Lessons Learned from Breast Cancer Dragon Boaters

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Lessons Learned from Breast Cancer Dragon
Boaters

• Dr. Terry Mitchell
• Wilfrid Laurier University
• Canada

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Collaborators

• Co-Investigators
• Robert Gebotys, Ph.D.,Ross Gray, Ph.D., Marg
  Fitch, Ph.D., Edmee Franseen, M.Sc.
• Community Advisory Group Eleanor Nielsen, Franci
  Finkelstein, Bonnie Marshall, Donnas Stuart
  Doris Rossi
• Organizational Support The Ontario Breast Cancer
  Community Research Initiative, Wilfrid Laurier
  University

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Dragon Boating

• Dragon boating is an ancient Chinese sport,
  dating back more than 2000 years
• Women with breast cancer began training with
  Dr. McKenzie in Vancouver, 1996

Vancouvers Abreast In A Boat team
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How do women thrive in the face of illness and
the threat of premature death?

• WHAT is the Psychosocial Impact of Survivor Boat
  participation?
• HOW does participation in Dragon Boating
  contribute to womens wellness?

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Methodology/Methods

• A community-based, participatory,
• mixed-methods study
• Survey development workshop
• Series of 56 qualitative interviews
• 405 standardized surveys (81.8 response rate)

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Participants

• Interview Participants (n56)
• 34 -78 years in age
• diagnosed between 2001 and 1974
• Survey participants (N 405)
• 27 81 years in age

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14 Breast Cancer Dragon Boat teams Across Ontario
Legend Dragon boat
teams/participants
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Survey 4 standardized measures were employed

• QOL Quality of Life
• MAC Mental Adjustment to Cancer
• PCL Post Traumatic Stress
• STS Transcendence

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Plus a Demographic sheet and a space to answer

• In your own words the most important thing
  for people to understand about survivor dragon
  boating and your health and well-being.

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Interview Themes

• Inspiring Hope
• Awakening to the Self
• Regaining Control
• Becoming Strong(er)
• Living Life to the Fullest.

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Inspiring Hope

• A symbol of hope to those who need it... I think
  we're a
• highly visible symbol of successful breast cancer
  treatments
• to a lot of people That is an enormous symbol of
  hope for
• people who are newly diagnosed....We're a very,
  very,
• visible example of a group of women who are doing
• something and having fun doing it and living life
• to the fullest.

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• Dragons of Hope, Thunder Bay

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Regaining Control

• Chemo sucks you dry. By the time you're
  finished, you have a shell of your former self...
  The cancer I can't control that, but this was
  something I control. I could get stronger and I
  could be a part of this team.

• Warriors of Hope, North Bay

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Becoming Strong(er)

• because breast cancer assaults our bodies, its
  the place where the fear lurks and so
  psychologically to feel the power in our bodies
  is very important.
• Weve gone through what weve gone through, and
  look where we are today. Were in boats paddling,
  paddling hard, paddling strong, feeling alive
  and feeling that you can do anything that you
  can take on the world. Its a real sense of
  accomplishment.

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• Living Life to the Fullest

Dragons Abreast, Toronto
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Public Awareness
Private Experience
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Survey Findings

• Dragon boaters had greater burden of illness than
  many other study samples on breast cancer and
  PTSD in the literature.
• Significantly less post traumatic stress found
  among the dragon boaters as compared to other
  studies of women with breast cancer.
• Post treatment Psychological Wellbeing and
  Quality of Life was not related to Stage of
  Disease.
• Those who trained with their team to a high
  degree had lower recurrence

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BURDEN OF DISEASE Among Ontario Dragon
Boaters with Breast Cancer

22 have Lymphodema
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Statistical Analysis

• Cox regression models with proportional
  hazards were used to predict the survival time
  indicator, time to recurrence of the cancer as
  measured in years from date of initial diagnosis.

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Recurrence

• The cox regression model was very significant ?2
  (3) 16.91, p .001 predicting the risk of
  recurrence of cancer significantly.
• Increased risk of recurrence was associated with
  the explanatory variables plc measure of trauma
  (p.03)
• Conversely, increased dragonboat training with
  the team(p.08) was associated with reduced risk
  of recurrence.

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Intensity and Type of Training

• Level of training was assessed using variables
  reporting
• year of joining the team,
• total time training with the team
• total time training alone, as well as
• the of solitary training activities
• the reasons given for dragon boating.

