Tag Archives: YWWACP

Younger Women’s Wellness after Cancer Program improves quality of life for women in New Zealand

Interview Programs Research

Preliminary results from the culturally adapted Kōwhai Study in New Zealand are showing positive signs that the Younger Women’s Wellness after Cancer Program has the potential to improve the quality of life of women after cancer treatment.

We spoke to the Kōwhai Study Manager and long-time Women’s Wellness collaborator, Janine Porter-Steele, about the latest results from the study, as well as future plans for implementation across Australia, New Zealand and Hong Kong.

How are lifestyle intervention programs proving to improve the quality of life for women after a cancer diagnosis?

Younger women, under the age of 50, treated for breast cancer in Australia and New Zealand (NZ) are a large and growing population and while advances in diagnosis, treatment and management have significantly improved survival rates, the medium, long-term and late side effects reflect a significant burden to young women. Side effects include physical, psychosocial and psychosexual issues, like early menopause and associated risks, fatigue, obesity, sleep disturbances, higher incidence of diabetes, and cardiac and bone health concerns.  Social aspects might include disruption to family, relationships and work-life as well as fitting in with peers. Psychosexual side effects of treatment include sexual dysfunction, fertility and body image issues.

Studies have demonstrated that women believe they lack information and confidence in ways to not only reduce their risk of recurrence of cancer and other chronic disease but also to manage the long-term effects that cancer has on their lives.

There is also evidence that lifestyle interventions can mitigate chronic disease risk and many of the side effects associated as well as improve quality of life for this group of patients.

This is why we developed the The Women’s Wellness after Cancer Program (WWACP), which is a twelve-week Program designed to address common treatment after-effects in women after cancer. This program was subsequently adapted to focus on the different needs of younger women (Younger Women’s Wellness after Cancer (YWWACP). It has been trialled as a feasibility study in New Zealand (NZ) (The Kōwhai Study), in Australia (The Emerald Study), and in Hong- Kong. As part of the NZ study, a separate and discreet sub-study offering a culturally adapted program was undertaken with a cohort of Māori women.

Can you tell us a bit more about the Kōwhai Study, which was recently completed in New Zealand?

The Kōwhai Study recruited women aged 18- 50 years who had completed intensive treatment (surgery, chemotherapy / targeted therapies and radiotherapy) for breast cancer in the preceding 24 months.

The participants were randomised into a control (usual care) group or to an intervention group. The participants allocated to the control group received general information from their usual health care professionals during their routine clinic visits. The intervention group received a journal, fact sheets, access to a website and 3-5 consultations over the twelve-week duration of the program with an experienced cancer care nurse.

Apart from assessing the usability, acceptability and accessibility of the Kōwhai Study, improving quality of life was equally important, as our aim with the Younger Women’s Wellness after Cancer programs is to improve late and long term side effects and reduce distressing ongoing symptomology.  Secondary endpoints include comparison of waist circumference measurements from commencement to completion of the study and changes in menopausal symptoms, body image, sexual function, sleep, physical activity and nutrition.

Despite launching the Study during the Covid pandemic, we received a rapid intake of participants, which demonstrated an enormous desire for this type of lifestyle intervention in New Zealand.

What were some of the outcomes of the Study?

 While we are still collating and analysing some of the data from the Study, the Kōwhai Study is showing promising signs of improving late and long-term side effects of cancer treatment and improving quality of life for participants, from a physical, psychosocial and psychosexual perspective.

Participants are reporting reduced levels of distress, improved emotional status and a downward trend in waist circumference.

What’s next for the Younger Women’s Wellness after Cancer Program?

We have now completed feasibility studies in New Zealand (Kōwhai Study), Australia (Emerald Study) and Hong Kong (YWWACPHK), with all three studies receiving high interest and uptake from local participants and positive feedback. This proves to us that the program is feasible and accepted and that, if rolled out more widely, could be very successful and have a great influence on improving the quality of life for younger women after cancer.

We are now pooling the results from these three studies and will be looking to secure a larger partnership grant, in the near future, to conduct a larger study and roll the program out more widely.

