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Helping Survivors to Adjust After Cancer in This Article Nursing Practice Keywords: Cancer/Survivorship/ Treatment effects Discussion ●This article has been double-blind Cancer survivorship peer reviewed As the number of people living with or beyond cancer is growing, nurses have a crucial role in helping them adjust to their new lives after their treatment Helping survivors to adjust after cancer In this article... 5 key Defining the concept of cancer survivorship points The consequences of cancer and its treatment for survivors People who have 1completed How nurses can help survivors adjust to their new lives treatment or are living with cancer are called cancer Author Victoria Harmer is team leader that more than 90% of survivors had asked survivors clinical nurse specialist, Breast Care Unit, to be seen by their GP in the last year, com- The National Imperial College Healthcare Trust, London pared with 68% in the general population. 2Cancer and a trustee for Against Breast Cancer. This suggests they have specific needs Survivorship Abstract Harmer V (2012) Helping which must be addressed. Initiative aims to survivors to adjust after cancer. Nursing Given the prevalence of cancer survi- improve support Times; 108: 6, 12-16. vors and their needs, Macmillan Cancer and services for The concept of “cancer survivorship” has Support (2009) argued that cancer follow- cancer survivors received considerable attention over the up is unsustainable in its current format Many cancer past three years as increasing numbers of and leaves patients dissatisfied. 3survivors people live with and beyond cancer. The cancer reform strategy identified experience Previously, attention may have focused the need for an initiative to enhance care long-term side- more on treatments for cancer and the and support for cancer survivors (Depart- effects from likelihood of their success. In recent years, ment of Health, 2007). As a result, the DH, treatment or from interest has moved to the after-effects of Macmillan Cancer Support and NHS having cancer treatment, and how people can return to Improvement launched the National Fatigue is a their lives while recovering. Cancer Survivorship Initiative (NCSI) in 4common This article discusses the various ways 2008 (www.ncsi.org.uk). Its aim was to consequence of in which cancer and its treatment may improve support and services for cancer cancer treatment affect survivors, and how nurses, in both survivors and to establish care and support Survivors have hospital and the community, can help for all survivors by 2012, enabling them to 5to live with the them to adjust and recover. lead as healthy and active a life as possible, possibility that for as long as possible. they may develop lthough “cancer survivorship” New models of care, including cancer unwanted is a relatively new concept, follow-up, and attitudes are being scruti- consequences there is emerging recognition nised as part of the NCSI initiative to of treatment Aand a growing body of knowl- improve patient experience and reshape edge in this area (Sheppard, 2011). cancer care. Survivors’ unmet needs in As treatments become more successful terms of social, spiritual, financial, psy- and mortality rates for cancers reduce, an chological, medical and informational increasing number of people living in the aspects of life are being examined and sup- community have completed cancer treat- port structures and information discussed ment; this group, along with those living and put in place. with cancer, are called cancer survivors. Research by Macmillan Cancer Support Consequences of treatment (2009) has revealed that around two mil- Many cancer survivors experience long- lion people are living with or beyond term side-effects from previous treatment cancer, and this figure is growing by over or from the cancer itself, and may have to 3% each year. Macmillan Cancer Support’s overcome a number of psychological and (2009) health and wellbeing survey showed medical issues. Fatigue is common after cancer treatment Reflexstock 12 Nursing Times 07.02.12 / Vol 108 No 6 / www.nursingtimes.net Nursing Practice For a Nursing Times Learning unit on oncological emergencies, Discussion go to nursingtimes.net/ oncological A health and wellbeing survey showed reframe and rethink their lives in some way. “baseline” or “norm”, to be more aware of that people living with or beyond cancer Breast Cancer Care has produced an their health and, more importantly, are seven times more likely to find it diffi- information pack for cancer survivors, whether something is different and needs cult to perform personal care tasks, such as which considers five aspects of life: to be reported to their GP or hospital washing and getting dressed, than those » Managing the effects and consequences specialists. who