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Intensity of Team Training

• Assumptions of a Cox proportional hazard model
  were verified.
• Those dragon boat members that trained
• more than twice a week with the team were put
  in a high training group. Those that trained
  less than this in a low group.
• Figure 3 shows that the high training group has
  a significantly lower risk than the low training
  group.
• .

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Benefits of Team Training

• A high level of training with a dragon boat team
  is associated with a significantly reduced risk
  of recurrence.
• Despite earlier studies which confirm the
  physical health and QOL benefits of exercise, we
  found no significant impact on rates of
  recurrence for those with a high degree of
  training alone.

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Special Contribution of Team Training

• Stage of initial diagnosis, experience with
  lymphodema, type of cancer treatment and the
  other breast cancer history variables as well as
  interactions of the above variables were not
  significant.
• Other physical activity measures and
  psychological measures did not play a role in
  predicting rate of recurrence.

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EXERCISE

• Exercise has been identified as a supportive
  therapy for cancer survivors providing improved
  physical, psychological status and quality of
  life benefits
• (Culos-Reed, Sheilds, and Brawley ,2005
  Courneya, Blanchard Laing, 2001 Segal et al
  2001 Pinto et al, 2003)
• Most survivors however do not achieve the minimal
  amounts of exercise required for benefit
• As well significant decreases in total
  exercise and moderate to vigorous intensity
  exercise from pre-diagnosis to post-diagnosis are
  almost universal in cancer survivors
• (Vallance, 2005, p. 988) benefits

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Exercise Immune Function and Survival Benefits

• Immune Function
• Increasingly research is showing a link between
  exercise and improved immune function
• Fairey, A.S., Courneya, K.S., Field, C.J.
  Mackey, J.R. (2002). Physical exercise and
  immune system function in cancer survivors A
  comprehensive review and future directions.
  Cancer, 94, 539-551.
• Survival Benefits
• Mortality risk reduction was found to be 6 at
  10 years for women who engaged in 9 or more hours
  of physical activity per week
• Holmes, M.D., Chen, W.Y., Feskanich, D., Kroenke,
  C.H. Colditz, G.A. (2005). Physical activity
  and survival after a breast cancer diagnosis.
  Journal of the American Medical Association,
  293(20), 2479-2486.

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What are the potential factors that
contribute to the observed benefits of team
training ?

• Mutual Empathy
• Egalitarian Structure
• Mutual Empowerment
• Jordon (2000) Jordon, Kaplan, Baker Miller,
  Stiver Surrey (1991)

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Mutual Empathy

• The opportunity to laugh, to cry and to share and
  endure 2.5 minutes of hell is priceless. You are
  with others who get it.
• to be out there with such a group of brave,
  courageous, determined, caring women. We are more
  than a team- we are family.
• Youre among friends who were also bald and
  throwing up and many who have lopsided chests!
  You share the joie de vivre which we seem to have
  learned from the experience.

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Egalitarian Stucture

• It is absolutely wonderful to see a boat with 22
  ladies, all ages and sizes, all kinds of
  backgrounds and fitness (levels) all working so
  hard and having lots of fun.
• when you no longer have the endurance to
  continue paddling, it is your fellow dragon
  boater that carrys you along.
• There is such an energy of mind, body and spirit
  that occurs when a group of breast cancer
  survivors are working together for a common goal.

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Mutual Empowerment

• Every time I race I feel like I am saying Look
  at me! I can do this. Cancer does not always
  mean death. In my case cancer has caused me to
  live more fully!
• I consider dragon boating one of the main
  influences in my life. I have learned lots about
  myself through participating and I think I am
  much stronger personally, both physically and
  mentally.
• Cancer has changed my life and dragon boating has
  been a true silver lining on this journey. I feel
  more powerful now than ever before even when I
  am scared.

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The Potential of Survivor Dragon Boating

• Exercise improves womens health status and their
  quality of life after treatment for cancer
• Social support and emotional expression mediate
  anxiety, denial, anger, depression and an altered
  self-image related to cancer

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LESSONS FROM DRAGON BOATERS

• B.C. is a chronic disease
• Living with NED
• Gender and health
• Holistic LIFE-style

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• Dragon boating provides a powerful vehicle for
  womens health
• Interaction of social support, emotional
  expression, and adequate and ongoing levels of
  physical activity
• Evidence of strong psychosocial and physical
  health benefits with potential survival benefits

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Conclusion

• Further Random Control Trial research is
• required to investigate observed links between
• dragon boat participation, intensity of team
• training, social support, and reduced recurrence.

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This research is possible through the generous
funding of
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• Thank-you