The Importance of Cancer Survivors Issues

Cancer, one of the most life-threatening diseases, ranks among the leading causes of death worldwide. Approximately 14 million new cancer cases were diagnosed in 2012, and it has been estimated that this number will rise to 22 million within the next two decades (Stewart & Wild, 2014). Fortunately, the rapid development and advancement of cancer treatments have made cancer more manageable and even curable. Cancer is increasingly recognized as a chronic illness, with cancer patients surviving significantly longer than in the past.

The National Cancer Institute, Office of the Cancer Survivorship (NCI/OCS) defines a cancer survivor as 'an individual from the time of diagnosis, through the balance of his or her life'. The number of cancer survivors in the United States in January 2014 was 14.5 million (DeSantis, Chunchieh, Mariotto, et al., 2014). This number is expected to continue increasing to nearly 19 million by January 2024. Approximately 60% of cancer survivors are currently 65 years of age or older (DeSantis et al., 2014).

It has been estimated that 64%, 41%, and 15% of cancer survivors have survived for 5 years or more, 10 years or more, and 20 years or more after their cancer diagnosis, respectively (DeSantis et al., 2014). The increasing number and large population of cancer survivors have brought new challenges to cancer care and to the healthcare system. The increasing population of people who are living with cancer, both in terms of gross numbers and as a percentage of the population, represents an increasingly important contemporary social issue. Identity is a complex issue for many cancer survivors. These survivors must continue their social role and function, which requires their living with cancer and struggling to be normal (Lin, Lin & Lin,2015). The balance between being a cancer patient and being a normal individual is challenged by the impacts of the disease, the complex treatments, and the related acute, delayed, and long-term side effects and functional declines (Farsi 2015).

Care for Cancer Survivors

The report of the Institute of Medicine entitled "From Cancer Patient to Cancer Survivor: Lost in Transition" (Hewitt, Greenfield, & Stovall, 2005) addresses the essential components of cancer survivorship care. These components include: (1) access to the information necessary to prevent cancer recurrence and the onset of new cancers; (2) surveillance for cancer recurrence and secondary cancer and assessment for medical and psychological problems or late effects; (3) Interventions for the consequences of cancer and its treatment, including related physical distress and symptoms, psychological distress (e.g., depression and fear of cancer recurrence), functional decline, and disabilities (e.g., sexual or relationship dysfunctions), insurance issues, and employment problems; and (4) Coordination among different treatment and care agencies to ensure that the healthcare needs of survivors are met. Providing resources to survivors for recurrence management and end-of-life care planning are part of the overall care that should be provided to cancer survivors. Furthermore, the role and functions of caregivers should be considered and incorporated into survivor-care programs.

Problems and important issues faced by cancer survivors vary according to the phases of the cancer process (aka phases of survivorship in this article). These phases of survivorship include the acute diagnosis to treatment phases, the extended or intermediate phase, and the long-term survival or cure phase (Mullan, 1985; Decker, Haase, & Bell, 2007). Thus, the care needs of survivors may also vary by different cancer diagnoses, stages, and treatment modalities. Those unmet care needs may further influence the quality of life (QOL) of survivors. The City of Hope QOL Model for cancer survivors addresses four dimensions of cancer survivor QOL. These dimensions include: (1) physical well-being and symptoms (for example: functional activities, strength-fatigue, sleep, pain, overall physical health, and fertility), (2) psychological well-being (for example: control, anxiety, depression, fear of cancer recurrence, cognitive function, distress / diagnosis, and control of treatment), (3) social well-being (for example: family distress, role function and relationship, appearance, enjoyment of life, isolation, and work), and (4) spiritual well-being; for example: meaning of life, hope, uncertainty, and inner strength; (Grant, Economou, Ferrell & Bhatia, 2007).

Challenges for Survivorship Care

National Cancer Institute- Office of the Cancer Survivorship (NCI/OCS, n.d.) focus the cancer survivorship on the issues related to the ability to get health care and follow-up treatment, late effects of treatment, second cancers, and quality of life. Family members, friends, and caregivers are also considered part of the survivorship experience. The challenges for survivorship care may be categorized into five primary categories.

First, the rapidly increasing number of cancer survivors worldwide challenges existing healthcare systems. Moreover, the differing needs of survivors in different survivor phases challenge the current acute treatment and care-oriented healthcare models. A majority of cancer patients receive their treatments in outpatient settings rather than in inpatient settings. Furthermore, complex anti-cancer treatments may cause acute / delayed side effects as well as long-term side effects and complications. How to handle the care problems and care needs of survivors in busy outpatient settings remains a challenge for healthcare professionals. Research and services that reflect and meet the care needs of survivors should be strengthened in order to enhance the care and life quality of cancer patients and survivors.

Second, the treatment and care transition programs from the acute through post-treatment care phases must be strengthened to reflect the cancer-control continuum (Rowland, 2008). Moreover, the health impact of cancer on patients and their families must be better understood. Because over 60% of cancer survivors are older adults, the cancer-survivor care programs must take into consideration the specific needs of this age group. Furthermore, in light of the current lack of care guidelines for cancer survivors, culturally appropriate guidelines and models should be developed in order to enhance the transition and continuum of quality of life of cancer survivors and their caregivers.

Third, the treatment regimens for some types of cancers require the use of oral anti-cancer treatments such as oral chemotherapy and targeted therapy. The effectiveness of these interventions relates closely to medication adherence. Thus, adherence support and follow up are major challenges for oral anti-cancer medications. Using technologically advanced systems such as tele care and long-distance care to remind patients and to monitor the side effects / conditions of treatments represents a potentially effective new direction for improving survivor care.

Fourth, the psychological and social wellbeing of survivors deserves greater attention. Due to the lack of culturally appropriate guidelines for cancer-survivor care in most countries, the limited number of currently available general survivor guidelines may be used to provide an initial framework for this care. An example of the latter is the proposed clinical pathway for the psychosocial care of cancer survivors (Jacobsen, 2009). The clinical pathway of care for cancer survivors addresses the end-of treatment evaluation through the development of a survivorship care plan and uses evidence-based interventions in the follow-up and re-evaluation process. Thus, the end-of treatment evaluation and personalized survivorship care plan (Ganz, Gasillas, Hahn, 2008) is an important part of survivor care that should be carefully developed and rigorously implemented.

Fifth, advanced cancer treatments and better-quality cancer care are increasing the post-diagnosis lifespan of cancer survivors. Nurses are best positioned to coordinate the efforts of the healthcare team to decrease the distress and promote the health of cancer survivors (Corcoran, Dunne, McCabe, 2015). Advanced practice nurses may develop related care models in order to enhance the care and quality of life of cancer survivors. The comprehensive assessment, coordination, and care model may help better define the physical and psychosocial distresses of cancer survivors and provide better health-promotion strategies to patients. Advanced practice nurses have the skills and knowledge necessary to assess patient needs, address the care needs of cancer survivors, and refer cancer survivors to available resources. How to apply these skills and knowledge to develop better survival care programs/services is a big challenge.

In conclusion, the traditional model of healthcare does not effectively address the needs of today's rapidly growing population of cancer survivors. Further effort is necessary to assess the challenges of cancer-survivor care and to construct a culturally appropriate system that addresses cancer-survivor healthcare needs to enhance their quality of life.

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