CAPO Digest

CAPO Digests are summaries of recent psychosocial oncology research which have published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members. We hope you enjoy these Digests. If you are interested in submitting a CAPO Digest please contact the CAPO office at [email protected].


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  • 15 Aug 2018 1:59 PM | Anonymous

    Written by: Keith Wilson, PhD, CPsych, Department of Psychology, The Ottawa Hospital Rehabilitation Centre

    Psychosocial oncology has done a good job of documenting the 10% – 20% prevalence of major depression (MD) among people with cancer, as well as the fact that MD accounts for a disproportionate amount of suffering. Where we have lagged is in demonstrating that we can treat MD with a sensible, evidence-based, practical and efficient intervention suitable for integration into oncology settings. With this study by Sharpe et al., we may finally have caught up.

    “Depression Care for People with Cancer” consists, in part, of a brief (up to 10 sessions), manualised psychotherapy that draws on the cognitive-behavioural strategies of behavioural activation and problem-solving. In this trial, the therapy was administered by nurses who received rigorous training in these therapeutic techniques. The nurse-therapists were supervised by psychiatrists, who also consulted on medications and worked with patients who were not improving.

    Sharpe et al. randomized 500 patients diagnosed with MD at three Scottish cancer centres to receive either the Depression Care for People with Cancer program or usual care (which could include referral to existing psychosocial oncology services). The trial endpoint was depression status at 24 weeks, but patients were followed for almost a year.

    The authors describe the results as “striking”. Among patients who received the Depression Care for People with Cancer program, 62% reached the pre-specified primary outcome of a 50% reduction in depression symptoms. In contrast, only 17% of those receiving usual care achieved this degree of improvement. Moreover, a third of patients receiving the Depression Care for People with Cancer program met criteria for full remission of MD, compared to only 4% of those receiving usual care. In addition to these statistically robust differences in depression itself, secondary outcomes of anxiety, pain, fatigue, social participation, and quality of life were all reliably better for those receiving the Depression Care for People with Cancer program, and sustained over the duration of follow-up. Interestingly, the researchers also kept careful records of the time spent administering the intervention. They calculated the cost as £613 – about $1,100 Canadian.

    Why I like this article: It is rare in psychosocial research to read individual studies that have the potential to be game-changers for an entire field, but this work comes close. Methodologically, this is a textbook example of how to design a rigorous clinical trial of a complex intervention. The findings should be appreciated widely by everyone involved in cancer care. If this treatment was available in a pill form that could reduce the suffering of that many people, for that duration of time, in multiple dimensions of distress, at such a low cost, we can speculate that it would quickly become a routine standard of care. Our challenge now is to translate this compelling research knowledge into genuine and widely available integrated care in cancer treatment programs.

    Article: Sharpe, M., Walker, J., Hansen, C.H., Martin, P., Symeonides, S., Gourley, C., Wall, L., Weller, D., Murray, G., for the SMaRT (Symptom Management Research Trials) Oncology-2 Team. (2014). Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet, 384, 1099-1108.

    Journal Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61231-9/abstract

    Author Website: http://www.psych.ox.ac.uk/team/PIs/michael-sharpe


  • 15 Aug 2018 1:58 PM | Anonymous

    Digest commentator: Andrea Feldstain, Ph.D. Candidate, University of Ottawa; Resident in Clinical Psychology, Alberta Health Services

    The field of palliative care is advancing, developing, and innovating. In the past few decades, it has evolved from care at end-of-life to a practice seeking to relieve or prevent suffering as early as diagnosis. Palliative care can entail symptom control, improving quality of life, increasing engagement of patients in their own care, potentially extending life expectancy, and/or increasing comfort when dying. However, the integration of palliative care into the full cancer trajectory is still a work in progress, as exemplified in the selected article.

    Wentlandt and colleagues (2014) examined the referral practices to palliative care of pediatric oncologists versus adult oncologists. To compare these two groups, the researchers surveyed the majority of Canadian medical, radiation, surgical, and pediatric oncologists. Topics discussed included the availability of specialized palliative care services (i.e., inpatient consultation, inpatient units, outpatient clinics), referral practices (e.g., timing of referrals, life expectancy at time of referral), and attitudes (e.g., referring to palliative care adds too many care providers, uncomfortable referring before end-of-life).

