Some people may be overjoyed at the prospect of completing their cancer treatment and returning to normal life, but for many others, fear and anxiety can overshadow feelings of elation. The survivorship phase of a cancer journey can be confusing and uncertain. Comments like, “I don’t know what is next” and “The responsibility for care is now up to me” can alert oncology nurses that patients need additional communication and strategies to transition into healthy survivorship.

Patients younger than 40 who elected to have breast-conserving surgery instead of mastectomy to remove breast cancer reported having better quality of life (QOL) more than five years after diagnosis, according to study findings reported in JAMA Surgery.

More than 150 Office of Cancer Survivorship grants totaling nearly $112 million funded research on cancer survivorship in 2020, including “resources for implementation of the STAR Act and additional resources provided through legislation such as the 21st Century Cures Act, which authorized funding for the Cancer Moonshot,” according to the office’s 25th anniversary report.

Adolescent and young adults (AYAs)—those diagnosed between the ages of 15 and 39—comprise about 5% of all annual cancer diagnoses. The population has unique challenges that must be considered as part of patient-centered survivorship care planning.

Among patients with metastatic, castration-resistant prostate cancer, treatment with the experimental ¹⁷⁷Lu-PSMA-617 radiopharmaceutical, along with other standard treatments, improved survival by four months over treatment with standard therapies alone, researchers reported in the New England Journal of Medicine. The therapy targets the PMSA protein and may one day be an option when other treatments have failed.

Using two agents that target two different receptors more than doubles length of survival for advanced melanoma than a single agent alone, researchers reported at the 2021 American Society of Clinical Oncology annual meeting.

In 2021, approximately 44,000 people will be diagnosed with thyroid cancer, most commonly younger patients and assigned females at birth.

Progression-free and overall survival rates for patients with metastatic testicular cancer have significantly grown since 1990, researchers reported in the Journal of Clinical Oncology.

In April 2021, U.S. Senators Chris Murphy (D-CT) and Joni Ernst (R-IA) introduced the Metastatic Breast Cancer Access to Care Act, legislation that would waive the five-month waiting period for social security disability insurance (SSDI) and the 24-month waiting period for eligible Medicare benefits.

As Americans reduce tobacco use and treatment and diagnosis advance, lung cancer survivorship rates are improving; however, it still remains the second most common type of cancer. The growing population needs appropriate survivorship care.

Historically, ovarian cancer is often diagnosed at advanced stages because of vague symptoms and presentation, but with new advancements in diagnosis and treatment options, patients with the disease are living longer than ever.

As the number of cancer survivors continues to grow in the United States, so too does the need for cancer survivorship programs. Oncology advanced practice RNs (APRNs) are essential team members as institutions develop and deliver comprehensive and holistic programs to meet survivors’ needs.

Chronic pain is a common but debilitating late effect for many patients with cancer. When undertreated, patients may experience negative functional, mental, and cancer-related outcomes. Although opioids are often effective for managing cancer pain, they may not be appropriate for some patients and others may struggle to access them because of the opioid crisis. The need for nonpharmacologic pain management options is critical. 

Despite accounting for only 3% of all cancer survivors, patients with head and neck cancers often require significant support and survivorship care. And oncology nurses can expect survivorship to grow with recent improvements in prognosis and treatment options, such as with reductions in human papillomavirus-related oropharyngeal cancers, which tend to affect young people and offer improved long-term survival rates.

As the third most common cancer among both men and women, colorectal cancer is a reality for the more than 1 million people in the United States who are living with or have a history of the disease. Advancements in early detection and treatment have improved outcomes, but many survivors experience late and long-term side effects that may vary in duration, intensity, and impact on their quality of life. Clinicians must tailor each survivorship care plan for a patient’s cancer type, stage, treatment received, psychosocial implications, and side effects or toxicities. Studies have shown that experiencing long-term side effects and symptoms can reduce survivors’ quality of life. 

