Author: Reegan Knowles
Knowles, Reegan, 2025 Supporting Self-Management of Cardiovascular Disease and its Risk Factors in People Diagnosed with Cancer , Flinders University, College of Medicine and Public Health
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This thesis describes the research program I have undertaken as my PhD candidature, including the experiences of the scholarly journey.
Chapter 1 presents an overview of the conceptualisation of the research program, a summary of the thesis and how the research journey evolved, particularly regarding how the original plan for subsequent studies within the program changed based on findings of previous studies. In Chapter 2, an introduction and presentation of relevant existing literature provides a background for the reader and generates rationale for the research program. In particular, the seriousness and prevalence of CVD risk in cancer is described and the existing relevant guidelines and interventions (e.g., cardio-oncology clinics) are presented with detail. The aim of the research program was to develop understanding of perspectives of cancer care providers and people with cancer to inform the codesign of a new approach to reduce the impact of CVD risk in people who have been diagnosed with cancer.
Chapter 3 presents a review of systematic reviews investigating the effectiveness of lifestyle interventions in older people with cancer. The findings strongly support the inclusion of information and support to optimise physical activity behaviour as an important and effective component of a resource to reduce the impact of CVD risk in cancer. Limited dietary data suggests some favourable outcomes for older people with cancer, but there is no review-level evidence for smoking and alcohol interventions.
Chapters 4 and 5 report the findings of two qualitative studies to examine the perspectives of cancer care providers and people diagnosed with cancer regarding CVD in cancer. Providers were aware of the issue of CVD care in cancer and perceived it important, but many people with cancer were unaware. Cancer care providers perceived they could not deliver CVD care alone due to time and role constraints. Both providers and people with cancer suggested a diverse range of possible solutions to improve CVD care in cancer including education. These findings suggest the need for a flexible and individualised approach to provide information and support to people affected by cancer to self-manage aspects of the CVD care.
The codesign and usability testing of the first website, ‘My Heart and Cancer’, to provide information and support for patients to self-manage CVD risk in cancer, is described in Chapter 6. The website is visually-appealing, easy-to-use and interactive, and provides information and support including CVD risk assessment, self-management and access to services and resources. After testing for feasibility and effectiveness, the website has the potential to contribute to reducing the impact of CVD in cancer, including mortality and morbidity, through providing information and support according to the preferences of people diagnosed with cancer and cancer care providers.
Keywords: cancer, cardiovascular disease
Subject: Medicine thesis
Thesis type: Doctor of Philosophy
Completed: 2025
School: College of Medicine and Public Health
Supervisor: Bogda Koczwara