    Their study provides some good news in that both pediatric oncologists and adult oncologists perceived excellent access to at least one form of specialized palliative care, with consultation being the most available and outpatient services being the least available. In addition, the majority of pediatric oncologists and adult oncologists reported they were comfortable referring patients to palliative care as early as at diagnosis (87% and 70%, respectively). Unfortunately, despite perceiving excellent access and confidence, the bad news is that this is not reflected in practice. Both pediatric oncologists (79%) and adult oncologists (84%) reported that the large majority of their palliative care referrals were for patients with uncontrolled symptoms and a life expectancy of 1 to 6 months. Approximately 90% of pediatric oncologists and adult oncologists reported they would refer patients with uncontrolled symptoms for a prognosis of less than 1 year but only 57% would refer for uncontrolled symptoms and a prognosis of greater than 1 year. Less than 1% reported having referred patients with a prognosis of greater than 1 year (0% pediatric oncologists; 0.6% adult oncologists). So, why is there this discrepancy between perceptions and practice?

    Two possible explanations can be found in Wentlandt and colleagues’ (2014) Table 4. On one hand, they found that oncologists may believe they can provide palliative treatment themselves. On the other hand, they found some may avoid palliative care referrals because they believe their patients associate palliative care with impending death. The majority of pediatric oncologists (58%) reported that they would refer earlier if palliative care was renamed Supportive Care, while adult oncologists were equally split. This is unfortunate because (1) it robs patients/caregivers of the expertise of palliative care, (2) misconceptions of palliative care could be easily clarified with a discussion, and (3) delaying referrals until disease is terminal reinforces this misconception. Although pediatric oncologists and adult oncologists both seem aware of the evolving scope of palliative care practice and associated benefits, referral practices have yet to catch up. Echoing Wentlandt et al.’s (2014) suggestion, more education and advocacy is needed as this may be a more viable option than hiding behind a new name.

    Article: Wentlandt, K., Krzyzanowska, M.K, Swami, N., Rodin, G., Le, L.W., Sung, L., & Zimmerman, C. (2014). Referral practices of pediatric oncologists to specialized palliative care. Support Care Cancer, 22, 2315-22. DOI: 10.1007/s00520-014-2203-6.

    Journal website: http://www.springer.com/medicine/oncology/journal/520.

    Author website: http://ca.linkedin.com/pub/kirsten-wentlandt/18/595/11a


  • 15 Aug 2018 1:57 PM | Anonymous

    Digest commentators: Gaya Narendran and Dr. Fiona Schulte, The University of Calgary

    Specialized summer camps have been established as an environment where children faced with chronic illnesses, such as pediatric cancers, may find a place to have fun in a safe way. Currently, few studies have investigated the influence of attending specialized summer camps on children with cancer. Reports indicate that attending camp positively influences camper’s quality of life by affecting factors such as mood, and social interaction skills. The role of specialized summer camp in the long-term psychosocial development of children affected by cancer has not been addressed until recently.

    Beckwitt (2014) investigated the potential for long-term influences of attending specialized camp programs for children who had been affected by cancer. Twenty-three Adults Surviving Childhood Cancers (ASCCs) were involved in the study.  ASCCs face ongoing psychosocial challenges into adulthood. During time of treatment, they are often isolated from social interactions and consequently often develop social adjustment problems that have the potential to continue into adult life.

    ASCCs were identified as having been diagnosed with cancer at 1 to 18 years of age. The study consisted of a demographic survey and illness narrative interviews. Illness narratives were carried out using in-depth interview techniques in order to gain understanding and insight into how ASCCs view their camp experience. As a result from these interviews, three themes were identified: (1) attending camp provided normalcy, (2) meaningful camp experiences, and (3) access to information. This investigation reports that ASCCs recognized camp as a setting in which they could feel “normal” and relate with other children facing similar challenges. Furthermore, ASCCs’ responses indicated that camp provided a source of long-lasting relationships facilitated by the meaningful experiences felt while attending camp. ASCCs also reported that they were given informational support to learn and discuss potential physical, emotion, and cognitive late-onset effects of their cancer during camp. Together, the results of this investigation indicate that specialized childhood camps play a significant role in ASCCs’ survivorship.

