-six percent of partners of a person with "nonreproductive" cancer types and 84% of partners caring for a person with cancer involving "reproductive" sites reported an impact on their sexual relationship. Cessation or decreased frequency of sex and intimacy was reported by 59% of the women and 79% of the men. Renegotiation of sexuality and intimacy after cancer was reported by only 19% of the women and 14% of the men. Reasons for changes to sexuality after cancer were the impact of cancer treatments, exhaustion due to caring, and repositioning of the person with cancer as a patient, not a sexual partner. Changes to sexuality were associated with reports of self-blame, rejection, sadness, anger, and lack of sexual fulfillment. Positive consequences of changes included accepting the changed sexual relationship and having increased closeness and intimacy. These findings reinforce the need to acknowledge the sexual needs of partners as well as people with cancer, by healthcare professionals working in cancer and palliative care.

Cancer knowledge and perception of skills of general practice registrars in Australia.

BACKGROUND: The objective was to assess cancer knowledge and perception of skills of general practice (GP) registrars in Australia. This will help design future educational resources. METHODS: We surveyed GP registrars in different Australian states. RESULTS: Of the registrars, 86% rated highly their ability in performing cervical smears. Registrars reported examining more patients with breast cancer, lung cancer, or melanoma than rectal cancer, cancer of mouth/tongue, or lymphoma. More registrars rated the quality of their training as reasonable or better in assisting patients to stop smoking or modify alcohol intake than in cancer-related tasks. One third rated their teaching on management of curable/incurable cancer and care of the dying as poor and/or very poor, and over half had never examined prostate or rectal cancers. CONCLUSIONS: GP registrars generally have good knowledge of cancer. Their exposure to cases of cancer is low, and it is of concern that many have never examined common tumors in our community.

Older women's sexuality.

In consultations with older women, doctors should ask about sexual problems. A holistic approach is needed to examine the many different factors that can affect sexuality. Hormonal changes associated with ageing have an impact on women's sexuality. Doctors need to have a clear idea of the place of hormonal treatment for different sexual problems. Physical changes associated with ageing, including illness and disability, may interfere with sexual expression. Diseases of the endocrine, vascular and nervous systems will most commonly affect sexual function. A broad range of psychosocial factors associated with ageing may influence sexuality.

Sexuality and body image after cancer.

BACKGROUND: Cancer and its treatments can profoundly affect a person's sexuality including their body image, sexual functioning, relationships, identity and self esteem. One of the more common long lasting effects of cancer treatment is sexual dysfunction, yet for a number of reasons, health practitioners may not adequately address these topics. OBJECTIVE: This article describes the range of factors contributing to psychosexual problems for people with cancer and provides a useful framework for addressing problems and taking a sexual history. DISCUSSION: More than half of all people diagnosed and treated for cancer in Australia now survive their disease. Many of these survivors suffer from significant physical and emotional changes during and after their cancer treatments that affect their sexuality and sexual functioning. Such patients need an opportunity to discuss these changes with their health practitioners, but all too often are not given the opportunity to do so.