Often falling between the pediatric and adult health-care systems, many young adults report a lack of support after medical treatment ends, says Professor Jennifer Brunet of the School of Human Kinetics at uOttawa’s Faculty of Health Sciences.
Brunet and her research team have developed a counselling intervention to promote physical activity among young adults aged 18 to 39 who have completed medical treatment for cancer. Results of a small-scale randomized controlled trial suggest it may help young adults engage in more physical activity to deal with lingering physical and psychological side effects.
Filling a gap in post-cancer care
“There’s definitely a gap in services when it comes to supportive care,” says Brunet, Canada Research Chair in Physical Activity Promotion for Cancer Prevention and Survivorship.
“The health-care system is stretched beyond its limits, so I understand that supportive care is not always a priority when compared to other life-saving treatments. As researchers, I think we play a role in bridging that gap and improving access to tailored specialized care.”
To help fill this void, Brunet designed Physical Activity Counselling for Young Adult Cancer Survivors (ACCESS), a behavioural change intervention of six 60-minute sessions with a physical activity counsellor over 12 weeks. The one-on-one sessions take place via videoconference to reach people no matter where they live. They provide personalized support to help young adults engage in an active lifestyle to better manage physical and psychological side effects and enhance their overall well-being after cancer treatment.
“A common struggle that people have is that they and their social network, whether that’s family members, friends or co-workers, believe that when medical treatment for cancer is over you go back to your normal life,” says Brunet. “That could not be farther from the truth.”
Brunet notes that, after treatment, most people will experience side effects such as reduced muscle strength, decreased bone density, weight changes, anxiety, brain fog and chronic fatigue. This can thwart their motivation to be active.
Finding motivation, starting small
Physical activity counselling seeks to boost that motivation, starting with broadening people’s perception of what physical activity is. “It does include exercise, but it’s movement, and basically any kind of movement,” says Brunet. “Just helping people understand that is very powerful. Many people feel they must go to a gym or sign up for a fitness class or do something very vigorous, which they might not be ready to do. We tell them to start small — it could be as simple as 10-minute bouts of activity. There’s evidence that that still provides health benefits.”
Forty-two young adults between the ages of 18 and 39 enrolled in the randomized controlled trial after completing medical treatment for cancer. The trial, which ended in 2023, delivered the ACCESS intervention to 18 participants, who received individualized counselling sessions. Another 22 participants continued receiving usual care and received the intervention handbook after the trial ended. Both participants and counsellors recognized the potential of the intervention for increasing physical activity levels, by offering them tangible strategies tailored to their situation.
“This intervention meant moving on from a really traumatic experience,” said one participant, “and repairing the relationship with my body.”
Towards a new standard of care
Brunet and her research team, which includes experts in oncology, exercise physiology and physical activity psychology from across Canada and abroad, have embarked on the next phase of their project, a large-scale randomized controlled trial. Funded by a five-year Canadian Institutes of Health Research (CIHR) grant, they will compare the effects of the ACCESS intervention with usual care on physical activity levels and well-being immediately after the counselling sessions end and nine months later. They will also analyze how the intervention fosters change in physical activity, to see how it can be optimized.
If the ACCESS intervention is linked to increased physical activity levels and well-being among the participants, the trial will support the case for offering it in practice to young adults, says Brunet. She points out that, just as exercise rehabilitation has become the standard of care for cardiovascular patients, so too could the promotion of physical activity for young adults post-cancer.