    This study provides strong testimonies for the effectiveness and importance of the childhood camp experience from multiple ASCCs. However, due to the small sample size and the similarity of participants, such that most were female and Caucasian, these results cannot readily be generalized. Future research utilizing objective measures, such as psychological assessments and questionnaires, are needed to establish the benefits of attending specialized summer camp programs for ASCCs.

    Why I liked this article

    This article works to fill a gap in the literature in a way that is easily understood. The included quoted testimonies that were appropriate and supported the conclusions they made. The quotes were also insightful into the emotional and social challenges of ASCCs but also work together with the author’s conclusions to illustrate a strong and complete image of the cancer experience and the role of camp in easing the challenges of this experience.

    Article: Beckwitt, A. E. (2014). Childhood Cancer Camps Their Role in Adults Surviving Childhood Cancers Lives. Journal of Pediatric Oncology Nursing, 1043454213515335.

    Journal website: http://jpo.sagepub.com/

    Author website: http://www.ncu.edu/about-northcentral/our-people/faculty-members/asher-beckwitt



  • 15 Aug 2018 1:57 PM | Anonymous

    Digest commentators: Lauren C. Capozzi & S. Nicole Culos-Reed

    Digest editor: Jennifer Brunet, University of Ottawa

    It has been well established that exercise has numerous benefits for cancer survivors, both during and after treatment. In a population where psychosocial concerns like fatigue, pain, anxiety, depression, and decreased physical functioning are a reality for most patients, exercise can positively impact overall quality of life (QOL). But how does this happen? There are few researchers who have examined the underlying mechanisms responsible for improvements in QOL in patients with cancer who exercise. Identifying these mechanisms will aid in developing better targeted interventions, which will likely enhance the impact of exercise interventions on QOL.

    Buffart and colleagues were determined to further analyze the factors mediating improvements in QOL during a 12-week group-based exercise program. They hypothesized that the intervention would increase activity levels, as well as perceptions of general self-efficacy and mastery. In turn, this would decrease fatigue and distress, which would then improve QOL. For their study, which was part of a larger multi-site trial, they recruited 209 patients diagnosed with different types of cancer who were on average 48.8 ± 10.9 years of age. A total of 147 patients were included in the exercise intervention group, and 62 were included in the wait list control group. The exercise intervention consisted of two weekly sessions targeting aerobic and strength components.

    Interestingly, Buffart and colleagues found that there was no significant direct effect of the group-based exercise intervention on QOL. Rather, the intervention had an indirect positive effect on QOL. Specifically, the intervention positively impacted QOL by increasing physical activity, self-efficacy, and mastery, and subsequently decreasing fatigue and distress. The improvements in fatigue management were partially explained by the indirect effect of increased physical activity and self-efficacy, while the improvements in distress management were partially explained by the indirect effect of increased self-efficacy and mastery. Increased physical activity was directly linked to enhanced QOL. This study not only supports previous findings linking exercise with symptom management and QOL, but also provides insight into the mechanisms linking exercise with improvements in QOL. Accordingly, researchers and health professionals developing exercise intervention should consider approaches and strategies shown to increase perceptions of self-efficacy and mastery as this may decrease fatigue and distress, and in turn improve QOL.

    Why I liked this article?

    This article is important as it helps identify ways through which exercise can lead to improvements in QOL. This knowledge is also valuable when considering the design of effective exercise interventions as well as sustainable clinic or community-based exercise programs for cancer patients. Further work in this area is needed to identify additional pathways that are perhaps unique to specific cancer groups so we can not only develop targeted interventions, but also developed tailored intervention for patient diagnosed with different types of cancer.

    Article: Buffart, L. M., Ros, W. J. G., Chinapaw, M. J. M., Brug, J., Knol, D. L., Korstjens, I., Weert, E van, Mesters, I., Borne, B. van den, Hoekstra-Weebers, J. E. H. M., May, A. M. (2014). Mediators of physical exercise for improvement in cancer survivors’ quality of life. Psycho-oncology, 23: 330-338.

    Journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

    Author website: http://www.emgo.nl/team/924/laurienbuffart/personal-information/



  • 15 Aug 2018 1:47 PM | Anonymous

    Digest commentators: Nicole Culos-Reed and Heather Leach, University of Calgary

    Digest editor: Jennifer Brunet, University of Ottawa

    Many prostate cancer (PC) and breast cancer (BC) survivors are interested in optimizing their health through lifestyle behaviors. The use of health behavior theories can help to understand patterns of nutrition and physical activity following a cancer diagnosis. In this study, predictors from the Commonsense Self-Regulation Model (CSM) and the Transtheoretical Model (TTM) were examined for associations with adherence to physical activity (PA) and healthy diet in PC or BC survivors. PA was measured using the International Physical Activity Questionnaire (IPAQ), assessing PA in the past seven days. Nutrition was assessed using the Past Seven Days Nutrition, assigning a score of 0-6, with higher scores indicating healthier eating guidelines adhered to. Participants were also asked the extent to which their diet and PA behavior had changed since diagnosis, and their preferences for interventions. CSM constructs were measured by the Illness Perception Questionnaire-Revised (IPQR). TTM constructs were represented by a previously developed scale that measured exercise stage of change, which ranges from pre-contemplation (not thinking about exercise), through contemplation, preparation (making small steps towards regular exercise), action (exercising regularly), to maintenance (over 6 months of regular exercise). Self-efficacy was measured using the Exercise and Nutrition Self-Efficacy Scales. Participants in this study were ninety-two men with PC (M age=66.6±7.7 years) and 145 women (M age=56.8±10.5 years) with BC. The median time since diagnosis was 30.0 months for PC and 53.5 months for BC participants. PA guidelines were met by 88% of PC and 85% of BC participants based on self-reported data. PC respondents met on average 2.2 healthy eating guidelines and BC respondents met 2.7. Higher self-efficacy and stage of change from the TTM model were associated with increased PA and greater adherence to nutritional guidelines. Increased PA since diagnosis was associated with higher stage of change and lower illness identity and higher personal control. Healthier eating since diagnosis was associated with longer time since diagnosis, higher stage of change, and higher personal control and higher negative emotional representations. The majority of participants indicated they would be very interested in receiving interventions to assist with improving nutrition or PA, and that they would prefer these interventions at the time of diagnosis or soon after. The associations between a higher TTM stage of change and self-efficacy with adherence were consistent with findings of other studies that have examined PA and healthy eating. No CSM variables were associated with adherence, but some did predict changes in health behaviors. Lower illness identity was associated with increased PA after diagnosis, which suggests that cancer related symptoms may act as a barrier to PA. Higher negative emotions related to cancer was associated with improved post diagnosis diet, suggesting that concerns about cancer may motivate healthy eating behaviors. Associations between higher personal and treatment control beliefs and improved health behaviors since diagnosis suggests that PC and BC survivors are more likely to change health behaviors if they believe that their actions can make a difference in their cancer outcome. The application of theoretical models to explain health behaviors can enhance knowledge of how to provide effective support for the PA and healthy eating needs of PC and BC survivors.

    Green HJ, Steinnagel G, Morris C & Laakso EL (2014). Health behaviour models and patient preferences regarding nutrition and physical activity after breast or prostate cancer diagnosis. European Journal of Cancer Care. Advance online publication. doi:10.1111/ecc.12190.

    Journal website: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2354

    Author website: http://www.griffith.edu.au/health/school-applied-psychology/staff/dr-heather-green



  • 15 Aug 2018 1:46 PM | Anonymous

    Li, H.C., Chung, O.K., Ho, K.Y., Chiu, S.Y., & Lopez, V (2013). Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors. Psycho-Oncology, 22, 2601-2610.

    Journal Website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

    Advances in treatment protocols have resulted in improved rates of survival for childhood cancer patients. Despite enhanced prognosis, treatment regimens are associated with a myriad of adverse side effects. Physical activity has been shown to be a safe and effective strategy to ameliorate and potentially reverse the sequelae of cancer and its treatments in children with cancer. Moreover, it is a beneficial strategy to promote improved psychosocial and physical health. Unfortunately, there is growing concern about low rates of physical activity in childhood cancer survivors. Previous research shows that education alone is not enough to increase physical activity levels; therefore, more research is needed to explore alternative strategies. In this study, Li et al. examined if an integrated adventure-based training and health education program would increase perceptions of self-efficacy, physical activity levels, and quality of life (QOL) in 71 cancer survivors between the ages of 9 and 16 years. They found that participants reported increased perceptions of self-efficacy, physical activity levels, and QOL over the course of the intervention. Additionally, they found that participants who completed the program had greater perceptions of self-efficacy, were more active, and were more willing to participate in physical activity than participants who did not complete the program.

