The Case Supporting the Seasons of Survivorship
Jamie is completing her last cycle of carboplatin and paclitaxel for stage I ovarian cancer. The oncology infusion nurse notices that Jamie appears withdrawn and nervous, so he takes time to ask her how she is feeling about completing treatment. Jamie responds, “I feel as frightened about finishing treatment as I did when I was diagnosed with cancer.” She also shares that she doesn’t want to ring the cancer center’s bell to ceremoniously signify the end of her treatment because she doesn’t want to “jinx it.”
What Would You Do?
Holding to the definition that cancer survival begins at diagnosis, Fitzhugh Mullan described three seasons of survival (https://www.nejm.org/doi/full/10.1056/NEJM198507253130421): acute, extended, and permanent (see sidebar). Patients can experience feelings of fear and uncertainty at any time during the cancer journey; however, these and other emotions may be magnified during diagnosis and active treatment completion. Transitional survivorship is the time between acute and extended survival (https://www.ons.org/books/after-you-ring-bell-10-challenges-cancer-survivor), when people are adapting to the emotional, social, and physical changes that occurred during cancer treatment.
Oncology nurses should be aware of the personal and cultural considerations around ceremonies signifying the end of treatment such as ringing a bell. Some people, like Jamie, may feel that ringing the bell may be tempting fate, whereas others may see such public ceremonies as disrespectful to others who may be in treatment for the remainder of their lives.
Recognizing the uniqueness of each individual and taking time to ask how and if survivors want to signify the end of active treatment is being personally and culturally sensitive. Nurses can validate the emotional reactions associated with transitional survival, such as:
- Fear and uncertainty about the future and cancer recurrence
- Sadness about the loss of intense relationships with professional caregivers
- Guilt over being finished when others need ongoing treatment
The transitional survivorship phase is a good time to suggest support groups and referrals to cancer rehabilitation programs. Other evidence-based interventions that show promise during this time (https://www.health.harvard.edu/blog/fear-of-cancer-recurrence-mind-body-tools-offer-hope-2019030716152) include cognitive behavioral therapy, tai chi, yoga, expressive dance, breathing techniques, guided meditation, and some types of art therapy.