Tag Archives: Resources

One program doesn’t suit all – translating the WWACP in New Zealand and Hong Kong

Following the success of the Women’s Wellness after Cancer Program (WWACP) trials in Australia, Professor Sandie McCarthy had the opportunity to take Women’s Wellness outside of Australia when she took up a position at the University of Auckland back in 2017. We talked to Professor McCarthy about why there was a need for Women’s Wellness programs overseas and how the programs have been translated to be culturally appropriate and successful in different countries and regions.

What was the impetus for translating the programs for different cultures?

In 2017 I took up the role as Head of the School of Nursing at the University of Auckland. Given my background as a chemotherapy nurse in Australia and many years in research developing the Women’s Wellness after Cancer Program, it soon became very clear that there was no cancer research happening in supportive care in New Zealand.

The system was similar in terms of acute cancer treatment but, like Australia, it lacked the aftercare that women were crying out for. And the more I embedded myself in the system and heard from clinicians and patients, the more I realised the critical need for a program like the Women’s Wellness after Cancer Program in New Zealand.

How did you adapt the program for New Zealand and, in particular, Māori women?

I started talking to Cancer Trials NZ, who traditionally dealt with acute treatment, but who were very interested in exploring the development of a supportive cancer recovery program for women in New Zealand. At the same time, we identified that Hong Kong women were also hungry for a program. We successfully secured a grant to support New Zealand and Hong Kong to work together to build up the Women’s Wellness after Cancer Programs to be culturally appropriate and address specific needs in each country.

We worked with community leaders, health practitioners and academics to tailor the programs. In New Zealand, the program we run looks very different to the one we run in Australia. For example, in New Zealand our sessions are run in a Māori cultural space in groups, rather than individual sessions, to recognise that illness is shared by the whole family rather than just tackled by the individual who is unwell.

In Hong Kong, where alcohol is not really a health concern, we stripped that out of the program and the approach we’ve taken is much more direct to suit the learning culture. The Hong Kong program also focuses mainly on gynecological cancer with a strong emphasis on sexuality.

And what’s next?

The trials in New Zealand and Hong Kong have been hugely successful and we’ve since secured two grants to develop Hong Kong and Cantonese versions of the program. We also secured a grant from the Health Research Council of New Zealand to develop a culturally appropriate program for younger women in New Zealand with breast cancer. This trial has just been completed and was a huge success, finishing 12 months earlier than expected, even though it started 9 months late.

We are also really excited to announce that we will be implementing our Women’s Wellness after Cancer Program across a major health service in Queensland and will start to train more than 200 clinicians across their public and private services.

For more information about the Women’s Wellness Programs, visit www.dawncomplete.org.au

Life after cancer treatment – bridging the wellness gap

With the launch of the Women’s Wellness podcast, we spoke to Professor Sandie McCarthy from the University of Queensland about the Women’s Wellness after Cancer Program; its origins, its purpose and how lifestyle interventions can improve post-treatment experiences.

Why do we need a program for Women’s Wellness after Cancer?

The catalyst for the Women’s Wellness after Cancer program happened when I was working as a chemotherapy nurse many years ago. I would provide care for women over an intensive period of time and then never see them again and would often wonder what happened to these women after their cancer treatment. One day I ran into a lady I had helped treat and she looked really unwell. I asked how she was doing and she said that while the cancer was gone, she was left with heart failure. And this was many years before we fully understood the many side effects cancer treatments have.

So from that moment on, I started researching what happened to these women and was quite devastated as a clinician as to the after effects, and long term side effects, of the treatments that I had been administering. In those days these weren’t really well recognised – they are now.

Today we also understand that if we implement certain lifestyle changes, both during and after treatment, we can often prevent those side effects from happening or moderate their effects. And this was ultimately the impetus for the development of the Women’s Wellness after Cancer Program.

What sort of lifestyle modifications can women put in place if they are undergoing cancer treatment or completed treatment?

There’s a raft of different lifestyle changes and modifications women can make after cancer treatment but what ultimately underpins success for women’s wellness is good psycho-social support. We’ve got to wrap these women in a support blanket, because essentially when they’ve left cancer treatment, they’re left to recover on their own – they are considered well. Many women don’t know what lifestyle changes or strategies to use to change their treatment outcomes and post treatment experience.

