Facilitating and encouraging clinicians and researchers to connect across the globe will help to support the growth of the physiotherapy profession. With this idea in mind, we are happy to provide a platform for researchers to share their current research projects and findings with the Physiopedia community.
We would like to introduce you to Dr. Jenna Smith-Turchyn, a physiotherapist and postdoctoral researcher at the University of Toronto in Ontario, Canada. Dr. Smith-Turchyn will be presenting an eye-opener session at the Canadian Physiotherapy Association Congress this November. Her talk will be addressing the know-do gap in oncology physiotherapy research. Recently, Dr. Smith-Turchyn shared with us some insights from her work as a clinician-scientist.
Dr. Smith-Turchyn, thank you for taking the time to share your knowledge and research with the Physiopedia community.
Q. What inspired you to pursue a career in research?
A. While working clinically, I treated many women suffering from secondary effects of cancer treatments. As I searched for strategies to help decrease their pain and improve their functioning and quality of life, I became passionate about the role that physiotherapy and exercise can have in helping women with cancer manage the side effects of treatment. The majority of the people I worked with were not aware of the benefits of exercise during or after their cancer treatment; they had not been educated about the importance of maintaining their physical fitness. Knowing that physiotherapy and regular exercise has a beneficial effect on managing many of the physical, psychological, and social side effects of cancer treatment, as well as potentially decreasing recurrence and improve survival rates, I felt it was important to conduct research to determine the best way to put the research evidence into clinical practice.
Q. Can you describe to the Physiopedia community your research to date and a little about your current work?
A. To date my research has focused on implementing novel exercise intervention strategies for women with breast cancer in order to try and bridge the knowledge to practice gap. To being I interviewed both survivors of breast cancer and health care professionals who treat women with breast cancer to determine barriers to exercise participation and promotion. Using these findings we ran a pilot trial at the Jurvinski Cancer Centre in Hamilton, Ontario. The intervention implemented within this study was for women with breast cancer who were undergoing chemotherapy. It included 8 sessions of moderate intensity exercise, using a recumbent bike, and 8 self-management modules that participants viewed on an iPad. The self-management modules conveyed information about the benefits of exercise, different types of exercise and FITT parameters, exercise-related safety precautions during chemotherapy, and focused on goal setting and action planning. Unique characteristics of this intervention strategy were that there was no cost to participants, participants received these intervention sessions when they were already coming into the cancer centre for another appointment, and that goal setting and action planning components of the self-management modules allowed the participants to become actively engaged in this healthy behaviour change early in the course of their cancer treatment. Results found the intervention to be feasible (recruitment rate of 96%, retention rate of 100%, and adherence rate of 89%) and demonstrated preliminary evidence of effectiveness (between-group difference of mean change scores for physical activity level: p=0.03, exercise knowledge: p=0.01, and perceived health status: p=0.02). With these promising findings, we are currently in the process of implementing this program at multiple sites in southwestern Ontario. Along with this, my research is now focusing on how to access hard to reach populations in cancer rehabilitation. It is well known that rural and remote communities have decreased access to health care services and that those with lower socioeconomic status have less access to these services and higher incidence and mortality rates. Where you live and what you do for a living should not affect the health care services you receive. Therefore my future work will focus on implementing accessible and affordable cancer rehabilitation services that meet the needs of this population.
Q. Why is exercise such an important component of cancer treatments and what is our role as physiotherapists?
A. Exercise is a safe and cost-effective way to manage the physical and psychological sequelae of cancer treatment. Preliminary evidence also supports the use of exercise to decrease recurrence rates is some forms of cancer and prevent cancer-specific and all-cause mortality rates. Cancer survivors want to return to their pre-cancer level of functioning, independence, and social roles and exercise can help to do this! Along with this, the incidence of cancer in the Canadian population is suspected to significantly increase in the next decade. The Canadian Cancer Society’s 2015 report suggested that by the year 2032 the incidence of cancer in Canadians will increase by 79%. This is due both to the aging population and population growth. As physiotherapists, we need to advocate for our profession and the role that we can have in improving the lives of individuals with cancer both during and after treatment. We need to tell others about what we can do: patients, other health care professionals, policy makers, government officials. We need to provide adequate education to our physiotherapy students on this topic and devise novel knowledge translation strategies to spread the word using the latest health care The road has been paved by many oncology leaders in Canadian physiotherapy (Margie McNeely, Kristin Campbell, Oren Cheifetz). Our job is to work together, and with other professions, to implement this evidence and help this growing number of Canadians as best as we can.
Q. What do you think is the biggest barrier to implementing evidence from research into clinical practice?
A. I think implementing new ideas and research is difficult in extremely busy health care settings, especially in the face of budget constraints. From my experience, health care professionals who work in oncology settings are eager to implement the best evidence, but with many competing priorities due to the severity and complexity of patient concerns, it is a difficult process. Health care teams must stay up-to-date on current best practices and educate their patients on many different facets. It is also difficult for patients to follow exercise advise when they are not feeling their best. It is my job as a physiotherapist and researcher to come up with ways to implement this research easily and effectively despite these obstacles.
Q. Can you recommend any resources that physiotherapists may be interested in or links to open access articles that may be of interest?
- The Cancer Care Ontario exercise guidelines. This is a huge step in getting both survivors and fellow health care professionals educated on the importance of exercise during and after treatment. The next steps continue to be effective implementation of these guidelines!
- Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71-92.