do not have a long-term condition of treatment; (Macmillan Cancer Support, 2009). Fatigue » The person and their relationships; The person and their relationships is a common consequence of cancer treat- » Improving wellbeing; Social support literature demonstrates ment, and survivors can find this particu- » Finance, work and practical issues; that interpersonal relationships play an larly difficult to cope with as it has serious » Watching for signs and symptoms of important part in adapting to serious ill- implications and a detrimental effect on the cancer returning. ness (Pistrang and Barker, 1995). quality of life. These sections are examined individu- Partners of cancer survivors may also The NCSI (2011) found that, after treat- ally below. face a period of readjustment after their ment, 60% of cancer survivors had unmet loved one has completed treatment and physical or psychological needs and 34% Managing the effects and need time to accept what has happened. had at least five unmet needs. It defined consequences of treatment Some may take an overly protective role, consequences of treatment as symptoms This may involve getting used to any trying to do everything and protect the and/or changes in function that arise after new symptoms experienced after cancer survivor from further distress, while seemingly successful treatment for cancer. treatment. others may not be able to come to terms It also reported that 50% of patients who Some people may have thicker skin in with the new situation and may reject their had had radiotherapy to the pelvis said areas due to radiotherapy. Chemotherapy partner emotionally, either temporarily or they had bowel problems that affected can cause hair to grow back with a dif- permanently. quality of life, and that over one third of ferent texture; it can also prompt early Some couples become closer as a result survivors described problems with close menopause, which can cause confusion of one having gone through cancer treat- relationships, issues in performing rou- about personal identity. ment, although it can put additional strain tine household chores and an inability to Whatever the symptom, survivors need on the relationship (Macmillan Cancer fulfil career ambitions. to redefine and reframe what is now their Support, 2011a). A partner may not wish to This area of study is relatively new, and mention or initiate sexual activities for links between previous treatment for fear of upsetting or hurting the survivor, cancer and its consequences are only now Box 1. Possible yet failing to do so may compound the sur- being discovered and documented; there is loNg-TerM issueS vivor’s worries about their attractiveness. limited data about the frequency and For SurvIvorS Although health professionals’ main occurrence of detrimental late effects. responsibility is to their patients, pro- Although some treatment effects may ● Living with a cancer diagnosis viding holistic care does involve sup- be considered of low importance, others ● Altered body image porting relatives, which also helps patients may be serious, such as the increased risk ● Fatigue (Brewin, 1996). Nurses can encourage com- of breast cancer after mantle radiation for ● Lymphoedema and risk of this munication between couples, as both part- Hodgkin’s lymphoma. ● Fertility/future pregnancies ners may be making assumptions about ● Genetic issues how the other feels without realising it. Potential onset of consequences of ● Altered bowel habit The age of cancer survivors may have treatment ● Changes in hair texture implications. Those who are older and Survivors also have to live with the possi- ● Loss of hair after radiotherapy have retired are likely to have different bility that they may later develop ● Menopausal symptoms concerns from those who are still working. unwanted consequences of treatment. ● Risk of osteoporosis Likewise, survivors who have small chil- For example, after treatment for breast ● Cardiac problems dren at home have different problems cancer, women who have had lymph nodes ● Weight gain from those with grown-up children. The removed as part of surgical treatment have ● Weight loss age of children is important in terms of a life-long risk of developing lym- ● Neuropathic pain what is communicated to them about a phoedema in that arm. They therefore ● Bladder dysfunction parent’s cancer diagnosis and treatment, need to adopt behaviour patterns to reduce ● Scarring although in general children are more at this risk such as avoiding having blood ● Difficulty in forming new relationships ease when they have been informed of the pressure measurement or blood taken ● Life and travel insurance issues situation and the plans ahead (Breast from the affected arm. ● Living with a stoma Cancer Care, 2010). Box 1 outlines the
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