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Cancer survivorship care has ‘crucial impact’ on patients’ overall well-being
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Editor’s note: HemOnc Today’s regular columns for advanced practice providers (APPs) tackle common issues APPs face, discuss day-to-day practice and regulatory concerns, and share research advances. To contribute to this column, contact Alexandra Todak at stodak@healio.com.
With the number of cancer survivors projected to exceed 20 million by 2026, cancer survivorship is an issue that clearly impacts the oncology community, as well as primary care and family medicine.
To adequately provide comprehensive care for the cancer survivor, it is imperative their health care team understands the implications of their previous cancer diagnosis as it relates to their return to healthy living.
Although the utility of nurse practitioners and physician assistants is obvious across the spectrum of health care, these clinicians are especially effective in the field of oncology and are distinctively poised to help meet the growing need of oncologic survivorship care.
Building trust
As an APP, I provide survivorship care for patients with thoracic and head and neck cancers with whom, often, I have had the opportunity to form a relationship throughout the course of their treatment, sometimes starting from the time of diagnosis. This unique relationship allows the APP to play an instrumental role, not only in managing symptom burden related to the disease or treatment, but also in offering support with psychosocial, economic and family issues.
There is a certain degree of trust that is built between me and my patients during treatment. This trust is especially helpful in the delivery of their survivorship care plan — which includes a wealth of information regarding general healthy behaviors, prevention and risk reduction of new cancers, and, perhaps most importantly, symptoms of disease recurrence — at the conclusion of treatment.
I set aside every Tuesday afternoon specifically for hour-long survivorship visits; many other survivorship APPs at my institution also carve out regular times in their work week. This is a luxury, which the demanding schedules of physicians with whom we work do not generally allow, and patients are content to benefit from the increased availability of APPs.
McCorkle and colleagues posit that oncology APPs are a “viable solution to address workforce issues and the increased needs of more acute patients receiving increasingly complex care without compromising on quality and efficiency.” APP roles seem to vary widely among institutions but, clearly, APPs are well suited to provide cancer survivorship care.
Aspects of survivorship care
In addition to a thorough physical exam, during the survivorship visit APPs also:
The survivorship visit also is an ideal time to screen for psychological stressors and to offer help if needed. Symptoms of anxiety and depression can manifest even after treatment ends, and fear of recurrence can also be identified and managed. Because many patients receiving treatment become accustomed to weekly appointments, lab visits, infusions and phone calls, they sometimes experience feelings of abandonment when treatment ends and feel as though they have been deserted by their health care team.
Some patients describe this phenomenon as being “pushed off a cliff” with no support or lifelines. Despite knowing how to contact their team, they often don’t want to “bother” us for seemingly trivial issues. Survivorship visits can prevent these feelings and provide encouragement and reassurance.
The APP can identify specific areas needing improvement and offer recommendations to maximize quality of life after treatment. The patient leaves the appointment with realistic and measurable health-related goals, such as cutting back on tobacco use, improving nutrition and getting more sleep. Recommendations are included with their treatment record for easy reference, and the APP should follow up on progress toward these goals at their next visit.
One area in which oncology APPs may be used to their highest scope of practice within survivorship is the close monitoring of those patients cured of late-staged cancers or those with higher risk for recurrence. APPs come from diverse backgrounds, experiences and cultures, and solid communication is one of our chief strengths. We aim to provide holistic care and to optimize overall well-being by considering not only the patient, but also their family, environment and other external factors.
Deborah Mayer, PhD, RN, AOCN, FAAN, director of cancer survivorship at UNC Lineberger Comprehensive Cancer Center — my professor and mentor during graduate education — helped instill the profound significance of survivorship in my personal practice as a nurse practitioner and as an oncology clinician, a lesson that guides the care I deliver even today. The entire health care team, not limited to the field of oncology, should recognize the value of cancer survivorship and its crucial impact on the global care of our patients.
References:
McCorkle, R. et al. J Adv Pract Oncol. 2012;doi:10.6004/jadpro.2012.3.1.4.
Miller KD, et al. CA Cancer J Clin. 2016;doi:10.3322/caac.21349.
For more information:
David L. Jennings II, MSN, RN, AGPCNP-BC, is a nurse practitioner at Levine Cancer Institute at Carolinas HealthCare System. He also is a HemOnc Today Editorial Board Member. He can be reached at david.jennings@carolinashealthcare.org.
Disclosure: Jennings reports no relevant financial disclosures.