Hearth Place Cancer Support Centre – Do it with Ease

1. Mission 

1. 1. To help regain and maintain range of motion, maintain physical fitness, build core strength, and reduce the risk of lymphedema.  

2. At a Glance

1. 1. Location: Oshawa, Ontario
   2. Program Site: Hearth Place Cancer Support Centre
   3. Program Launch Date: October, 2002

3. Key Stakeholders in Initiation

4. Contact Information

1. 1. Website: http://hearthplace.org/support-services/programs/do-it-with-ease/ 
   2. Facebook: Hearth Place Cancer Support Centre @hearthplace
   3. Email: hearthplace@hearthplace.org 
   4. Phone: 905-579-4833

5. Community Partnerships and Affiliations

6. Development and History

1. 1. 1997: Hearth Place was established to address the social, practical, emotional, educational and spiritual needs of cancer survivors, family members, and caregivers. 
   2. 2002: Do it with Ease was initiated as a research project in partnership with physiotherapists and nurses from Lakeridge Health Hospital, studying the efficacy of an exercise program in supporting patients with lymphedema. 
   3. 2003: Through participant feedback and demand, the original program designed to target strategies for lymphedema management, transitioned to focus on overall wellness for all cancer survivors after cancer treatment (strength, flexibility, etc.)
   4. 2005: An addition was made to the Hearth Place facility to provide more space for programming. The Do it with Ease program is now run weekly out of a multi-purpose room within the new addition. 

7. Barriers to Program Development

1. 1. Financial burden 
      1. “There is a demand for this program, and there has always been a waiting list…and it is just coming up with the funding for that.”

8. Facilitators of Program Development

1. 1. Interdisciplinary team 
      1. “It started out as an interest to see if they could do something to help support patients with lymphedema, so the hospital physiotherapy department was involved, and some of the nurses from the hospital, just in terms of trying to develop an exercise program that might prove some benefits for lymphedema”.
   2. Patient demand
      1. “As the program developed over the years it became more focused on just exercise and building muscle mass after chemotherapy… [this transition was made] by looking at feedback from the participants and the demand for this type of programming.”

9. Current Staff Structure

10. Core Practices

1. 1. Facility 
      1. 624 square foot multi-purpose room

10. 2. Parking
       1. Private parking is available on-site at no cost and free street parking is available. 

10. 3. Cost Structure
       1. The Do it with Ease is free to program participants. However, participants must register as a member of Hearth Place prior to class participation (at no cost to participants). 

10. 4. Funding and Support
       1. Fundraising Initiatives  (50%)
       2. Donors (e.g., individual donations, corporate sponsor’s) (50%)

10. 5. Recruitment
       1. Referral Sources
          1. Physician referral (e.g., Family Physician’s, Surgeon’s, Oncologists, Radiologist, and medical support staff)
          2. Word of Mouth
       2. Awareness initiatives
          1. Program information is displayed on bulletin boards in the regional hospitals.
          2. An interdisciplinary focus group was held with cancer-related community organizations to discuss strategies for implementing the CCO exercise guidelines in the community.
             1. The focus group executive summary was presented at grand rounds, in combination with a presentation of the Hearth Place facility and its program offerings. 
          3. Booths are set up at wellness fairs and cancer-specific events in the community.
          4. Media (e.g., newspaper, bi-monthly newsletters to corporations)

10. 6. Participants
       1. Eligibility criteria: Adult individuals of any age, with any type of cancer are eligible to participate (participants are encouraged to be mid-way to end of treatment phase). Physician’s note is required.
       2. Participants per session: 14 participants
       3. Staff to participant ratio: 1:14 leader to participant ratio
       4. Total number of participants in program: 14

10. 7. Initial intake session
       1. Do it with Ease does not currently conduct intake assessments.

10. 8. Program Schedule 
       1. Duration: 1 hour
       2. Frequency: 1 session per week
       3. Length: 8 weeks

NOTE: Participants have opportunity to re-enrol in program, however priority given to new members.

10. 8. 4. Session Schedule: Thursday 9:15-10:15am
       5. Additional supports available:
          1. Occasional transportation to program provided on a needs-based basis.

10. 9. Program Structure
       1. The Do it with Ease program meets the CCO exercise guidelines for people with cancer.
       2. Group-based exercise prescription
          1. Fitness components include aerobic, strength, balance, lymph drainage exercises, and flexibility 
       3. Equipment
          1. Resistance bands, free weights, ankle weights, stability balls, and floor mats

10. 10. Educational Components
        1. Informal education (optional): Educational elements are provided by a registered kinesiologist within their scope of practice.

10. 11. Program Evaluation
        1. Self-report program evaluations are distributed at the end of the program.

11. Current Barriers to Participation

1. 1. Treatment schedule
      1. “And treatment schedules [are barriers] too, you are working with specialists so you might not be able to schedule your appointments around your exercise programming.”
   2. Treatment-related side effects (fatigue, pain, depression)
      1. “I think a lot of it comes down to physically how they are feeling…if you are in treatment, it’s hard to get up and out the door for a 9am, when mornings aren’t your best.”
   3. Perceived risk
      1. “I think a lot of them are hesitant to come and participate in a class like this because they have heard so many things about ‘don’t do this, don’t do that, but really, anybody can start this class, because we can modify it for each participant.”

12. Facilitators of Participation

1. 1. Social program atmosphere
      1. “The biggest piece of the program is the peer support aspect, and again finding that motivation, finding that work out partner, finding someone who is in a similar situation as them…the acceptance of being able to work out in the program…you know that I don’t have to put m wig on…everybody accepts me and everybody understands why we do this”.
   2. Non-judgemental environment
      1. “…the acceptance of being able to work out in that program… and the sense that everybody here gets it, and everybody understands us, and if I can’t keep up at the gym, nobody here is judging me…that is a huge piece of what the program is.”
   3. Release of the CCO guidelines 
      1. “I think the new CCO guidelines coming out, and because that is becoming a standard of practice right now [it has facilitated participation].”
   4. Accessible space
      1. “We have the stairs, we have an elevator…we have a lot of variance [in the equipment].”

13. Future Directions

1. 1. To focus on program expansion, and offer additional sessions that accommodate member availability.