The number of long-term cancer survivors is growing globally.1 This new health scenario requires the implementation of a comprehensive care approach that supports the efforts of cancer survivors and their families to manage the physical and psychosocial sequelae of cancer and late effects of treatments while at the same time promotes their health and well-being in living beyond cancer.2 The request to meet such needs of cancer survivors was first addressed in 2005 in the report From Cancer Patient to Cancer Survivor: Lost in Transition, published by the Institute of Medicine of the United States.3 Supporting the Institute of Medicine initiative, the Centers for Disease Control and Prevention, the Lance Armstrong Foundation for cancer survivorship, and other oncology associations around the world recommended the implementation of a survivorship care plan (SCP) to enhance communication and care coordination among cancer survivors and health professionals. However, although initiatives and demonstration models of cancer care have been implemented on different continents to support long-term survival, the lack of actual continuity and integrated care delivery remains a weakness in many health systems.2,4 This lack of long-term care continuity contributes to a feeling of "being lost in transition" in some survivors, many of whom report a reduced quality of life and well-being.

That is why an emerging area of interest for researchers, practitioners, and stakeholders is on the most cost-effective model of care for long-term cancer survivors and on a more responsive primary care system, capable of supporting people living with and beyond cancer. Care shared between oncology specialists and primary care professionals can be as efficient and even more cost-effective than follow-up performed only by cancer specialists.4 Primary care nurses can play a key role in the optimization of SCPs.5 Long-term cancer survivors and their families also prioritize the accessibility of health services, continuity, and coordination of care-fundamental pillars of primary healthcare-and express greater satisfaction when professionals understand their experiences of living beyond cancer and offer them comprehensive care.6 In this regard, recommendations of an SCP in primary care to achieve positive well-being among cancer survivors are the promotion of healthy lifestyles, personalized advice and education for self-management of sequelae derived from treatments and the cancer itself (fatigue, pain, depression, interpersonal relationships, emotional, social and occupational adaptation, and reproductive complications), prevention of relapse, as well as emotional and family support.4

Despite the increasing evidence that shows that the integration of primary care in the care of cancer survivors is an opportunity for cost-effective and very acceptable quality cancer care,4 this integration is slow to take form. Furthermore, the role of primary care providers in long-term survival is not clearly defined, and few actions have been aimed at improving care activities, standardizing procedures and protocols, developing documentation and records, and updating training of primary care professionals. It is unquestioned that the path toward comprehensive, efficient, and sustainable primary care is the result of the collaboration of a multidisciplinary team. However, it is equally true that each discipline in primary care (nursing, medicine, psychology, and social work) should respond from its full professional scope of practice to accomplish the common goal of improving the health of cancer survivors and their families.

Nurses in primary care have been recognized as key professionals in empowering individuals, families, and communities to achieve the highest attainable standard of health.7 The recent Global Conference on Primary Health Care, held on October 25 to 26, 2018, in Astana (Kazakhstan) and cohosted by the World Health Organization and United Nations International Children's Emergency Fund, reaffirmed the contribution of primary care nurses to achieving Universal Health Coverage for the 21st century. In cancer survivorship, nurses can contribute, along with the rest of the health team, to improving the quality of life of long-term cancer survivors and their families and to increasing efficiency of primary healthcare.8 Capable of providing comprehensive follow-up care in a variety of settings, advanced practice nurses are uniquely positioned to deliver evidence-based interventions and provide quality care to cancer survivors and families.8 Today more than ever, it is important for primary care nurses to practice to their fullest in cancer survivorship and measure the impact of their role in achieving the highest attainable standard of health and well-being for the growing number of survivors and families living beyond cancer.

Our very best,

Cristina Garcia-Vivar, RN, PhD

University of Navarra, School of Nursing and IdiSNA, Navarra

Institute for Health Research, Pamplona, Spain

Nerea Elizondo, RN, MSc

Hospital Complex of Navarra, Pamplona, Spain

Leire Ambrosio, RN, PhD

University of Navarra, School of Nursing and IdiSNA, Navarra

Institute for Health Research, Pamplona, Spain

References