    This study provides compelling evidence that an alternative type of physical activity program (e.g., adventure-based training such as rock wall climbing, relay games and three-legged races) can effectively promote positive changes in physical activity behaviour, as well as psychosocial constructs. While these findings are promising, more research is needed to determine if the length and format of the program should be modified based on participants’ personal and/or cancer-related characteristics in order to optimize outcomes. Furthermore, greater research efforts exploring dissemination strategies should be conducted to ensure a greater number of childhood cancer survivors are impacted.

    Why I like this article: Currently, data supporting effective means to promote physical activity behaviour, and in turn QOL, for older childhood cancer survivors are lacking. This study sheds light on an exciting alternative type of physical activity that may be more readily adopted and maintained by this age group – adventure-based activities. Accordingly, it offers a novel approach to potentially address the physical inactivity epidemic in childhood cancer survivors.

    Digest writer: Amanda Wurz, MSc.

    Digest editor: Jennifer Brunet, PhD



  • 15 Aug 2018 1:44 PM | Anonymous

    Wenger, L. (2013). Moving through illness with Strong Backs and Soft Fronts: A substantive theory of men’s help-seeking during cancer.  Men and Masculinities, 16, 517-539.

    Journal Website:  http://jmm.sagepub.com

    In recent years, we have begun to understand men’s responses to prostate cancer and its treatment in order to provide psychosocial support. However, men experience a wide range of other types of cancer. When it comes to these other types of cancer, we often assume that men and women respond to a cancer diagnosis in similar ways and need similar types of support.   In Dr. Lisa Wenger’s recent publication, she turns this assumption on its head. Drawing on a growing body of knowledge constructing health and illness as opportunities for gendered practices, she asks how men navigate the disruptions to life and identity that are triggered by a diagnosis of cancer. Based on in-depth interviews with 30 men, ranging in age from 30 to early 80s with a range of cancer diagnoses, she details patterns of help-seeking using the metaphor of “strong backs” and “soft fronts.”  Dr. Wenger explains that, in line with hegemonic masculinities, men present themselves as strong, stoic and brave. So for the men in her study, the “strong back” approach felt natural and they were comfortable with clinicians and family who wanted to support them in recovering who they were. However, difficulties were often experienced as the men confronted losses, uncertainties and the profound disruptions to their identity. These difficulties were related to their discomforts in expressing vulnerability and resistance to identity changes, and the lack of responsiveness of our health system to men’s emotional pain.  Dr. Wenger explains that we have been pretty good at “strong back” supports to help men hold onto familiar selves by focusing on information, stress management and healthy living. She encourages us to ask how we are addressing men’s “soft front” needs and challenges us to develop innovative approaches that assist men in balancing “strong backs” and “soft fronts” as they learn to live with cancer.

    Why I like this article:  The article provides a new window into men’s experiences of a range of cancers and raises questions about how cancer supports should be designed for men. I think the rich descriptions of men’s experiences in balancing “strong backs” and “soft fronts” as they confront cancer hold great potential in increasing our ability to be gender aware in our interactions with men with cancer.  The time has come to recognize the limits of a one-size-fits-all approach to psychosocial oncology.

    Prepared by Dr. Joan Bottorff



  • 15 Aug 2018 1:44 PM | Anonymous

    Moorey, S. (2013). “I know they are distressed. What do I do now?” Psycho-Oncology,22, 1946-1952.

