Translating research into practice: outcomes from the Healthy Living after Cancer partnership project

Abstract

Background Healthy 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. Methods In 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. Results Four 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. Conclusions This 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 registration Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Evaluation of the Healthy Living after Cancer Text Message-Delivered, Extended Contact Intervention using the RE-AIM Framework

“…Participants eligible for HLaC were adults (18 + years) diagnosed with any form of localised cancer (nonmetastatic) who had been treated with curative intent. Participants were required to have: completed primary treatment (i.e., surgery, chemotherapy, radiation; patients receiving hormonal treatment or Herceptin were still eligible); no contraindications to engaging in unsupervised physical activity (i.e., active heart disease, breathing problems requiring hospitalisation in the six months prior to joining the program, undergoing dialysis, diabetic complications such as severe neuropathy or retinopathy, planning a knee or hip replacement in the next six months, pregnant); no cognitive or mental health impairments that would hinder program participation: and were able to speak and read English su ciently to allow for program participation; wanting support for healthy living via physical activity and healthy eating and willing to make a 6-month commitment to HLaC program participation (26,27). Participants who completed the HLaC program between December 2015 and January 2017 and who consented to completing an additional assessment six months after completing HLaC formed the control cohort.…”

“…To date, the initial HLaC program is being adapted and offered by three CC at a reduced scale or in a webbased format (27). The CCs are funding the delivery of these adapted programs, as the research grant funding is complete and at the time of publishing this manuscript no CCs were continuing to offer textmessage delivered extended contact.…”

“…This paper describes the implementation and evaluation of a text message-delivered, extended contact intervention for Healthy Living after Cancer (HLaC). HLaC was a 6-month, telephone-delivered health coaching intervention targeting physical activity, diet and weight loss in cancer survivors who had previously been treated with curative intent (26,27). The intervention was delivered by Cancer Councils (CCs) across Australia and evaluated in the context of a dissemination and implementation trial (26,27).…”

Evaluation of the Healthy Living after Cancer text message-delivered, extended contact intervention using the RE-AIM framework

“…Using the RE-AIM framework [ 26 ], this paper describes the outcomes of a text message-delivered, extended contact intervention for Healthy Living after Cancer (HLaC). HLaC was a 6-month, telephone-delivered health coaching intervention targeting physical activity, diet and weight loss in cancer survivors who had previously been treated with curative intent [ 27 , 28 ]. The intervention was delivered by Cancer Councils (CCs) across Australia and evaluated in the context of a dissemination and implementation trial [ 27 , 28 ].…”

“…HLaC was a 6-month, telephone-delivered health coaching intervention targeting physical activity, diet and weight loss in cancer survivors who had previously been treated with curative intent [ 27 , 28 ]. The intervention was delivered by Cancer Councils (CCs) across Australia and evaluated in the context of a dissemination and implementation trial [ 27 , 28 ]. Following completion of the HLaC program, clients were offered HLaC+Txt, a 6-month text message-delivered, extended contact intervention.…”