Promoting lifestyle strategies to help keep elderly cancer survivors able and functional.
Today, some cancers like prostrate, breast and colon cancer are considered chronic condition, with characteristic “persistent or recurring health consequences” lasting years. The many after-effects of cancer and treatments, and the issue of recurrence, require some level of self management.
The rising tide of cancer survivors calls not only for better professional support, but for survivor- and community-level engagement. Cancer survivors must play an active role in self-management and adopt self-care strategies for a better quality of life.
The idea of patient self-management has been around for some time. Many countries, Malaysia included, have developed some form of self-management support programmes to enable survivors to cope effectively and reduce the long-term impact of cancer.
Cancer survivorship is an emerging field that's been described as a period with at least three distinct “theoretical” phases linked to cancer survival – the time from diagnosis to the end of initial treatment, the transition from treatment to extended survival, and long-term survival.
Nevertheless, in practice, this concept of survivorship is often associated with the period after active treatment. This is a critical period for readjustment back into roles and relationships. During this period of cancer survivorship, the focus needs to shift to rehabilitating and readjusting to a new “normal”, and importantly, into adopting a healthy lifestyle while coping with the fear of cancer recurrence.
In fact, a cancer diagnosis has been identified as a potential “teachable moment”, wherein the illness experience becomes a catalyst for behaviour change and sustainable lifestyle benefits for survivors (and caregivers who are not spared the emotional and personal journey of fear).
There's mounting evidence that caregivers are often impacted and can also be motivated to help make positive changes to improve their health after a loved one’s cancer diagnosis. It is within the “teachable moment” that lifestyle redesign interventions can have the greatest potential for long-term success throughout the cancer continuum for both survivors and caregivers.
In simpler terms, self-management is a concept referring to the component of self-care that's informed by evidence-based health. It's about the daily actions, which survivors and carers undertake for themselves, their children, families and others to stay fit and maintain a good physical and mental health; to meet social and psychological needs; to prevent illness (or even age-related falls or accidents); care for minor ailments (joint stiffness, flu, etc); and long-term conditions.
It’s essentially the human occupation of maintaining health and well-being after an acute illness or discharge from hospital.
Managing Risk Factors
Cancer is a multi-factorial condition with a wide variety of risk factors.
During cancer survivorship, cancer survivors should engage in modifying some of the modifiable lifestyle risk factors – excess weight, physical inactivity, poor diet, smoking and alcohol consumption – which are increasingly being implicated in the development of many cancers.
Among the many risk factors, some of the most common are modifiable health behaviours.
In 2009, the World Health Organisation (WHO) highlighted these, and they include sedentary lifestyle, lack of physical activity, unhealthy low fibre and high fat diet, tobacco use, and excessive alcohol consumption. In the same year, the World Cancer Research Fund had estimated that 27%-39% of cancers can be prevented by improving diet, physical activity and body composition.
The relationship between these lifestyle factors and issues of cancer recurrence, development of subsequent primary cancers, and overall survival rates provide researchers the required evidence for making useful conclusions, especially as these factors are lifestyle habits that are modifiable. Last year, WHO reported that insufficient levels of physical activity causes a 20%-30% increased risk of all-cause cancer mortality and has been attributed to 3.2 million annual cancer deaths worldwide.
Maintenance of a normal body mass index (BMI) is a vital factor in cancer outcomes and general health in survivorship. Community and occupational therapy, and support for better lifestyle activity during survivorship is now warranted for cancer survivors.
Overall, given the evidence of the effectiveness of lifestyle modifications on cancer and health in general, promoting healthy occupational behaviour choices can hardly do the cancer survivor population any harm. Instead, it may positively impact on cancer care and overall survival in the long run. The strategies will also serve to educate the cancer-free population about cancer and its risk factors.
> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail firstname.lastname@example.org. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.