Early diagnosis and advancements in cancer treatment have markedly improved five-year cancer survival rates. By 2026, an anticipated 20.3 million cancer survivors will be living in the United States. On Saturday April 13, 2019, Kathleen Wiley, RN, MSN, AOCNS®, discussed survivorship care and the challenges that nurses are perfectly positioned to address during a clinical chat at the ONS 44th Annual Congress in Anaheim, CA.
Survivorship Care Begins at Diagnosis
Promoting and ensuring comprehensive survivorship care are uphill battles for nurses, Wiley explained. She drew parallels between survivorship care and the challenge of incorporating palliative care throughout the treatment trajectory instead of only at the end of life. Nurses led the charge to ensure palliative care is integrated into treatment plans at the time of diagnosis and are preparing to do the same for survivorship care. Wiley explained that although survivorship care ramps up as treatment plans end and patients reach the end of their treatment trajectory, the same considerations and conversations should begin when treatment starts.
Wiley identified four major components of survivorship care:
- Prevention of new and recurrent cancers
- Management of medical and psychosocial late effects of treatment
- Consideration of cancer and treatment effects
- Coordination between primary and specialty care
New primary and secondary malignancies (especially leukemia and solid organ malignancies) are a major risk for cancer survivors, and preventative measures and screening tools must be used during cancer care, Wiley said. Combination chemoradiation, especially with an anthracycline and pelvic, chest or abdominal radiation, is a major culprit. Nurses can lead conversations about nutrition, exercise, and healthy lifestyles in preventing new primary or secondary malignancies.
Models of Survivorship Care
Wiley described three different models for survivorship care. In some cases, the cancer specialty team takes the lead and continues to manage chronic and late effects. In other cases, patients return to their primary care providers for management of chronic and late effects and screening tests. But the most common approach, Wiley noted, is a shared care model, where the cancer team ensures that patients’ primary care team is involved in knowing treatment plans, risks for late and chronic effects, and other components of survivorship care. In that model, both the cancer team and other providers involved in patients’ care play a role in implementing survivorship care. It requires careful collaboration and communication, which oncology nurses can help facilitate.
Survivorship care plans have gained popularity as the Commission on Cancer has required their implementation for a cancer center to obtain accreditation. Wiley emphasized that care plans are patient care tools, not a piece of documentation or a checklist. They must be individualized and considered a working tool to help engage patients and caregivers in conversations, as opposed to a document to complete.
Late Effects in Survivorship
Finally, Wiley reviewed some of the common late effects experienced by cancer survivors based on their treatment plan entailed but emphasized that each patient’s experience is individualized to combination regimens, disease sites, and other factors. Clinicians are challenged because evidence is lacking to outline how frequently patients may require cardiac and pulmonary function tests, laboratory tests, and other diagnostics as part of their survivorship care. But knowing what to look for, including individualized risk based on agents received, can help clinicians stay a step ahead.