Cancer Treatment Cancer Treatment to Survivorshipto Survivorship

What’s the Plan?What’s the Plan?Building a Building a

Survivorship PlanSurvivorship PlanRose Bell, PhD (c), ARNP-c, OCNRose Bell, PhD (c), ARNP-c, OCN

Oncology Nurse PractitionerOncology Nurse PractitionerGenetics EducatorGenetics Educator

Northwest Specialties, Tacoma Wash.Northwest Specialties, Tacoma Wash.

ObjectivesObjectives

Understand the definition, concepts Understand the definition, concepts and stages of the survivorand stages of the survivor

Define the major tasks of the Define the major tasks of the survivor and their anchors and survivor and their anchors and outcomesoutcomes

Discuss survivorship issues and Discuss survivorship issues and rationales for building survivor plansrationales for building survivor plans

Understand the concepts and Understand the concepts and components of a survivor plancomponents of a survivor plan

Survivorship: The Survivorship: The definitiondefinition

““to remain alive or in existence” or to to remain alive or in existence” or to “continue to function or prosper” “continue to function or prosper” (Merriam-Webster, 2006)(Merriam-Webster, 2006)

A concept that begins on the day of A concept that begins on the day of cancer diagnosis and encompasses cancer diagnosis and encompasses changes that occur over a lifetime as a changes that occur over a lifetime as a result of the diagnosis (Chen, 2006; result of the diagnosis (Chen, 2006; Marco, 2004; Dow, 2003; NCCN, 2006Marco, 2004; Dow, 2003; NCCN, 2006))

Survivorship-The Survivorship-The definition (cont)definition (cont)

National Cancer Institute adds;National Cancer Institute adds;

The individual, their family and The individual, their family and friendsfriends

Survivor Facts and Survivor Facts and FiguresFigures

PastPast- 3 million survivors in 19713 million survivors in 1971- PresentPresent- 10 million survivors in 2008 10 million survivors in 2008 - Future Future - Estimates 20 million survivors by 2020Estimates 20 million survivors by 2020Why?Why?- Aging Population - Aging Population - Better Cancer outcomes- Better Cancer outcomes- Oncology Nurse and Physician Shortage!!!- Oncology Nurse and Physician Shortage!!!

Stages or Seasons of Stages or Seasons of SurvivorshipSurvivorship

--Acute survival (0-6 months)Acute survival (0-6 months)

-Extended survival (active treatment into a -Extended survival (active treatment into a period of remission)period of remission)

-Permanent survival (when enough time has -Permanent survival (when enough time has passed that recurrence is unlikely)passed that recurrence is unlikely)

Add revised stagesAdd revised stages

-Relapse-Relapse

Stages or Seasons of Stages or Seasons of SurvivorshipSurvivorship

revisitedrevisited

--Intense initial therapyIntense initial therapy

-Transitional cancer survivorship-Transitional cancer survivorship

-Alive and “living with cancer”-Alive and “living with cancer”

-Extended survival -Extended survival

-Permanent survival (when enough -Permanent survival (when enough time has passed that recurrence is time has passed that recurrence is unlikely)unlikely)

-Relapse-Relapse

Needs of the SurvivorNeeds of the Survivor(and family)(and family)

PsychosocialPsychosocialPhysicalPhysicalSocialSocialSpiritualSpiritualFamily EconomicFamily EconomicEmotionalEmotionalInformationalInformationalSexual Sexual VocationalVocational

Survivorship ConceptsSurvivorship ConceptsLiving With CancerLiving With Cancer

Distinct from quality of lifeDistinct from quality of life Identify and integrate a lifelong chronic Identify and integrate a lifelong chronic

conditioncondition A new sense of identity that changes A new sense of identity that changes

over time over time Diagnosis can lead to distress for years Diagnosis can lead to distress for years

and is unique to the cancer survivorand is unique to the cancer survivor Survivors seldom receive all the Survivors seldom receive all the

information they seekinformation they seek

Survivorship ConceptsSurvivorship ConceptsLiving With CancerLiving With Cancer

Cognitive changes affect their livesCognitive changes affect their lives

■ ■ Assigns new meaning to their lives Assigns new meaning to their lives that didn’t exist previouslythat didn’t exist previously

