Psychosocial and Supportive Care Interventions

Recommendation 1: Supporting Healthy Lifestyle Behaviours

It is recommended that survivors have access to self-management focused education and support to facilitate tailored adoption of healthy lifestyle behaviours inclusive of: daily physical activity; balanced nutrition; and smoking cessation programs designed to improve health related quality-of-life and physiological outcomes, reduce distress and risk of recurrence.

Tactics:

1. Exercise, dietary, or smoking-cessation programs should be tailored to meet the individual survivor’s goals, ability level, and available resources. The appropriateness and safety of the program should be considered in consultation with the survivor and the interdisciplinary health care team.
2. Advise cancer survivors to gradually increase physical activity intensity, as tolerated, for a minimum goal of 30 minutes of exercise a day for five days a week if possible.
3. Advise cancer survivors to integrate a combination of aerobic exercises (e.g., leisure sports, jogging, exercise classes, bike riding), strength training (e.g., resistance training with weights, bands or body weight), flexibility training (e.g., stretching, yoga, Pilates), as appropriate.
4. Refer cancer survivors to the Canada Food Guide for recommendations for a healthy diet, considering special needs related to cancer diagnosis and treatment (e.g., ostomy management, swallowing difficulties, drug interactions).
5. Consider referring cancer survivors to a registered exercise professional and registered dietitians to facilitate the adoption of healthy lifestyle management behaviours, especially for issues such as weight maintenance, body composition and management of persistent fatigue.

Recommendation 2: Use of Theory-based Approaches

It is recommended that psychosocial and supportive care programs and interventions be designed based on health-behaviour change theories that are known to be influential and necessary for sustaining the adoption of healthy lifestyle behaviours.

Tactics:

1. Developers and providers of cancer survivorship services should consider using well-tested theories of behaviour change such as the trans-theoretical model, theory of reasoned action, or social cognitive theory, to support the development of effective psychosocial and supportive care behavioural change interventions for post-treatment cancer survivors.

Recommendation 3: Management of Psychosocial Concerns and Distress

It is recommended that survivors at risk of, or with identified and significant, psychosocial concerns or distress be offered referral to psychosocial health services, individualized or group-based cognitive behavioural or psychoeducational programs provided by trained professionals.

Tactics:

1. Psychoeducational and cognitive behavioural therapy interventions should be adopted or developed to address the unique needs of cancer survivors in the post- treatment phase and should:
   • Address a specific and explicit need of the cancer survivor population (i.e., cancer- related fatigue or psychosocial distress).
   • Incorporate multiple components such as education, problem solving, stress management, coping skill training and psychosocial support.
   • Use individualized therapy and potentially incorporate group counselling.
   • Integrate a variety of interventions such as face-to-face, group, video, and telephone counselling.
   • Empower individuals and their families with the skills and knowledge necessary to be active participants in their life-long care.

Recommendation 4: Monitoring for Symptoms and Late and Long-term Effects

It is recommended that protocols for routine follow-up include monitoring for and managing physiological and psychosocial symptoms, including pain and fatigue, and late and long-term effects, such as pulmonary or cardiac effects, osteoporosis, and other endocrine or body system abnormalities. A coordinated shared-care approach should be used, including referrals to appropriate interdisciplinary team members as appropriate.

Tactics:

1. Standardized screening and assessment protocols for early identification of late and long term effects should be adopted for use in all cancer programs.
2. Protocols for management of late and long term effects adopted from evidence- based guidelines should be implemented in cancer follow-up programs and family physician practices.
3. Early interventions in anticipation of late effects such as osteoporosis implemented early in the treatment trajectory may be important in reducing persistent problems.

Recommendation 5: Managing Concerns Regarding Sexual Health

It is recommended that survivors receive specific psychoeducational-based care regarding changes in sexual health and function. They should have access to programs that include couple’s therapy for both the cancer survivor and his or her partner, and sexual rehabilitation programs to promote healthy post-treatment sexual health and maximize function.

Tactics:

1. All health care providers should be trained to assess sexual health concerns using structured assessment processes supported by models ( e.g., BETTER or PLISSIT [Reference 153,154]) to ensure systematic assessment and appropriate referrals to specialists.
2. All health care providers should be trained to provide education and support regarding changes in sexual health and offer appropriate referrals to specialists when necessary.
3. Management of survivors’ concerns regarding sexual health and sexual function should also include an assessment of possible causal factors to determine whether other targeted interventions (e.g., counselling, medical management) are also required.
4. Early intervention is critical, particularly in populations with prostate or gynaecological cancers, where the management of interruptions in sexual functioning throughout the course of treatment may influence long term recovery.

Recommendation 6: Managing Post-treatment Fatigue

It is recommended that survivors be screened for cancer related fatigue and have access to exercise programs combined with psychoeducational interventions and/or multi-component cognitive behavioural therapy to manage post-treatment fatigue.

Tactics:

1. Psychoeducational interventions and/or multi-component cognitive behavioural therapy approaches targeted to alleviating fatigue should include a variety of elements, including sleep education, problem-solving skills, stress management, and psychosocial counselling.
2. Exercise programs targeted to alleviating fatigue should promote a range of physical activity options, including cardiovascular, flexibility and/or strength training, as appropriate.
3. Management of post-treatment fatigue should also include an assessment of possible causal factors to determine whether other targeted interventions (e.g., medical management) are additionally required such as specific interventions for sleep disturbances or depression.

Recommendation 7: Managing Vasomotor Symptoms

It is recommended that all female cancer survivors have access to multi-component cognitive behavioural therapy and lifestyle management programs to effectively manage vasomotor symptoms. This is also important for other cancer survivors, such as those with prostate cancer, where hormonal deprivation therapies may lead to significant physical and emotional effects.

Tactics:

1. Psychosocial and supportive care programs to manage post-menopausal vasomotor symptoms should consider using education, counselling and/or hypnosis-based approaches to alleviate symptoms.
2. Management of vasomotor symptoms should include an assessment of possible causal factors to determine whether other targeted interventions (e.g., medical management) are also required.
3. A trial of pharmacological therapies could be helpful but the evidence for these approaches is weak.

Recommendation 8: Managing Disruptions in Sleep-wake Patterns

It is recommended that survivors have access to multi-component cognitive behavioural therapy programs to manage disruptions in sleep-wake patterns.

Tactics:

1. Multi-component cognitive behavioural therapy programs should include stimulus control instructions, sleep education, sleep restriction, and proper sleep hygiene to promote improved sleep-onset latency, wake after sleep onset, total sleep time, and time in bed.
2. Management of disruptions in sleep-wake patterns should include an assessment of possible causal factors to determine whether other targeted interventions (e.g., counselling, medical management) or specialist medical interventions for insomnia disorders are also required.