No it’s not a misprint. CaRE is Cancer Rehab and Exercise, a joint venture of the Ann B. Barshinger Cancer Institute (Lancaster General Health/Penn Medicine) and the YMCAs of Lancaster County, Pennsylvania.

Started in September, 2011, at one location, the CaRE program now extends to all three YMCA facilities in Lancaster County. It offers a safe and supportive environment for exercise to cancer survivors and addresses fatigue issues as recommended by the NCCN Guidelines. In many studies exercise is shown to decrease the risk for disease recurrence. Per the American College of Sports Medicine, “…exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups” (Schmitz et al., 2010, p. 1409).
                                            
CaRE is a 12-week exercise program for cancer survivors, which is supervised by a YMCA personal trainer who has received specialized education from Cancer Institute staff regarding the unique issues of cancer survivors. Survivors can be referred by any oncology staff person; first, however, they must receive approval from their oncologist and undergo a physical therapy assessment, including physical skills testing. Once they have passed the initial assessment, they are then listed with their preferred YMCA site for the next available session.

Preference may be based on geographical location, class schedule and/or first available opening. The program is advertised via strategically placed flyers throughout the Cancer Institute as well as information on our web site. All patients participating in a survivorship visit meet with a social worker and receive an informational folder that highlights survivorship services and programs, including CaRE.

The CaRE program is held three times a year in January, April and September. Classes are one hour in length and meet twice a week. Although participants exercise within the context of a group, their goals are individualized based on their ability level. Two of the sites meet during the day and one in the evening. The evening program, which opened in September 2015, serves the needs of those who work during the day and also includes survivors who live in the eastern part of the county. Due to the generosity of our local community and the efforts of Lancaster General’s Auxiliary, the CaRE program is funded and supported, so there is no cost to participants.

The exercise component of CaRE supports improving the physical endurance and flexibility of participants as they seek to find their “new normal” with their bodies. Although it is optimal to complete treatment prior to participating in CaRE, exceptions have been made for individuals with a stage IV diagnosis whose treatment is ongoing. Regardless of diagnosis, participants are expected to participate in at least 80 percent of the classes. 

An equally important component of CaRE is the three presentations that are spaced out over the 12-week period—a social worker leads a discussion on Survivorship, a chaplain on Spirituality and a dietitian on Nutrition. An additional hour per week is allotted for these presentations. Fear of recurrence, spiritual distress and diet concerns are openly addressed. It is not uncommon for tears to be expressed and for the quiet to find their voice. Support staff participating in these discussions continue to be amazed by the emotional bonding and support that is exhibited within the group as survivors are surrounded by fellow survivors who “get it” and offer one another encouragement and acceptance.

Following the 12-week session, outcomes testing is conducted. A physical therapist evaluates participants in the areas of lower and upper extremity flexibility, balance and endurance. Weight goals are also addressed. These measurements are compared with the initial measurements recorded prior to the start of CaRE. Participants receive immediate feedback from the therapist regarding any improvements and whether they have reached their goals. Below is an overview of the CaRE metrics for the year 2015 as provided by Debbie Schrodi, DPT CLT-LANA, Oncology Rehabilitation Supervisor.

Immediately following the outcomes testing, a social worker conducts a distress screening to identify any continuing concerns for participants. The top five issues identified by screenings at the end of the 12 weeks from 2013-2015 data have been fatigue, worry, memory/concentration, sleep issues and neuropathy. The social worker reviews appropriate support services at the Cancer Institute and in the community and makes any necessary referrals. A program evaluation is also conducted to elicit participants’ feedback and suggestions for program improvement. All distress screenings and program evaluations are forwarded to the manager of Oncology Clinical Support for further review and data collection.
So what do CaRE participants say about the program?

• “I found the program very helpful in regaining strength and stamina.”
• “I feel so much better, stronger. Just working out, meeting other friends in same circumstances gives you joy.”
• “I’m not one for support groups so this was great to speak with others on an informal level.”
• “This was a wonderful way to connect with other survivors. It helped make my recovery time realistic hearing others’ experiences–similar and different.”

Most impressive is the letter submitted by a survivor who had a special birthday while participating in CaRE:
“I just want you to know how much my CaRE program is helping me. On Friday May 20th at 80 years of age, I did the zip lines at Refreshing Mountain. It was absolutely scary being up 60 feet in the trees but I had fun with my granddaughter. I loved the zip lines but was not crazy about the rope challenges!! I prayed a lot on them. Ha!

Now, if I wouldn’t have had four weeks at the "Y" doing my work out, I don’t know how I would have done it. It really has strengthened me. Jane is a great trainer. She works us out and I am really enjoying it. I have told her, ‘I don’t want to be weighed but my ankles and knees are more pronounced. I really look forward and am enjoying every day exercising.’”