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.
survivorship research originated from studies conducted with adolescent and
adult survivors of pediatric cancers culminating from 3 decades of successful
treatment for pediatric cancers.
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.