Integrating a Wellness Perspective into Survivorship Care

June 2011, Vol 2, No 3 -


Washington, DC—Improved treatment, more effective screening, and an aging population have fueled the rapid growth of cancer survivors—approximately 12 million today in the United States, up from just 3 million in 1971. Since even before the Institute of Medicine’s pivotal 2005 report “From Cancer Patient to Cancer Survivor: Lost in Transition,” there has been a growing recognition of the need to treat cancer survivors across the continuum of care.

“Survivorship begins at themoment of diagnosis and lasts for a lifetime,” Frances Zandstra, RN, MBA, OCN, Director of the Cancer Survivorship Program at M. D. Anderson Cancer Center, Houston, told attendees at a session on survivorship care.

Survivors, of course, require surveillance screening, but they also benefit from care targeting everything from psychosocial issues and sexual health to monitoring for comorbidities and exercise and nutrition counseling.

The broader contours of survivorship are often “lost in transition,”when oncologists hand patients off to primary care physicians. Cancer survivorship programs leverage multidisciplinary teams and electronic communication tools to reduce these obstacles.

“We’d give them the cake and say, ‘Congratulations, you’ve finished treatment,’ and then they would go to the parking lot and just collapse,” said Denice Economou, RN, MN, CNS, AOCN, Project Director for Survivorship Education for Quality Cancer Care at City of Hope National Medical Center, Duarte, CA. “They didn’t know what they were supposed to do next; they were scared.” Now our idea is to try to keep surviving patients in the loop “and make a difference in that posttreatment phase.”

Communication is key. “How do we help our community physicians take care of survivors in the community?” Ms Zandstra asked. “You get the call: ‘My doctor won’t give me a shingles vaccine because he’s afraid it’s going to stimulate my immune system and my cancer may come back.’ How do we help to educate and partner with them to take care of these survivors in the community?”

Patients with cancer undergo a battery of treatments, and the specifics can be hard to remember, especially after the passage of time.

Breast cancer comprises a large number of patients with a variety of diagnoses, and it can be hard to define when the treatment stage ends.

Becky Ball, RN-BC, BSN, Clinical Services Manager at the Sanford Cancer Center in Sioux Falls, SD, said that the degree of patient organization still makes patients with breast cancer an attractive option for instituting a program. “It’s a difficult one to get going for a lot of reasons. But one of the benefits is that you have a patient population that really wants that service, so they’re willing to participate and give you input into that program development.”

The basic components of survivorship care are standard, although the specific treatment needs vary by disease and disease severity. For patients with breast cancer, at M. D. Anderson they sort survivors into low-and highrisk tiers.

Providers are a good resource for dealing with cancer survival, according to Ms Ball. “Those first-line caregivers tend to have a better feel” for patient needs.

Aligning the needs of patients with payers’ approaches, however, can be a challenge.Ms Ball notes that it remains a challenge to know what aspects of survivorship programs payers will reimburse for.

She advocates that a wellness perspective be integrated throughout the entire survivorship process, because cancer should never be treated in isolation. Sanford has an American Cancer Society navigator on campus that runs support groups, which can be a big part of survivorship care.