National organizations such as CancerCare, the American Society of Clinical Oncology (ASCO), and the National Cancer Institute (NCI) strive to raise awareness among patients, caregivers, and professionals about the need to address both a patient’s physical health as well as their emotional/psychosocial well-being during posttreatment. Following the Institute of Medicine’s landmark 2006 report, Cancer Patient to Cancer Survivor: Lost in Transition, the concept of a survivorship care plan has emerged as the standard of care for posttreatment cancer survivors. A detailed and comprehensive survivorship care plan focuses on possible contingencies related to a patient’s emotional, social, and psychological well-being, as well as addressing follow-up appointments, scans, and schedules. Potential long-term side effects and chronic symptoms should also be discussed with the patient. Simply, a comprehensive survivorship care plan should account for patients’ needs by managing their physical and emotional/psychosocial health.
I cannot address the topic of posttreatment care without being reminded of a client I worked with years ago. Christine, an experienced RN who had worked in critical care and was now retired on disability, came with her husband to CancerCare for help coping with a stage IV ovarian cancer diagnosis. She had been in and out of treatment for years. On more than one occasion, she shared with me that she felt much better emotionally and psychologically when she was in chemotherapy treatment, even though this meant managing rigorous and life-altering side effects. “When I’m not in treatment,” she shared, “I have much more anxiety and panic attacks.”
When crafting a survivorship care plan, keep in mind that it should not be prepared for the patient and based solely on their medical history and needs. Rather, it should be crafted with the patient, and guided by the person’s goals and desires for their posttreatment life. The patient’s answers to questions such as “What is meaningful or important to you?” “What helps you to feel calm and focused?” and “What are your personal goals?” should inform plans for how the health care team will continue monitoring the patient.
Oncology clients will have different approaches to their posttreatment lives. For Christine, regular monitoring helped assuage her feelings of anxiety and occasional panic, providing more of a sense of control about her diagnosis. Conversely, I recently worked with a CancerCare client who, when symptoms of a recurrence led her oncologist to suggest she preemptively undergo chemotherapy, communicated that she would rather wait until the results of her 6-month evaluation came in before embarking on another round of treatment. She chose to go this route because, she recalled, “During chemotherapy, I lost my quality of life completely.”
Resources for survivors
Both clients were fortunate to have a health care team that worked closely with her to develop a plan that addressed both medical and emotional/psychosocial concerns. The counseling they received at CancerCare helped them to learn skills and strategies to cope with the multiple physical and cognitive manifestations of anxiety and panic. Empowered by this knowledge and the support received, both clients were able to discuss and negotiate concerns and issues with their oncology teams as well as their CancerCare counselors, who helped them to understand and identify the warning signs of anxiety and panic while providing cognitive/behavioral strategies to diffuse these reactions.
Mind/body techniques such as deep breathing, yoga, meditation, or light exercise can also calm the mind and sharpen a patient’s ability to focus. Even a simple walk around the neighborhood can provide a welcome distraction from racing, anxious thoughts. Posttreatment patients and caregivers of posttreatment patients can benefit from sharing their feelings and concerns with a professional oncology social worker.
As I often remind CancerCare clients (posttreatment and otherwise), life after cancer treatment is emotionally and psychologically complicated. But by working with patients to account for the emotional as well as the medical issues they may encounter posttreatment, you help to ensure that patients maintain the highest quality of life after treatment ends.
William Goeren is the director of Clinical Services at CancerCare and a cofounder of the organization’s LGBT services.