What we’re really focused on with the Women’s Wellness after Cancer Program is quality of life and function for these women, and how lifestyle modifications can enhance that. This includes things like lots of movement, minimising alcohol wherever possible, eating a really healthy diet, getting enough sleep, minimising the effects of early onset menopause that is brought on by many breast and gynecological cancer treatments and minimising psycho-social distress.

So what can women expect from the Women’s Wellness after Cancer Program?

The Women’s Wellness after Cancer Program is a 12-week, very supportive, lifestyle management intervention program, where we give a lot of clinical and psycho-social support to women. Throughout the 12-weeks we guide them through the lifestyle changes that they need to make in a very evidence-based way. So things like, what’s the best way to get your body moving, particularly when you’ve got pain or neuropathy; what’s the best diet to have – women who have undergone breast cancer treatment, for example, often come out of the treatment weighing a lot more than when they went in due to the nature of the drugs, so we support women to lose weight in the best and safest way. We also help women work through how best to manage the hot flushes and the sleeplessness that is a result of treatment-induced menopause and how to manage lymphedema, which is the swelling of limbs that can occur after some surgeries.

These are just some of the ways we support women during the 12-week program and we’ve had a great deal of success with the program. Since then, we’ve moved onto younger women with the Younger Women’s Wellness after Cancer Program because they have very specific issues around sexual function, fertility, social support and how to bring up young children in the context of this condition, for example.

What’s next for Women’s Wellness?

We’ve expanded the Younger Women’s Wellness after Cancer Program into New Zealand and Hong Kong and next year we’ll be developing a whole new program with Canteen for younger women and young men between the ages of 15 and 24. We’re developing a lifestyle intervention for them, which will be totally delivered by telehealth and designed by the participants – they’ve even designed the logos for the program.

We’ll also be moving into addressing issues like body image in our Programs, because a lot of cancer surgeries, chemotherapy and radiotherapy result in a lot of bodily alteration that can be quite difficult to deal with, from the removal of breasts, lymphedema and stomas on the outside of your stomach rather than normal bowel function, for example. So we’re considering how to support women to develop a ‘normal’ lifestyle in the context of bodily alterations that come as a result of cancer treatments.

For more information about the Women’s Wellness after Cancer Program and other wellness programs, visit www.dawncomplete.org.au 

Intimacy, Sexuality and Cancer

Cancer can have an impact on just about every aspect of a person’s life but one of the more common long lasting effects of cancer, especially breast cancer, are issues relating to body image, intimacy, and sexual function. This supports the principle that these concerns need to be focused on and the opportunity created to discuss them at any stage of the treatment pathway.

There are many definitions for human sexuality and 1  how we feel about intimacy, sex, sexuality, and sexual relationships depends on a range of issues and it’s important to remember it’s not unusual to have sexual difficulties, even in times of good health and well-being. There are numerous reasons for this and often it can come down to inadequate information and education concerning sexual or reproductive health.

So why is it important to talk about sexuality and intimacy when diagnosed with cancer? It’s because this topic is very often overlooked and not discussed. This can be because it is often felt there are more important things to think about and discuss at this time, such as treatments and treatment schedules. Of course, it’s not going to be the first question someone asks their doctor but it commonly is an issue that comes to the fore at some point during or at the end of treatment. Understanding this will help you feel more confident to know when to talk more about it with someone who can help.

Living with cancer can affect a person’s sexual functioning in various ways, some of these effects may be due to the cancer itself, the treatments, or a person’s sense of self and/or their emotions at the time. Some of the sexual issues people with cancer have to deal with can be relatively minor, but sometimes they are ongoing and can be more serious and importantly, these questions change from the time of diagnosis, through treatment, and then into recovery.

As well as a cancer diagnosis, people may also have other conditions such as depression or hypertension, or they may be trying to manage menopause symptoms and along with this, their partners may be dealing with their own medical, psychological, and sexual issues. In fact, one of the best predictors of sexual concerns after a cancer diagnosis is to look at what a person’s intimate life was like before their diagnosis.

