Cancer Treatment to Survivorship What

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Cancer Treatment to SurvivorshipWhats the
Plan?Building a Survivorship Plan

• Rose Bell, PhD (c), ARNP-c, OCN
• Oncology Nurse Practitioner
• Genetics Educator
• Northwest Specialties, Tacoma Wash.

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Objectives

• Understand the definition, concepts and stages of
  the survivor
• Define the major tasks of the survivor and their
  anchors and outcomes
• Discuss survivorship issues and rationales for
  building survivor plans
• Understand the concepts and components of a
  survivor plan

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Survivorship The definition

• to remain alive or in existence or to continue
  to function or prosper (Merriam-Webster, 2006)
• A concept that begins on the day of cancer
  diagnosis and encompasses changes that occur over
  a lifetime as a result of the diagnosis (Chen,
  2006 Marco, 2004 Dow, 2003 NCCN, 2006)

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Survivorship-The definition (cont)

• National Cancer Institute adds
• The individual, their family and friends

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Survivor Facts and Figures

• Past
• 3 million survivors in 1971
• Present
• 10 million survivors in 2008
• Future
• Estimates 20 million survivors by 2020
• Why?
• - Aging Population
• - Better Cancer outcomes
• - Oncology Nurse and Physician Shortage!!!

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Stages or Seasons of Survivorship

• -Acute survival (0-6 months)
• -Extended survival (active treatment into a
  period of remission)
• -Permanent survival (when enough time has passed
  that recurrence is unlikely)
• Add revised stages
• -Relapse

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Stages or Seasons of Survivorshiprevisited

• -Intense initial therapy
• -Transitional cancer survivorship
• -Alive and living with cancer
• -Extended survival
• -Permanent survival (when enough time has passed
  that recurrence is unlikely)
• -Relapse

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Needs of the Survivor(and family)
Psychosocial Physical Social Spiritual Family
Economic Emotional Informational Sexual
Vocational
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Survivorship ConceptsLiving With Cancer

• Distinct from quality of life
• Identify and integrate a lifelong chronic
  condition
• A new sense of identity that changes over time
• Diagnosis can lead to distress for years and is
  unique to the cancer survivor
• Survivors seldom receive all the information they
  seek

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Survivorship ConceptsLiving With Cancer

• Cognitive changes affect their lives
• Assigns new meaning to their lives that didnt
  exist previously
• Ultimately leads to the development of a
• New Normal

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Major Task

• Continuity development
• Review of their life
• Make decisions on their future life
• Future memory construction
• Goal is to infuse their life experiences with
  meaning, increasing their identity and retaining
  future memory

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Anchor Points

• Developed as a result of becoming a survivor
• may include
• Community
• Family
• Friends
• Religious support

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Consequences

• Survivors all reported perceived benefits
• Stronger appreciation of life
• Positive changes including social and personal
  relationships
• Heightened motivation for health
• Post traumatic growth

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Survivorship Issues

• Late Effects
• Secondary Malignancies
• Co morbidities such as diabetes, high blood
  pressure
• Oncology in Primary Care

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Medical Management in Survivorship

• Prevention and wellness
• Surveillance
• Intervention of post treatment
• effects
• Coordination of care

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Medical Management of late effects

• Cardiopulmonary
• Oral
• Endocrine
• GI
• GU
• Skin
• Musculoskeletal
• Nervous System
• Ears, Eyes
• Quality of Life and Psychosocial

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Survivorship Plan Components

• History of Cancer treatment
• Persistent Effects
• Possible Late Effects
• Signs and symptoms to report
• Wellness Plan
• Future Cancer Screening

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• Survivorship Plan

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Types of CAM usePotential Benefits

• DIET- dietary considerations ie a low fat plant
  based diet , Cancer risk reduction, decreased
  co-morbidities
• EXERCISE- exercise, weight reduction ,cancer risk
  reduction, decreased co-morbidities
• ELECTROACUPUNCTURE- ameliorated nausea and
  vomiting
• ACUPRESSURE- chemotherapy-related nausea and
  vomiting
• ACUPUNCTURE- Possible use for radiation induced
  xerostomia, Blom,, evidence for hot flashes,
  fatigue and shortness of breath
• MASSAGE- anxiety and lymphedema, relaxation,
  decreased pain and improved sleep
• AROMATIC OIL-enhances effects of the massage
• BIOFEEDBACK- muscle strengthening in urinary and
  fecal incontinence and constipation as well as
  insomnia

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Genetic Considerations in Survivorship
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I look forward to your questions and comments