As treatments have advanced and patients and providers have more options, cure and survivorship rates for lymphomas are improving: five-year survival rates for Hodgkin and non-Hodgkin lymphoma are 86% and 71%, respectively. Despite good results from treatment, research indicates that lymphoma survivors carry a significant amount of late and chronic effects. Even in a complete remission, late effects of treatment present a burden for patients' physical and psychosocial well-being.

More than 3.5 million people in the United States are living with a breast cancer diagnosis. Despite their large number, patients often report they do not receive appropriate follow-up care after completing treatment—and the situation is worsening, with pandemic-related delays in care affecting approximately half of breast cancer survivors.

Pancreatic cancer is the ninth most common cancer in the United States, accounting for 3% of all cancers but causing 7% of cancer-related deaths, which equates to about 57,500 diagnoses and 47,050 deaths each year. The average person’s risk for pancreatic cancer is about 1 in 64.

Lisa, a 32-year-old tax accountant, completed treatment for stage III triple-negative breast cancer 18 months ago. During a follow-up appointment, Lisa reported worsening headaches and difficulty concentrating at work. A magnetic resonance imaging scan and subsequent biopsy revealed a solitary brain lesion. She completed stereotactic brain radiation two months ago.

Lung cancer is the leading cause of cancer death in the United States, accounting for about one quarter of cancer deaths, and more than a quarter of million lung cancer diagnoses are projected in the United States for 2020. Lung cancer has various types, pathologies, and histologies, each with its own prognosis and treatment plan. Non-small cell lung cancer consists of about 80%–85% of lung cancer diagnoses.

Until recently, past ONS President Deborah Mayer, PhD, RN, AOCN^®, FAAN, served as interim director of the National Cancer Institute’s (NCI’s) Office of Cancer Survivorship, a part of the Division of Cancer Control and Population Sciences. As an oncology nurse, Mayer brought a special perspective to the office’s mission to better understand and meet the unique needs of the growing number of U.S. cancer survivors.

Glioblastoma or glioblastoma multiform (GBM) is a primary central nervous system tumor. Approximately 23,890 new brain tumors are diagnosed in the United States each year, with GBM accounting for 38%. GBM can present as a primary diagnosis or evolve from a lower grade brain tumor.

Users of two common antihistamines—desloratadine and loratadine—have lower mortality rates from cutaneous malignant melanoma than patients who use other antihistamines, researchers reported in Allergy.

Although opioid-related deaths are increasing in the general U.S. population, leading to the U.S. Department of Health and Human Services declaring it a public health emergency, new research shows that the increase is much smaller among patients with cancer, even though opioids are used as an option for cancer-related pain. The findings were published in JAMA Oncology.

Most cancer diagnoses in the United States occur later in life, in patients older than 60 years, although most of the common pediatric diagnoses occur in those younger than 10 years. Pediatric and adult patients receive similar cancer therapies. The goal is to kill rapidly dividing cancer cells. Unfortunately, most of a child’s cells also undergo rapid division, and treatment can damage healthy tissue. Therefore, treatment that cures pediatric cancer can also cause long-term survivorship issues.

Myeloproliferative neoplasms are a group of blood cancers that start with a small mutation in the stem cells of the bone marrow. Although MPNs are quite rare, essential thrombocythemia, polycythemia vera, and myelofibrosis are the most common types. Each represents a mutation of a different source of stem cell.

A child’s cancer diagnosis can tear apart a family’s sense of security. After successfully navigating the cancer experience and all that comes with it, no one wants to face that again, and patients and families may fear an increased risk for secondary cancers. Oncology nurses can support pediatric cancer survivors and their families with resources for monitoring and reassurance about the possibility of facing secondary cancer.

Primary care for patients who are cancer survivors is multifaceted. Although my goal as a primary care physician (PCP) remains the same as with all my patients—to continue helping them lead long, healthy lives—care for this population requires some additional steps. 

Colorectal cancer (CRC) is the third most common cancer affecting men and women in the United States. When CRC is found at an early stage before it has spread, the five-year relative survival rate is about 90%, yet it remains a leading cause of cancer-related death among both genders. 

