Oncology Nursing and Cancer Care
As we move forward in the new millennium more people are living with cancer than dying from it (National Cancer Institute [NCI], 2003). Indeed barring death by other causes, 63% of adults treated for cancer are alive 5 years after diagnosis, accounting for 10 million cancer survivors (NCI).
For most people
this means that cancer has gone from a death sentence to a chronic disease.
This success has resulted from continued advances made both in the laboratory
and at the bedside.
What Is Cancer Survivorship
The word survivor is derived from the Middle French survivre, to outlive, and from the Latin superviser , to live more (Merriam-Webster Online, 2004). Thus, cancer survivorship is the period of time after the diagnosis and treatment of cancer through the remainder of life (NCI, 2003).
It encompasses the physical,
psychosocial, and economic sequelae of cancer diagnosis and its treatment and
issues related to health care delivery, access, and follow-up care among both
pediatric and adult survivors of cancer (NCI).
Steps for Cancer Survivor Ship Worldwide
The current focus on cancer survivorship is in large part a result of the visionary efforts of the National Coalition for Cancer Survivorship (NCCS). Founded in 1986, it was established to refocus attention from people victimized by cancer to people living with and surviving cancer (NCCS, 2003).
The NCCS evolved from a peer support organization to what is now a formidable advocacy group setting public policy priorities on behalf of people with cancer. Moreover, as a result of the efforts of the NCCS as well as other grass-roots organizations, in 1996 the NCI created the Office of Cancer Survivorship (OCS) in recognition of the large number of individuals now surviving cancer and their unique and unstudied needs .
Since its inception the OCS has funded initiatives geared towards the
stimulation of research on long-term cancer survivorship. Thus, although the
concept of cancer survivorship is relatively young, these novel efforts have
provided important structure for a small but rapidly increasing field of cancer
survivorship research.
In his annual report to the nation, Dr. Andrew von Eschenbach of the National Cancer Institute identified areas of focus for survivorship research. They included long-term follow-up of childhood cancer survivors and issues faced by cancer survivors from underserved populations (NCI, 2003).
These areas are uniquely relevant to nursing practice and therefore represent important areas for future research as the number of cancer survivors increases in the coming decades. Findings of studies related to these foci will be discussed.
Recent statistics indicate that 1 in 1,000 20-year-olds is a childhood cancer survivor (Meadows, Krejmas , & Belasco, 1980). Ironically, the same treatment that produced successful response rates can also cause long-term adverse effects (Smith, M., & Hare, 2004).
For many pediatric cancer survivors, survivorship is marked by the occurrence of treatment-related late effects, ie, side effects that do not resolve or that arise after completion of therapy, and may result in physical, social, and emotional consequences.
Such effects include a plethora of physical, intellectual, pubertal, and reproductive manifestations, as well as the potential for secondary cancers (Swartz, 1999).
These effects represent a lifelong risk that often negatively influence quality of life and may be linked to the practice of high-risk lifestyle behaviors, including smoking and consumption of alcohol, practices that are further complicated in this population because of their genetic predisposition and previous exposure to cytotoxic agents ( Larcombe , Mott, & Hunt, 2002; Swartz).
Funded Care For Cancer Survivors
An important vehicle for addressing some of these and other childhood cancer survivor concerns is the Childhood Cancer Survivor Study (CCCS). Funded by the National Cancer Institute, the CCCS is a collaborative, multi-institutional, longitudinal survey of over 14,500 5-year childhood cancer survivors initially diagnosed between 1970 and 1986.
Survivors who participated in the study completed baseline and follow-up questionnaires including items related to organ system functioning, health habits, psychosocial health, fertility, and second malignancies.
Highlights of four studies reporting initial findings were:
(a) a statistically significant excess of secondary malignancies, the most common being breast cancer, thyroid cancer, meningioma, sarcoma, and bone cancer ( Neglia et al., 2001)
(b) reduced general physical and mental health, and activity and functional limitations when compared with siblings (Hudson et al., 2003)
(c) increased use of special education services when compared with siblings (2.3% vs. 8%) ( Mitby et al., 2003)
(d) increased reports of depressive and somatic distress when compared with siblings ( Zebrack et al., 2002).
These important findings provide insight into a variety of concerns
relevant to childhood cancer survivors. As a result of this work, the CCCS has
laid the groundwork for further examination into other issues that will provide
additional important contributions to childhood cancer survivors.
Cancer Survivorship And Undeserved Population
Cancer survivors from underserved populations may include the elderly, those with low income and educational levels, survivors from ethnic and cultural minorities, and those who live in remote areas (Rowland, Aziz, Tesauro , & Feuer, 2001).
As increasing numbers of people from underserved populations are diagnosed and treated for cancer, significant differences have been reported with respect to patterns of cancer-specific survival and relative risks of cancer death (Surveillance Epidemiology and End Results [SEER], 2004), as well as other issues such as access to care (Shavers & Brown, 2002).
Cost of treatment (Brandeis, Pashos , Henning, & Litwin, 2001), access to educational and emotional support services (Wilson, Andersen, & Meischke , 2000), and meaning of cancer (Phillips, Cohen, & Moses, 1999).
These
differences have implications for the adaptation to and survival of cancer.
Moreover, these factors may be complicated by poorer overall health status as a
result of comorbidities or lifestyle.
Cancer Survivorship And Ethnicity
In a review of the current state of knowledge of cancer survivorship among ethnic minorities and medically underserved groups, Aziz and Rowland (2002) found that research related to the impact of ethnic and minority groups on issues of survivorship is largely related to epidemiologic analysis of cancer risk and survival. Thus, research related to issues of the underserved and cancer survivorship is needed.
Some of their findings included the following:
(a) a majority of studies of late effects of treatment of secondary cancers were conducted on Caucasian survivors of cancer
(b) while there is a growing body of literature on sociocultural and behavioral determinants of cancer decision making, few studies explored interventions in underserved populations
(c)
culturally relevant measures that capture concerns of cancer survivors were
largely absent.
The number of people with cancer is expected to reach 2.6 million by the year 2050. Thus, there is a growing emphasis on conducting research that improves the understanding of cancer survivors.
Needed are intervention studies that develop or test strategies to promote optimal health status in survivors of cancer, information on survivors of cancer who have previously been understudied, and research on the impact of cancer on the family (Rowland et al., 2001). Nurse researchers have the potential to make a significant contribution to improving the lives of people who live with cancer.
Give your opinion if have any.