1. Prepared by Amanda OReilly Manager, Cansupport Clinical Oncology, Royal North Shore Hospital November 2011 Breast Foot Forward A walking information and support group for early breast cancer patients.

2. Background Cansupport was established in 1981 to offer information and support to cancer patients through groups and volunteer peer support. Cansupport operates within a psychosocial service for cancer patients at Royal North Shore Hospital, Sydney Australia. A wide range of groups are offered with the following breast cancer specific options.

3. Breast Cancer Information and Support Services Early Breast Cancer  6 week series x 4 times per annum  Life After Breast Cancer Workshops x 2 times per annum  Bi-annual Forums  Look Good Feel Better Workshops x 8 per annum  Relaxation and meditation sessions - weekly Advanced Breast Cancer  Monthly meetings

4. Barriers to existing services Extensive hospital rebuilding program causes access problems Parking and Sydney traffic Resistance to attending traditional groups Childcare causes limitations for younger women

5. Impetus for Breast Foot Forward Project No existing form of ongoing group support provided Offering psychological support in a non-threatening non clinical environment Evidence for support and information groups promoting social connection and peer support Evidence for benefits of physical activity in recovery and rehabilitation Evidence suggests a reduction in recurrence risk by up to 50% if a regime of 3-5 hours of moderate exercise per week is maintained Patient and Volunteer fundraising $11,000

6. Project planning Advisory committee formed with representation of patients, volunteers, breast care specialist nurse, physiotherapist, local community member and a psychologist. Tasks included finding a venue, planning the route, developing paper work, legal/insurance aspects, promotion of the walk.

7. Breast Foot Forward - The name and logo patient approved, distinctive and encouraging

8. The Venue- Manly, Sydney Australia

9. Manly Beach

10. THE MODEL traditional peer support, professional facilitation, topics eg teaching a walking meditation. THE WELCOMEintroductions and morning tea. THE ORIENTATION includes safety measures.

11. The Route - 5kms, level, scenic, regular seating, own pace.

13. The Members - varied fitness levels, any stage of early breast cancer journey, female supporters welcome.

14. Paperwork Information flyer and walking date calendar Registration Medical approval form

15. Other preparations  Legal/insurance clearance  First aid training for facilitators  Promotion  Catering  Resources: exercise recording book, pedometers

16. EVALUATIONS 29 registered participants -14 returned evaluations 11 completed treatment - 3 currently in treatment

21. Other Comments  “Motivates me to get off my bum. My husband pulls the covers off me now so I have to go in the mornings too.”  “I appreciate the information from the facilitators.”  “I’m not local but am happy to travel to Manly.”  “I appreciate the support and evolving information on breast cancer.”  “Manly is a very beautiful easy walk and the ocean views, beach and landscape add to the enjoyment.”  “Love walking by the ocean – very therapeutic.”  “Its encouraging to see there is life after the treatment.”`  “Keeping an exercise record book has been helpful to monitor my weekly activity.”

23. LESSONS LEARNED Due to varied levels of fitness the walk stretches over distance and requires volunteers to supervise. Maintaining an email data base allows for monthly reminder notice Future and recovery focussed rather than disease and clinical focus. Patient enabling.