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Cancer Treatment to Survivorship What’s the Plan? Building a Survivorship Plan

Cancer Treatment to Survivorship What’s the Plan? Building a Survivorship Plan. Rose Bell, PhD (c), ARNP-c, OCN Oncology Nurse Practitioner Genetics Educator Northwest Specialties, Tacoma Wash. Objectives. Understand the definition, concepts and stages of the survivor

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Cancer Treatment to Survivorship What’s the Plan? Building a Survivorship Plan

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  1. Cancer Treatment to SurvivorshipWhat’s the Plan?Building a Survivorship Plan Rose Bell, PhD (c), ARNP-c, OCN Oncology Nurse Practitioner Genetics Educator Northwest Specialties, Tacoma Wash.

  2. 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

  3. 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)

  4. Survivorship-The definition (cont) • National Cancer Institute adds; The individual, their family and friends

  5. 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!!!

  6. 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

  7. 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

  8. Needs of the Survivor(and family) Psychosocial Physical Social Spiritual Family Economic Emotional Informational Sexual Vocational

  9. 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

  10. Survivorship ConceptsLiving With Cancer • Cognitive changes affect their lives ■ Assigns new meaning to their lives that didn’t exist previously Ultimately leads to the development of a “New Normal”

  11. 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”

  12. Anchor Points • Developed as a result of becoming a survivor may include; Community Family Friends Religious support

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

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

  15. Medical Management in Survivorship • Prevention and wellness • Surveillance • Intervention of post treatment effects • Coordination of care

  16. Medical Management of late effects • Cardiopulmonary • Oral • Endocrine • GI • GU • Skin • Musculoskeletal • Nervous System • Ears, Eyes • Quality of Life and Psychosocial

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

  18. Survivorship Plan

  19. 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

  20. Genetic Considerations in Survivorship

  21. I look forward to your questions and comments

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