At SeaChange Retreats, we want to ensure that we are offering safe and effective interventions, based on research and evidence, targeting the specific needs of cancer survivors. This means that we are invested in keeping up-to-date with current research, working with colleagues across the field of cancer care, and continually seeking feedback from professionals and participants alike. The following research hopefully helps you to understand why we are doing what we are doing, and why we are doing it where we are.
The Impact of Cancer
In the UK alone, one in two people will develop cancer at some point in their lives(2). Currently there are around 367,000 new cases of cancer every year, equating to approximately 1,000 new cases a day. Worldwide, over 17 million new cases of cancer were diagnosed in 2018(3).
Cancer has the ability to impact absolutely every aspect of an individual; physically, psychologically, interpersonally, vocationally, spiritually(4), at times compromising all aspects of quality of life(5). From the moment of diagnosis, life fundamentally changes. Daily life is put on pause, and cancer treatment becomes the priority.
The end of treatment signifies a key milestone for all cancer survivors, however this is not the end of the journey. Physically, the lasting effects of treatment are substantial. Fatigue and pain, alongside body changes resulting from treatment require adaptation and adjustment. Many survivors report ongoing limitations to their activities of daily living more than a year post-treatment(6).
Evidence shows that many cancer survivors have unmet needs, particularly at the end of treatment(7) . Survivors may have to come to terms with a ‘new normal’, with both physical and psychological ramifications – the impact of cancer on their bodies, on their relationships, education and employment, their body image and self-confidence, navigating a changing identity, and learning to live with the fear that cancer will return. The latter is frequently prevalent in survivorship(8), as are higher than normal levels of anxiety, stress and depression(9). Permeating every element of our psyche, cancer “can challenge the fundamental assumptions (we hold) about security, controllability and life priorities”(10).
The Department of Health recognises that more focus is needed on the long-term consequences of cancer that extend far beyond the end of curative treatment. Whilst efforts have been made to improve outcomes for cancer survivors with the launch of the National Cancer Survivorship Initiative, delivery of these programs is not yet available across the country and there are still many individuals who do not receive the support that they need(11).
Reducing the risk of heart disease, stroke, diabetes, dementia and Alzheimer’s disease, and lowering the risk of death by up to 30%, exercise is one of the most overwhelming ways of staying physically healthy(12). And not just for the body, research shows that physical activity helps build self-esteem, mood, sleep quality, energy, and reduces the risk of stress and depression(13).
In relation to cancer prevention, research into primary cancer prevention has identified physical activity as playing a key role in reducing the risk of cancer occurring. Physical activity and exercise have been correlated with reduced risks of cancer occurrence for breast and colon cancer populations(14,15). Maintaining a healthy weight has also been identified as preventative in reducing the risks of colon, breast, endometrial, renal, oesophageal and thyroid cancer occurrence(16).
In addition to the use of exercise to prevent cancer occurring, physical activity is recommended prior to, during and following cancer diagnosis and treatment by many of the leading organisations in cancer research and intervention(17,18,19).
A growing body of research recognises the positive effect of exercise on several of the common side-effects of cancer treatment, including cancer-related fatigue, psychological distress, quality of life, bone-mineral density, thromboembolism and constipation(20).
Studies are also demonstrating that regular physical activity during and after cancer treatment appears to improve overall survival and reduces the probability of relapse. Thomas, Holm and Al-Adhami (2014) summarise some of the major studies exploring exercise, relapse prevention and survival in their review, where they highlight that the evidence is strongest for breast cancer, colorectal cancer and prostate cancer survivors(21). They also explore some of the reasons behind these outcomes, for example cell growth patterns, hormone levels, gene expression and tumour immunity.
Finally, when considering the ‘whole’ health of cancer survivors, research has identified that there is an increased risk of heart failure, coronary heart disease, hyperthyroidism and osteoporosis among breast cancer survivors; dementia, diabetes and osteoporosis among colorectal cancer survivors; and high rates of osteoporosis among prostate cancer survivors(22). This reinforces the importance of exercise specifically for cancer survivors, building all aspects of their physical health.
Research from the National Cancer Survivorship Initiative suggests that cancer survivors would like support in becoming more active, something which can be a significant challenge post-treatment, and therefore need this to be tailored to their specific requirements(23).
Human beings are naturally driven to be socially oriented for survival. In cancer-care, research has highlighted the positive impact of social support and connectedness on cancer survival, both during and post-treatment(24,25), as well as the positive impact on pain and depressive symptoms(26). Cancer support groups have been found to provide ‘a unique sense of community’ and ‘unconditional acceptance’ amongst participants, with one study finding that individual’s own relationships outside of the group benefitted from them having the opportunity to express their emotions without fear of judgement or burden. Group support was also identified as building empowerment and agency amongst members, giving confidence and a sense of control in living with cancer(27).
