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Introduction
Making Survivorship Care a Priority By Denice Economou, RN, MN, CNS, AOCN Guest Editor Project Director, Survivorship Education for Quality Cancer Care, Division of Nursing Research and Education City of Hope National Medical Center, Duarte, California
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recent editorial in the Annals of Internal Medicine states, “If survivorship is a priority, we can improve the lives of survivors.”1 Increasing recognition of the importance of making survivorship care a priority was the motivating factor for this issue dedicated to cancer survivorship. Cancer survivorship may be defined in general from the day of diagnosis and beyond and includes the family and caregivers as they are all impacted by the diagnosis and treatment of cancer. This definition is broad because the population is so large. Health settings need to define which survivorship services their institution is able to provide. Large academic settings, especially LIVESTRONG Centers of Excellence, are able to provide multidisciplinary options to meet multiple needs for patients, families, and caregivers. Their outreach programs also extend to smaller community healthcare settings. This collaborative care is essential and allows the many issues that survivors and their families may experience to be addressed. This collaborative focus also allows settings with specific expertise to focus on what they are good at and share the burden of care with others in the community as well as access national survivor-focused programs. Collaborative care models in which oncologists work closely with advanced practice nurses, physician assistants, and other “extenders” and primary care physicians take increasing responsibility for the long-term care of survivors are discussed in the article by Craig A. Bunnell, MD, MPH, MBA, and Lawrence N. Shulman, MD, of Dana-Farber Cancer Institute, a leader in survivorship care.
Marcia Grant and I provide a brief overview of the physical symptoms associated with cancer and its treatments. The goal is to describe these treatment effects to establish the basis of survivorship care and identify the core changes patients may experience. These symptoms have been recognized by many and have been the motivating stimulus to the survivorship movement. Susan Leigh, BSN, RN, an expert in survivorship care, who is herself a survivor, provides an overview of survivorship and its history. As she explains, various models of survivorship care have been developed, and this issue provides examples of several of these. Nancy G. Houlihan, MA, AOCN, and Zana Correa, MSN, NP-BC, describe the model of survivorship care provided at Memorial Sloan-Kettering Cancer Center. Their mission is to provide nurse practitioner–led survivorship follow-up in an effort to assist the patient with “optimal recovery and transition to wellness.”
Collaborative care is essential and allows the many issues that survivors and their families may experience to be addressed.
Susan Daubman, RN, BSN, Theresa Franco, RN, MSN, and Katherine Gross, RN, MSN, of the Nebraska Medical Center describe the development of a survivorship program in an academic medical center. Beginning with their institutional assessment of the components of survivorship care available at their medical center and the needs of
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their population, they review their program-building process and the model of survivorship care they follow. Scott D. Siegel, PhD, and Cindy Waddington, RN, MSN, AOCN, share their experience with building a psychosocial-focused survivorship program at the Helen F. Graham Cancer Center, Christiana Care Health System in Newark, Delaware. Their focus is to provide psychosocial care to patients as they transition to life after cancer, a critical time for a cancer survivor. Rehabilitation is becoming a major focus for the future. Arash Asher, MD, and his colleagues have begun a rehabilitation program for cancer survivors at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles. His article helps define the many components of rehabilitation and how psychosocial and supportive care work together to create a program that will include rehabilitation services, psychosocial care, and palliative/symptom management.
WHO ARE CANCER SURVIVORS?
Cancer survivors are people who have been diagnosed with cancer and those people in their lives who are affected by the diagnosis, including family members, friends, and caregivers. —US Centers for Disease Control and Prevention
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September 2010 I VOL 3, NO 6
Other articles in this issue provide insights into other aspects of cancer survivorship. The article by Rosemary Frei discusses the importance of including families as part of the patient care we provide. A family assessment is as important as a patient assessment to understand the capability the family has to care for the needs of the patient. As the article notes, the FOCUS model (family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management) can help promote optimal care for cancer patients. Recognition and attention to sexual and intimacy issues are also essential components of cancer survivorship care, as discussed in the article by Darja Brandenburg, DClinPsych, DipPST, CPsychol, AFBPS. She reviews sexual issues commonly experienced by cancer patients and provides suggestions for how healthcare providers can help patients and their partners cope with these concerns. We hope the information and insights provided in this issue will be helpful for those who have established survivorship programs and those planning to do so. For further information on the medical, psychological, legal, and financial issues involved in survivorship care, we have included a guide to resources for cancer survivors and their healthcare providers. ● Reference 1. Iwashyna TJ. Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med. 2010;153:204-205.
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