Cancer is second only to heart disease as the leading cause of death in the United States. But heart conditions overlap with cancer in more ways than mortality. Chemotherapy, immunotherapy, radiation, and the myriad medication combinations used in cancer can lead to various complications, including cardiotoxic side effects. Because of the prevalence of heart disease, many patients with cancer also present with pre-existing cardiac comorbidities.

Oncology nurses are critical to meeting three components of the newly revised Commission on Cancer (CoC) standards released in fall 2019: certification, survivorship, and barriers to care.

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.”

Since the National Academies of Medicine (formerly the Institute of Medicine) issued Cancer Patient to Cancer Survivor: Lost in Transition in 2005, the oncology field has made small strides to implement successful survivorship resources to support patients after their treatment. Because of the vast differences in patient populations, disease types, study locations, and institutional resources, best practices to support patients transitioning from treatment to survivorship care are often unclear. This poses an issue for providers, and patients hear mixed messaging or little information for follow-up care. With many patients receiving treatment in outpatient settings, ambulatory oncology nurses must understand how to provide support for patients during their transition.

Women who survived pediatric cancer but developed breast cancer as an adult are more than twice as likely to die prematurely, mostly from comorbid conditions, according to results of a study published in the Journal of Clinical Oncology.

Patients with hematologic cancers have a 19% increased risk for blood clots or bleeding events even 10 years after diagnosis, according to the results of a study published in the Journal of Thrombosis and Haemostasis.

Since 2016, then-candidate Trump promised he was going to bring healthcare costs under control. In a White House announcement on June 24, 2019, the president took steps to add transparency to the process by requiring insurance companies, hospitals, and physicians to identify fees and costs in public and simple ways for patients to see in advance and to understand.

As more patients receive treatment with chimeric antigen receptor (CAR) T-cell therapy, oncology nurses will need to be aware of the long-term effects of treatment that may persist into survivorship. However, because the treatment is so new, studies measuring those patient-reported concerns are still forthcoming. The majority of today’s recommendations for survivorship management are based on experts’ clinical experience.

Rising prescription medication costs has been a major focus area for both the Trump administration and the 116th Congress. In January 2019, both the House and Senate committees of jurisdiction held public hearings on soaring drug costs. Despite constant media attention and mounting pressure from government officials, no pharmaceutical company executives chose to testify. Congress threatened to subpoena the industry if it happened again.

Healthcare providers need to address three priority areas to improve outcomes for cancer survivors and support caregivers for patients with cancer, according to findings from an evidence review published in CA: A Cancer Journal for Clinicians.

A survivorship clinic allows APRNs to practice autonomously and highlights their strengths and skills, including assessing long-term toxicities, providing expert symptom management, coordinating with other disciplines, and making referrals as appropriate. Long-term toxicities from cancer treatment are disease- and treatment-specific and will be unique to each patient.

Cancer prevention is a full-time job, and the Centers for Disease Control and Prevention (CDC) works around the clock to raise awareness and promote necessary early detection and screening methods. Cancer survivors are a unique subset of patients and require information that’s been individualized to the survivorship experience.

In 2016, the American Cancer Society (ACS) reported that the number of currently living cancer survivors is estimated at 15.5 million Americans. For 2018, ACS is projecting another 1.7 million new cases of cancer diagnoses. On one hand, the growing number of survivors indicates that early diagnosis, new technologies, targeted interventions, treatment options, and access to care are making a huge difference for patients. 

Incorporating survivorship care plans into a hospital’s electronic medical records (EMRs) can be a tremendous aid for oncology nurses supporting their patients entering survivorship. Using the National Comprehensive Cancer Network treatment guidelines as a template for care, the oncology team can prepare a patient’s medical record with the necessary individualized information. 

The medical terms for living with and beyond a cancer diagnosis identify patients as entering the survivorship phase of their cancer journey. However, as science continues to develop new treatments responsible for extending patients’ lives, new levels of survivorship are being determined.

More than 13,000 children are diagnosed with cancer every year in the United States. Because treatment options continue to improve, more than 80% of those children will survive at least five years after their diagnosis.