Stress & Wellbeing
Whilst there is no evidence to suggest being stressed can cause cancer, research has shown that the ways in which people cope with and try to manage stress can impact negatively on their health.
Maintaining a focus on looking after ourselves is generally harder when we are stressed. Our diet may change, regular exercise may drop off, habits such as smoking and drinking alcohol can increase. All of these can lead us to be more vulnerable to health problems, including increasing the risk of cancer(28).
Stress & Wellbeing: Mindfulness
An increasing number of research studies are exploring the benefits of mindfulness practice on mental wellbeing. Ancient in origin, research now demonstrates significant effects of mindfulness on stress reduction, anxiety, depression, distress and quality of life among non-clinical populations(29).
When considering cancer-specific research, mindfulness-based interventions have been found to be beneficial across a variety of difficulties, including stress, anxiety and depression; managing pain intensity; cancer-related fatigue and attention; sleep; health-related quality of life; immune response; coping capacity and symptom burden(30,31,32).
Stress & Wellbeing: Yoga
Yoga, an ancient practice originating from India and focusing on strength, flexibility and breathing, has been suggested to benefit individual wellbeing for years. Building physical strength and balance as well as mental focus, multiple styles of yogic practice have developed.
While establishing a broad evidence-base for yoga intervention outcomes is challenging due to the variation across research studies (e.g. style of yoga practice, length of practice, control groups, outcome measures, rigour etc.), cancer-specific research is demonstrating some promising findings.
In a review of randomized controlled trials with adults undergoing cancer treatment, yoga was found to improve psychological outcomes (depression, distress, anxiety), quality of life, sleep and fatigue(33). In advanced breast cancer patients, a 3 month yoga program was found to be significantly more effective at improving fatigue than a supportive therapy and education program(34). A systemic review identified moderate-quality evidence supporting yoga in improving health-related quality of life, reducing fatigue and improving sleep disturbance when compared with no therapy, as well as reducing depression, anxiety and fatigue when compared with other psychosocial or educational interventions(35). And in breast-cancer survivors, those who maintained a yoga practice were found to have significantly lower stress, anxiety, depression, quality of life and better general health when compared to survivors with no yoga experience or practice(36).
Being near, in, on, or under the water, sets us at ease. It makes us happier, healthier, and more connected. Understanding why has become the focus of Wallace Nichols, author of Blue Mind(37). In his interview with Marla Cimini, November 2017, Nichols describes ‘blue mind’ as “the mildly meditative state we fall into when near, in, on or under water. It’s the antidote to what we refer to as ‘red mind,’ which is the anxious, over-connected and over-stimulated state that defines the new normal of modern life”(38).
Whilst much of the research is preliminary, ‘blue care’ interventions can have direct positive outcomes on health, specifically mental health and psycho-social wellbeing(39,40).
In a longitudinal analysis of over 400 case studies, a Wave Project review found that surf therapy sessions had a significant positive impact on the wellbeing of vulnerable young people, with sustained changes in positive functioning, feelings of competence, calmness and fun(41). Nichols identifies that even being exposed to the sight or sound of water triggers neurochemical changes in the brain that promote wellness and relaxation, with blue spaces offering full sensory immersion which has significant positive impacts on symptoms of anxiety and depression.
So, Why SeaChange?
We believe that SeaChange Retreats offer a unique opportunity for cancer survivors to holistically strengthen their recovery. Building skills and confidence in managing both the psychological and physical impact of cancer through workshops, yoga, mindfulness and surfing, in an environment that itself channels wellbeing, these restorative retreats facilitate positive connections. Driven by research, commitment and compassion, we look forward to welcoming you on our next retreat.
1 Shafi, Saba et al. (2019). “Psychological impact of cancer on patients in a tertiary care centre: a prospective study.” International Journal of Research in Medical Sciences 7, 2116.
2 Cancer Research UK (2015). 1 in 2 people in the UK will get cancer. Retreived from: https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2015-02-04-1-in-2-people-in-the-uk-will-get-cancer.
3 Cancer Research UK (n.d.). Cancer incidence statistics. Retreived from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence.
4 Hoffman, M., Lent, R., Raque-Bogdan, T. (2013). A Social Cognitive Perspective on Coping With Cancer: Theory, Research and Intervention. The Counselling Psychologist, 41(2), 240-267.