Sometimes, cancer can intensify these issues and while people may have managed different levels of desire before, cancer can complicate things and it can have an impact on both patients and their partners. People often say they experience loss of libido and interestingly, partners can too during this stressful time.

There are many solutions, and often a first step is knowing how to bring the topic up and ask for guidance. All patients should receive information about the possible side effects of the disease and treatment on sexuality and intimacy such as altered physical function and libido; problems regarding fertility; and menopause symptoms. It is, however, a difficult topic to bring up, not only for women but also for health care professionals who are also hesitant to initiate discussion and wait for the patient to voice their concerns –and consequently it often becomes an endless circle of inaction, frustration, and sadness.

It is also very important to acknowledge that these worries are valid regardless of a person’s age, whether or not they are in a relationship, the stage of their disease, and the type of cancer and surgery they are dealing with.

Here are some words you could use to help you bring the topic up.

How to bring up the topic with your health care provider:

“Is it safe to have sex / continue with our normal intimate relationship?”

“I have heard this treatment may affect my relationship with my partner.   Can you tell me what might happen?”

“My partner is worried he may hurt me if we have intercourse. Is this something I should be worried about?”

“I don’t feel attractive because of my scars and I’m worried my partner may not find me desirable any more. Can you recommend someone I can talk with about this?”

“I have developed vaginal dryness and its very painful and uncomfortable especially during intercourse – what can you suggest?”

And this may be helpful for health care professionals:

“I always ask how things are going with sexual relationships because it’s really very common to have difficulties after treatment. Is that something you would like to talk about?”

“I’m really pleased to hear the treatment side-effects are settling down. I find for most people at this stage another area of concern may be about intimacy and sexual function. Are there any issues you would like to discuss?”

If connection with a physiotherapist is available to you, their expertise can assist with advice relating to positioning and exercises to help improve pelvic floor strength. A breast care nurse or general practitioner may also be able to provide information regarding the appropriate use of gels and creams – and this is a topic we can provide more information about at another time!

Importantly, be kind to yourself and have realistic expectations.

1 W.H.O. Gender and reproductive rights: sexual health. 2002. who.int/reproductive- Health/gender/sexual_health.html. Accessed May 2007

By Janine Porter-Steele RN PhD and Leonie Young DUniv

This article first appeared in Reach to Recovery’s Bloom magazine, Issue 33 – December 2021.

Magnesium

Magnesium Deficiency

This information has been summarized from a discussion by George. D. Lundberg MD (in medscape.com May 2015)

Dr Lundberg says Magnesium is an essential mineral that has significance in multiple regulatory enzyme systems controlling, bone, muscle, nerve, protein, DNA, glucose and energy metabolism.  He discusses a report in 2009 by the World Health Organization that stated in America 75% of people did not consume enough magnesium in their diet. This may be due to the prevalence of fast or processed food intake. Interestingly consumption of alcohol even in moderate amounts can double or even quadruple the loss of magnesium from the body.

Deficiency in magnesium has been blamed for many illnesses including irregular heart beat, high blood pressure, anxiety, seizures, leg cramps, restless leg syndrome, fatigue, weakness, pre menstrual syndrome, osteoporosis and fibromyalgia. He points out that blood tests are not a reliable indicator of a person’s magnesium level but in people presenting with the issues described above, low magnesium should be considered

The recommended daily intake of magnesium varies according to whether you are male or female but Lundberg says 400mg is an average amount to include in your daily intake, preferably from your diet.

Magnesium is found in dark leafy greens, especially kale and spinach and broccoli, tree-nuts and peanuts; seeds; oily fish; lentils, legumes, whole-grains, avocado, yoghurt bananas, kiwi fruit, dried fruit, dark chocolate and molasses.

Check with your doctor whether or not it is ok to take a supplement if don’t think you are getting enough magnesium in your diet.  (I think I know what my supplement might be……!)

Healthy eating

Colour recipe wheel

The Queensland Health colour wheel – making fruit and veges look very attractive!

This is a great resource as has lots of evidence based nutritional information, including an app and healthy recipes.

Go to healthier.qld.gov.au/tools/colour-recipe-wheel/