Survivorship has been recognized as a distinct part of cancer care since the publication of the Institute of Medicine’s (IOM’s) 2005 report, From Cancer Patient to Cancer Survivor: Lost in Transition. The 5-year relative survival rate for all cancers diagnosed between 2001 and 2007 is 67%, compared with 49% for cancers diagnosed from 1975 to 1977.1
On January 1, 2012, 13.7 million Americans with a history of cancer were still alive, and that number is predicted to swell to 18 million.2 National Cancer Institute (NCI) statistics indicate that the number of patients cured of cancer and the number of those considered cured of the disease will increase, and many patients will survive multiple recurrences.3 What will your patients turn to you for as they continue through their survivorship journey?
Health promotion and survivorship Health promotion is defined as the process of enabling people to increase control over their health and its determining factors, thereby improving their health.4 Cancer survivorship is defined as the span of time from diagnosis through the balance of the patient’s life.5
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Cancer survivors may experience disease-related health issues such as organ damage and failure, infertility, premature aging, compromised immune system, and a damaged endocrine system; however, aging-related and other health problems may also emerge.6 Obesity, diabetes, dyslipidemia, menopause, osteopenia and osteoporosis, hypothyroidism, and hypertension are frequently reported.6 These comorbidities can occur as immediate, mid-range, or late-term issues, and in addition to late- and long-term effects of treatment.7 Latencies of some side effects can be quite long, and not all survivors are affected; therefore, predicting a particular patient’s risk for side effects is difficult. Furthermore, patients may focus more on cancer recurrence than on other aspects of their health.8
Teachable moments Experts in the cancer community have described cancer as an event that causes changes in health behavior.9 The occurrence of cancer can be interpreted as a teachable moment, as patients may be more open to making lifestyle changes after a cancer event in an effort to prolong their survival.
Oncology nurses are the ideal clinicians to engage patients in health promotion throughout the many stages of their treatment. Nurses’ multiple roles allow them to initiate important discussions about self-care and preventing recurrence, as well as comorbid conditions, at timely points in the patient’s journey.
Availability and accessibility Studies of the health behaviors of cancer survivors indicate that clinicians need to stay engaged with their patients. For example, 20% of cancer survivors continue to smoke, and only 29% of cancer survivors meet the current recommendations for physical activity.10 Nurses have many opportunities to teach patients about these and other lifestyle modifications that can improve their risks.
Modifiable risk factors that can reduce cancer incidence are tobacco use, obesity, poor diet, physical inactivity, alcohol abuse, unsafe sex and exposure to human papillomavirus (HPV), air pollution, indoor and/or secondhand smoke, and exposure to ultraviolet light.1
A wealth of resources The IOM’s report called for using evidence-based clinical guidelines to focus on the management of late side effects.11 The American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and other specialty organizations have developed specific guidelines. Other organizations have established clinical guidelines for several metabolic diseases that include guidance for cancer survivorship care, including the American Association of Clinical Endocrinologists (AACE); the American Diabetes Association; the National Heart, Lung, and Blood Institute (NHLBI); and the National Osteoporosis Foundation.
Preventive measures for health risks are quite teachable, and several ACS publications offer self-help information on how to improve the risk from these factors. American Cancer Society reports provide clear guidelines and recommendations.
Patients look to their nurses as credible health professionals for guidance and support. Programs for cancer survivors will vary from institution to institution, but nurses have a seat at the table for designing patient education and developing opportunities educate patients as they survive the cancer experience.
REFERENCES
1. American Cancer Society. Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society; 2012.
2. American Cancer Society. Cancer Treatment and Survivorship Statistics 2012-2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-033876.pdf. Accessed January 21, 2014.
3. Belluck P. Number of cancer survivors in U.S. rises by 20 percent. St. Louis Post-Dispatch Web site. http://www.stltoday.com/news/national/number-of-cancer-survivors-in-u-s-rises-by-percent/article_51833624-4b76-11e0-ae04-00127992bc8b.html. Published March 10, 2011. Accessed January 21, 2014.
4. Health promotion homepage. PanAmerican Health Organization/World Health Organization Web site. http://www.paho.org/hq/index.php?option=com_content&view=article&id=5164&itemid=3753&lang=en. Accessed January 29, 2014.
5. Clark EJ, Stovell EL. Advocacy: The cornerstone of cancer survivorship. Cancer Practice. 1996;4(5):239-244.
6. Edgington A, Morgan MA. Looking beyond recurrence: comorbidities in cancer survivors. Clin J Oncol Nurs. 2011;15(1):E3-E12.
7. Rowland JH. Cancer survivorship: rethinking the cancer control continuum. Semin Oncol Nurs. 2008;24(3):145-152.
8. Hansen LA. Challenges patients face in cancer care: implications for the healthcare team. Value-Based Cancer Care Web site. http://www.valuebasedcancer.com/article/challenges-patients-face-cancer-care-implications-healthcare-team. Accessed January 22, 2014.
9. Ganz PA. A teachable moment for oncologists: cancer survivors, 10 million strong and growing! J Clin Oncol. 2005;23(24):5458-5460.
10. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23(34):8884-8893.
11. Hewitt M, Greenfield S, Stovall E, eds; Committee on Cancer Survivorship: Improving Care and Quality of Life, Institute of Medicine and National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press; 2005. http://www.iom.edu/reports/2005/from-cancer-patient-to-cancer-survivor-lost-in-transition.aspx. Released November 3, 2005. Accessed January 21, 2014.
REFERENCES
1. American Cancer Society. Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society; 2012.
2. American Cancer Society. Cancer Treatment and Survivorship Statistics 2012-2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-033876.pdf. Accessed January 21, 2014.
3. Belluck P. Number of cancer survivors in U.S. rises by 20 percent. St. Louis Post-Dispatch Web site. http://www.stltoday.com/news/national/number-of-cancer-survivors-in-u-s-rises-by-percent/article_51833624-4b76-11e0-ae04-00127992bc8b.html. Published March 10, 2011. Accessed January 21, 2014.
4. Health promotion homepage. PanAmerican Health Organization/World Health Organization Web site. http://www.paho.org/hq/index.php?option=com_content&view=article&id=5164&itemid=3753&lang=en. Accessed January 29, 2014.
5. Clark EJ, Stovell EL. Advocacy: The cornerstone of cancer survivorship. Cancer Practice. 1996;4(5):239-244.
6. Edgington A, Morgan MA. Looking beyond recurrence: comorbidities in cancer survivors. Clin J Oncol Nurs. 2011;15(1):E3-E12.
7. Rowland JH. Cancer survivorship: rethinking the cancer control continuum. Semin Oncol Nurs. 2008;24(3):145-152.
8. Hansen LA. Challenges patients face in cancer care: implications for the healthcare team. Value-Based Cancer Care Web site. http://www.valuebasedcancer.com/article/challenges-patients-face-cancer-care-implications-healthcare-team. Accessed January 22, 2014.
9. Ganz PA. A teachable moment for oncologists: cancer survivors, 10 million strong and growing! J Clin Oncol. 2005;23(24):5458-5460.
10. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23(34):8884-8893.
11. Hewitt M, Greenfield S, Stovall E, eds; Committee on Cancer Survivorship: Improving Care and Quality of Life, Institute of Medicine and National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press; 2005. http://www.iom.edu/reports/2005/from-cancer-patient-to-cancer-survivor-lost-in-transition.aspx. Released November 3, 2005. Accessed January 21, 2014.
