Historically, the paediatric oncology physiotherapy service in our hospital was reactive, responding to and prioritising therapeutic need only. Despite emerging evidence showing the positive impact of physical activity on the long-term outcome of CYP with cancer, we had no capacity to implement this into our workload.
Research shows that physical activity levels are almost always reduced during treatment, and this can be seen for years after treatment ends. Moreover, exercise support and provision for CYP hasn’t been well integrated into healthcare and society, leading me to question whether we could change the way we work by implementing a pathway to keep them active, empower them, and support behaviour change from the day of diagnosis.
What did I do?
I submitted a charity application for funding to test this in the form of a quality improvement project called iCanMove, initially applying the pilot pathway to a group of children with ALL. Our research told us that in our hospital CYP and their families wanted support with three main things:
- Guidance on how to stay active during treatment
- Where to go in their local area with their friends and siblings
- How to continue their clubs and hobbies
From those three aims, I developed two vision statements for the project. The first was from a clinical perspective, and the second from a patient perspective:
- For physical activity and exercise to become a mainstream of cancer treatment for all CYP diagnosed at The Great North Children’s Hospital
- I want to still see my friends, have fun and stay strong
The new physical activity pathway was then developed and applied to all CYP with a new diagnosis of ALL. I’m currently working on collecting the retrospective data, but the anecdotal impact of the pathway so far has been incredible. I now work proactively with this group of CYP. They’re seen quicker and have active conversations from the day of diagnosis, where I’m able to educate and reassure them and their families about staying active safely and appropriately, adapting when required.
They’ve reported feeling empowered and more knowledgeable about how, when and why they should stay active. Parents have said it’s something they can help their child with during treatment, giving them a little control back.
There’s been no rehabilitation admissions, referrals to local services or extra physiotherapy outpatient appointments needed for any CYP on the pathway. I’ve made many new contacts and partnerships with charities, local activity clubs and public health, which has provided more opportunities for the CYP in their local areas. Some of these contacts are now also coming in and working on the ward, clinic and day unit.
Prior to my diagnosis I went to the gym every day. When I became unwell and was admitted to hospital, I soon had a portacath put in. I wasn’t sure how this would affect my ability to train but with support and guidance from Louise, I was able to go to the gym and know what I could and couldn’t do, helping me retain some of my strength. This meant I was still able to walk my dog instead of sitting in the house all the time and gave me a sense of normality.
Graeme-18-patient
What’s next?
I’m now hoping to apply the pathway for CYP with other types of cancer, and I’ve recently submitted a funding application for the next phase which includes the recruitment of sport coaches to work with CYP in the hospital, as well as in a community outreach setting. I’m also co-chairing a CCLG physical activity and exercise subgroup, which has been created alongside other health and social care professionals. Our national vision is for physical activity and exercise support to be a standard part of supportive care for all CYP following a cancer diagnosis.
From Contact magazine issue 105 | Winter 2024