For more information about the Kōwhai Study, click here.

For more information about the Emerald Study, click here.

For more information about the Younger Women’s Wellness after Cancer Program in Hong Kong, click here.

Women in Hong Kong pilot Younger Women’s Wellness after Cancer Program

Cancer Interview Programs Research Women's Wellness

A team of researchers at the Chinese University of Hong Kong have recently completed the pilot study of a culturally-adapted Younger Women’s Wellness After Cancer Program for Women in Hong Kong (YWWACPHK).

We sat down with Assistant Professor Dorothy Chan from the Faculty of Medicine at the University to discuss the program pilot and plans to conduct a full-scale study in the coming months.

What was the driver for developing a culturally-appropriate program for younger women after cancer in Hong Kong?

Breast cancer is the most common cancer among Hong Kong Chinese women, and its incidence rate has continued to rise in recent years. In 2020, 4,956 new cases of breast cancer were reported in Hong Kong. Of these, 1,314 patients were aged below 50 years, representing 26.5% of the total breast cancer cases.

The number of breast cancer cases diagnosed at age 50 or below in Hong Kong is increasing. Around 70% of Chinese women in this age group are married and participate in the work force. Younger Chinese women with breast cancer are therefore expected to return to work after their cancer diagnoses and treatment. Current health promotion programmes for women with breast cancer in Hong Kong do not specifically target the younger age group. Most require the women to physically attend during office hours, and thus many working women may not be able to participate. The availability of a flexible and Internet-based programme that overcomes the problems of time constraint and geographical location can offer a new channel through which women can receive health information, advice and care from healthcare professionals. Nearly 99% of Hong Kong citizens use their smartphones to connect to the Internet, and approximately 71% use desktop computers. The Internet-based YWWACP, aimed at providing a whole-lifestyle intervention to help younger women managing their health, can therefore represent a suitable approach, which meets younger women’s needs and facilitates the delivery of information and support.

How has the program been adapted for Chinese women in Hong Kong?

The programme was culturally adapted, and modifications made where necessary. The text of the electronic original YWWACP programme book was translated into traditional Chinese. Then, to enhance the cultural relevance, some modifications were made, for example, in relation to the diet (types of food), the types of physical activities commonly performed by Hong Kong Chinese women and the places where relaxation activities took place. The body mass index was modified with reference to the recommendation made by World Health Organisation for Asian adults. Information about alcohol after cancer was removed as alcohol intake is not common among Hong Kong women. Furthermore, instead of presenting the content in the form of an electronic book, the contents were presented on the website and scheduled on a daily and weekly basis (over a 12-week period). In addition, some health information, such as local cancer statistics and screening measures, and the official websites of health departments providing information on healthy eating and physical activities, were added.

To illustrate the steps to perform stretching and muscle strengthening exercises, graphics of young Chinese women were used. A voice plugin function was added so that the participants could click and listen to the content. Consultations with a cancer nurse were conducted either using telephone or text messaging with a cancer nurse at Weeks 6 and 12 as per the preference of Hong Kong Chinese women made during the virtual consultation at the beginning of the programme. The discussion board was removed as suggested by previous WWACP studies as it was rarely used by participants.

What are you hoping to achieve from conducting a full-scale study later in the year?

In our pilot study which was conducted during the COVID-19 pandemic, at 12 weeks after intervention completion, the intervention group showed a significant increase in the pain subscale scores of sexual function, and more improvement in the level of physical activity than the control group. Nineteen intervention group participants reported that they were satisfied with the programme and suggestions for improvement were provided. We hope that in our future full-scale study, not only could we see the changes in their level of physical activity and sexual function, but also we hope to see changes in other aspects, such as sleep quality, dietary intake and quality of life.

What are your long-term ambitions for the YWWACPHK?

In the long term, we hope that this programme will be incorporated into the routine health services offered to breast cancer patients or have the website of the programme made available to all cancer patients who would like to search and obtain information.

For more information about the Younger Women’s Wellness after Cancer Program for Women in Hong Kong, you can visit ywwacp.nur.cuhk.edu.hk/