5 Penn, A., Kuperberg, A., Zebrack, B.J. (2017). Psychosocial Issues in Adolescent and Young Adult Patients and Survivors. In: Bleyer A., Barr R., Ries L., Whelan J., Ferrari A. (eds) Cancer in Adolescents and Young Adults. Pediatric Oncology. Springer, Cham.
6 Ketterl, T., McCabe, M., Rosenstein, D., Jacobs, L., Palmer, S., Ganz, P., Casillas, J., Risendal, B., Overholser, L., Partridge, A., Syrjala, K., Baker, K. (2019). Impact of cancer on physical and mental activities of daily living in young adult (YA) survivors. Journal of Clinical Oncology, 37(15), 11517-11517.
7 Armes, J., Crowe, M., Colbourne, L., Morgan, H., Murrells, T., Oakley, C., Palmer, N., Ream, E., Young, A., Richardson, A. (2009). Patients’ supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. Journal of Clinical Oncology, 27, 6172–6179.
8 Sun, H., Yang, Y., Zhang, J., Liu, T., Wang, H., Garg, S., Zhang, B. (2019). Fear of cancer recurrence, anxiety and depressive symptoms in adolescent and young adult cancer patients. Neuropsychiatric disease and treatment, 15, 857–865. DOI: https://doi.org/10.2147/NDT.S202432.
9 Hall, A.E., Sanson-Fisher, R.W., Carey, M.L., Paul, C., Williamson, A., Bradstock, K., Campbell, H. (2016). Prevalence and associates of psychological distress in haematological cancer survivors. Support Care Cancer, 24, 4413–4422. DOI: https://doi.org/10.1007/s00520-016-3282-3.
1o Vehling, S., Philipp, R. (2018). Existential distress and meaning-focused interventions in cancer survivorship. CurrOpin Support Palliat Care, 12(1), 46-51. DOI: 10.1097/SPC.0000000000000324
11 Bell, D. (2017). Living with and beyond cancer 1: how well are we helping patients? Nursing Times, 113(8), 22-24. Retreived from: https://www.nursingtimes.net/clinical-archive/cancer-clinical-archive/living-with-and-beyond-cancer-1-how-well-are-we-helping-patients-10-07-2017/
12 NHS (2018). Benefits of Exercise. Retreived from: https://www.nhs.uk/live-well/exercise/exercise-health-benefits/.
13 NHS (2018). Benefits of Exercise. Retreived from: https://www.nhs.uk/live-well/exercise/exercise-health-benefits/.
14 Kyu, H. H., Bachman, V. F., Alexander, L. T., et al (2016). Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ, 354:i3857. DOI: 10.1136/bmj.i3857.
15 Vainio, H., Kaaks, R., Bianchini, F. (2002). Weight control and physical activity in cancer prevention: international evaluation of the evidence. Eur J Cancer Prev. 11 Suppl 2:S94‐S100.
16 IARC. (2002). Weight Control and Physical Activity. IARC Handbook of Cancer Prevention. (Vol. 6). Lyon: IARC.
17 World Cancer Research Fund (2018). Physical activity and the risk of cancer. Retreived from: https://www.wcrf.org/dietandcancer/exposures/physical-activity.
18 Cancer Research UK (2018). What are the benefits of exercise? Retreived from: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/physical-activity-and-cancer/what-are-the-benefits-of-exercise.
19 Macmillan Cancer Support (2017). Physical Activity and Cancer: A concise evidence review. Retreived from: https://www.macmillan.org.uk/_images/the-importance-physical-activity-for-people-living-with-and-beyond-cancer_tcm9-290123.pdf.
20 Thomas, R.J., Holm, M., Al-Adhami, A. (2014). Physical activity after cancer: An evidence review of the international literature. BJMP, 7(708), 1–7.
21 Thomas, R.J., Holm, M., Al-Adhami, A. (2014). Physical activity after cancer: An evidence review of the international literature. BJMP, 7(708), 1–7.
22 Khan, N.F., Mant, D., Carpenter, L., Forman, D., Rose, P.W. (2011). Long-term health outcomes in a British cohort of breast, colorectal and prostate cancer survivors: a database study. Br J Cancer, 105 Suppl 1(Suppl 1), S29‐S37. DOI:10.1038/bjc.2011.420
23 Department of Health, Macmillan Cancer Support & NHS Improvement (2013). Living with & Beyond Cancer: Taking Action to Improve Outcomes. Retreived from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/181054/9333-TSO-2900664-NCSI_Report_FINAL.pdf.