    Journal Website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

    Author Website: http://www.national.slam.nhs.uk/stirlingmoorey/

    Stirling Moorey has been at the forefront of psychotherapy research in palliative cancer care, and he is particularly known for his work in cognitive behaviour therapy (CBT). In this personal perspective, Moorey describes the evolution of psychotherapy research in oncology as a movement through three phases. The first consisted of identifying the prevalence of psychosocial problems and the corresponding need for interventions. The second, which is still in early stages but is making great strides, has tested treatment protocols derived from mental health research, as well as those developed specifically within cancer care. The third phase has to do with the dissemination of effective interventions, which in a Canadian context would be known as knowledge translation. Like other guidelines for screening and intervening with distress, including CAPO’s own depression guideline, Moorey proposes a stepped-care approach for people who have psychological problems of differing severity. Some basic communication skills should be part of the training of all professionals, but brief psychotherapy, internet, and telephone counselling have a place for providers with additional expertise. Patients with the most serious difficulties should be seen by team members with some specialization in mental health.

    Importantly, Moorey introduces the concept of “first aid CBT,” which comprises a core set of therapeutic techniques for defining and explaining problems, devising simple behavioural experiments, and applying time-limited problem-solving. In Moorey’s opinion, this type of approach can be implemented by various members of the treatment team, and is even applicable in palliative care. Moorey, a psychiatrist, then describes the success of his own recent research in training nurses in the model.

    Why I like this article: The tone of this paper is one of thoughtful reflection as it provides a personal overview of the literature; it is not intended to be a rigorously scientific systematic review. However, it outlines a sensible and practical way to conceptualize how to intervene with distressed patients. Since CBT is currently the predominant form of psychotherapy in the community generally, there is a place for more clinicians in cancer care to have a basic sense of how it works and how it can be applied to their patients. First aid CBT is probably a concept whose time has come.

    Prepared by Dr. Keith Wilson



  • 10 Aug 2018 3:55 PM | Anonymous

    Digest Commentators:

    Amanda Wurz, ACSM-CPT, MSc, PhD candidate, University of Ottawa
    Anika Petrella, RP, MA, PhD candidate, University of Toronto

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Evidence for why exercise and physical activity is important for individuals diagnosed with cancer is well established. However, pervasive uncertainty remains about how to connect this population to relevant services and resources (i.e., who should be involved/responsible and where to refer to). To address this gap, Santa Mina et al. (2018) proposed a model or pathway that goes beyond the what and systematically delineates how individuals diagnosed with cancer can be engaged in exercise programming and physical activity promotion. In addition, the authors tackle an existing barrier related to the lack of knowledge surrounding accessible services and resources by describing what is currently available across North America.

    The proposed pathway is depicted visually and described utilizing empirical evidence and clinical knowledge. At the beginning of the pathway are healthcare providers (e.g., oncologists, family physician, nurses, psychologists, social workers), who are described as playing a critical role in enhancing access to exercise programming and physical activity promotion resources for individuals diagnosed with cancer. Following this, the pathway forks to illustrate the parallel steps for exercise engagement (i.e., referral to a qualified exercise professional and screening/risk stratification) and/or physical activity promotion.

    Notably, Santa Mina et al. (2018) adopt a person-centred approach considering facilitators and barriers faced by individuals diagnosed with cancer, acknowledge the entire healthcare team by emphasizing a shared model of responsibility, and incorporate services (e.g., exercise programming) alongside self-management and behaviour change resources (e.g., online education). Thus, the emergent model is amenable to modification based on the individual and context. Finally, the authors flag areas requiring further attention/clarification (e.g., exploring home-based exercise programming) and conclude by encouraging future investigation of the applicability and economic sustainability of the pathway.

    Why we liked this article: First, the pathway was developed by a team of leading experts in the field of exercise, physical activity, rehabilitation, and cancer survivorship and represents an important step to bridging the gap between what to do (i.e., recommend/refer individuals diagnosed with cancer to exercise/physical activity) and how to do it (i.e., specific steps, guidance, and access to resources). Second, the authors clearly underscore that individuals diagnosed with cancer are not static throughout survivorship. As such, a non-prescriptive approach, acknowledging potential fluctuations in health status, changes in self-motivation and empowerment, and differing needs with regards to addressing barriers over time was adopted. The fluidity and flexibility inherent in this model have the potential to significantly impact the wellbeing of individuals from cancer diagnosis onward across a variety of contexts.

    Citation: Santa Mina D, Sabiston C, Au D, Fong AJ, Capozzi LC, Langelier D, Chasen M, Chiarotto J, Tomasone J, Jones J, Chang E, & Culos-Reed SN. (2018). Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement. Current Oncology, 25(2):149-162.


    Journal website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927786/

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