Ultimately leads to the Ultimately leads to the development of a development of a

““New Normal”New Normal”

Major TaskMajor Task

Continuity developmentContinuity development

Review of their lifeReview of their life Make decisions on their future lifeMake decisions on their future life Future memory constructionFuture memory construction

Goal is to infuse their life experiences Goal is to infuse their life experiences with meaning, increasing their identity with meaning, increasing their identity and retaining “future memory”and retaining “future memory”

Anchor PointsAnchor Points

Developed as a result of becoming a Developed as a result of becoming a survivorsurvivor

may include;may include;

CommunityCommunity

Family Family

FriendsFriends

Religious supportReligious support

ConsequencesConsequences

Survivors all reported perceived Survivors all reported perceived benefitsbenefits Stronger appreciation of lifeStronger appreciation of life Positive changes including social and Positive changes including social and

personal relationshipspersonal relationships Heightened motivation for health**Heightened motivation for health** Post traumatic growthPost traumatic growth

Survivorship IssuesSurvivorship Issues

Late EffectsLate Effects Secondary MalignanciesSecondary Malignancies Co morbidities such as diabetes, Co morbidities such as diabetes,

high blood pressurehigh blood pressure Oncology in Primary CareOncology in Primary Care

Medical Management in Medical Management in SurvivorshipSurvivorship

Prevention and wellnessPrevention and wellness SurveillanceSurveillance Intervention of post treatment Intervention of post treatment

effectseffects Coordination of careCoordination of care

Medical Management of Medical Management of late effectslate effects

Cardiopulmonary Cardiopulmonary OralOral EndocrineEndocrine GIGI GUGU SkinSkin MusculoskeletalMusculoskeletal Nervous SystemNervous System Ears, EyesEars, Eyes Quality of Life and PsychosocialQuality of Life and Psychosocial

Survivorship Plan Survivorship Plan ComponentsComponents

History of Cancer treatmentHistory of Cancer treatment Persistent EffectsPersistent Effects Possible Late EffectsPossible Late Effects Signs and symptoms to reportSigns and symptoms to report Wellness PlanWellness Plan Future Cancer ScreeningFuture Cancer Screening

Survivorship Survivorship PlanPlan

Types of CAM useTypes of CAM usePotential BenefitsPotential Benefits

DIET- DIET- dietary considerations ie a low fat plant based dietary considerations ie a low fat plant based diet , Cancer risk reduction, decreased co-morbidities diet , Cancer risk reduction, decreased co-morbidities

EXERCISE- EXERCISE- exercise, weight reduction ,cancer risk exercise, weight reduction ,cancer risk reduction, decreased co-morbidities reduction, decreased co-morbidities

ELECTROACUPUNCTURE- ELECTROACUPUNCTURE- ameliorated nausea and ameliorated nausea and vomiting vomiting

ACUPRESSURE- ACUPRESSURE- chemotherapy-related nausea and chemotherapy-related nausea and vomiting vomiting

*ACUPUNCTURE- *ACUPUNCTURE- Possible use for radiation induced Possible use for radiation induced xerostomia, Blom,, evidence for hot flashes, fatigue and xerostomia, Blom,, evidence for hot flashes, fatigue and shortness of breath shortness of breath

MASSAGE- MASSAGE- anxiety and lymphedema, relaxation, anxiety and lymphedema, relaxation, decreased pain and improved sleep decreased pain and improved sleep

AROMATIC OIL-AROMATIC OIL-enhances effects of the massage enhances effects of the massage BIOFEEDBACK- BIOFEEDBACK- muscle strengthening in urinary and muscle strengthening in urinary and

fecal incontinence and constipation as well as insomniafecal incontinence and constipation as well as insomnia

Genetic Genetic Considerations Considerations in Survivorship in Survivorship

I look forward to your I look forward to your questions and commentsquestions and comments