24 Pinquart, M., Duberstein, P. R. (2010). Associations of social networks with cancer mortality: A meta-analysis. Critical Reviews in Oncology/Hematology, Volume 57 (2), 122-137. DOI: https://doi.org/10.1016/j.critrevonc.2009.06.003.
25 Kroenke, C.H., Michael, Y.L., Poole, E.M., Kwan, M.L., Nechuta, S., Leas, E., Caan, B.J., Pierce, J., Shu, X.‐O., Zheng, Y. and Chen, W.Y. (2017). Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project. Cancer, 123(7): 1228-1237. DOI: 10.1002/cncr.30440.
26 Hughes, S., Jaremka, L.M., Alfano, C.M., Glaser, R., Povoski, S.P., Lipari, A.M., Agnese, D.M., Farrar, W.B., Yee, L.D., Carson, W.E., Malarkey, W.B., Kiecolt-Glaser, J.K. (2014). Social support predicts inflammation, pain, and depressive symptoms: Longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology, 42, 38-44. DOI: 10.1016/j.psyneuen.2013.12.016.
27 Ussher, J., Kirsten, L., Butow, P., Sandoval, M. (2006). What do cancer groups provide which other supportive relationships do not? The experience of peer support groups for people with cancer. Social Science & Medicine, 62, 2565-76. DOI: 10.1016/j.socscimed.2005.10.034.
28 Cancer Research UK (2019). Can Stress Cause Cancer? Retreived from: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/cancer-controversies/can-stress-cause-cancer.
29 Khoury, B., Sharma, M., Rush, S.E., Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. J Psychosom Res., 78(6), 519‐528. DOI: 10.1016/j.jpsychores.2015.03.009.
30 Haller, H., Winkler, M.M., Klose, P., Dobos, G., Kümmel, S., Cramer, H. (2017). Mindfulness-based interventions for women with breast cancer: an updated systematic review and meta-analysis. Acta Oncology, 56(12), 1665‐1676. DOI: 10.1080/0284186X.2017.1342862.
31 Mehta, R., Sharma, K., Potters, L., Wernicke, A.G., & Parashar, B.S. (2019). Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques. Cureus, 11.
32 Shennan, C., Payne, S., Fenlon, D. (2011). What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psychooncology, 20(7), 681‐697. DOI: 10.1002/pon.1819.
33 Danhauer, S.C., Addington, E.L., Sohl, S.J., Chaoul, A., Cohen, L. (2017). Review of yoga therapy during cancer treatment. Support Care Cancer, 25(4), 1357‐1372. DOI: 10.1007/s00520-016-3556-9.
34 Vadiraja, H. S., Rao, R. M., Nagarathna, R., Nagendra, H. R., Patil, S., Diwakar, R. B., Shashidhara, H. P., Gopinath, K. S., &Ajaikumar, B. S. (2017). Effects of Yoga in Managing Fatigue in Breast Cancer Patients: A Randomized Controlled Trial. Indian journal of palliative care, 23(3), 247–252. DOI: https://doi.org/10.4103/IJPC.IJPC_95_17.
35 Cramer, H., Lauche, R., Klose, P., Lange, S., Langhorst, J., Dobos, G.J. (2017). Yoga for improving health‐related quality of life, mental health and cancer‐related symptoms in women diagnosed with breast cancer. Cochrane Database of Systematic Reviews (1). DOI: 10.1002/14651858.CD010802.pub2.
36 Amritanshu, R.R., Rao, R.M., Nagaratna, R., et al. (2017). Effect of Long-term Yoga Practice on Psychological outcomes in Breast Cancer Survivors. Indian J Palliat Care, 23(3), 231‐236. DOI: 10.4103/IJPC.IJPC_93_17.
37 Nichols, W.J. (2014). Blue mind: the surprising science that shows how being near, in, on, or under water can make you happier, healthier, more connected and better at what you do. New York: Little, Brown and Company.
39 Britton, E., Kindermann, G., Domegan, C., Carlin, C. (2020). Blue care: a systematic review of blue space interventions for health and wellbeing. Health Promot Int., 35(1), 50‐69. DOI: 10.1093/heapro/day103.
40 Gascon, M., Zijlema, W., Vert, C., White, M.P., Nieuwenhuijsen, M.J. (2017). Outdoor blue spaces, human health and well-being: A systematic review of quantitative studies. Int J Hyg Environ Health, 220(8), 1207‐1221. DOI: 10.1016/j.ijheh.2017.08.004.
41 Devine-Wright, H. & Godfrey, C. (2018). Surf therapy: the long-term impact. Retreived from: https://www.waveproject.co.uk/wp-content/uploads/2018/05/Wave-Project-Evaluation-2018.pdf.