Survivors Need Research-Based Interventions and Stronger Coordination Across Care Continuum

Patricia Jakel, MN, RN, AOCN

What does it mean to be a cancer survivor? The National Cancer Institute (NCI) defines a survivor as “one who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.”¹

There are many types of survivors, including those living with cancer with continuous treatment and those free from cancer. Because of new screening tools and treatments, there has been tremendous progress in life expectancies for those living with cancer. Subsequently, there is now a large community of cancer survivors in the US.

The American Cancer Society reported that there are currently 16.9 million cancer survivors in the US, which accounts for approximately 5% of the population.² In addition, 18% of these survivors have lived with their disease for over 20 years. The most common cancers associated with this population are breast, prostate, and colorectal.

As the number continues to grow for cancer survivors, oncology nurses require well- developed education about what it means to be a cancer survivor. Moreover, as it is estimated that there will be 26.1 million survivors by 2040, the care of these individuals will need to be more than a care plan in their electronic medical record.

The NCI Office of Cancer Survivorship (OCS) was not established until 1996.³ Cancer survivor Ellen Stovall helped establish the OCS to enhance the quality and length of survival of all persons with cancer to prevent, minimize, or manage adverse events of cancer and its treatment. Two decades later, the American College of Surgeons Commission on Cancer (CoC) created survivorship standards in the United States.⁴ These 2016 standards created questions for many oncology practices regarding whom could establish and update care plans for all cancer survivors. Why are the CoC’s new survivorship standards so important? Many facilities see the CoC accreditation as providing value to their programs for the patient, family, and community. The early standards (standard 3.5) received criticism for allowing practices to “check a box” instead of providing comprehensive survivorship care and programs. However, the newest standard CoC (4.8) now places the emphasis on the actual program and the process of delivering survivorship care.^5,6 This standard states that a survivorship program should include a team of providers and a survivorship coordinator, as well as services that include survivorship care plans, seminars for survivors, and rehabilitation, nutritional, and psychological services.

In addition, care of patients via technology has been pushed to the forefront by the pandemic and has yielded great success. There are many apps designed for survivors with a focus on health and wellness from both a physical and psychological perspective. However, further development of cancer survivorship apps for adolescent, young adult, and older adult survivors will be necessary if this technology is to become a component of long-term care planning.

As a longtime oncology nurse and cancer survivor, I am thrilled at the rising number of survivors and people thriving after cancer. We have come so far. However, oncology nursing needs to embrace the survivorship movement by providing research-based interventions with equality for all patients.

Patients are asking for transitional and continuous care to be coordinated and available for all patients with cancer. Survivorship care should be focused on new and current programs, education, and rehabilitation services, and nutritional, and psychological services. The current emphasis on survivorship programs should involve a team approach with a focus on delivering the care with flexibility. There should be no time restrictions on survivorship care. Be open to assist.

For nurses who support cancer survivors—you are doing amazing work. Keep moving your patients toward their best lives. Thank you for all you do.

References

1. Definition of survivor. National Cancer Institute. Accessed November 1, 2021. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/survivor

2. Cancer treatment & survivorship facts & figures 2019-2021. American Cancer Society. Accessed November 1, 2021. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2019-2021.pdf

3. About cancer survivorship. National Cancer Institute. Updated Febuary 25, 2021. Accessed November 1, 2021. https://cancercontrol.cancer.gov/ocs/about

4. Cancer program standards: ensuring patient-centered care. Commission on Cancer. Accessed November 1, 2021. https://www.facs.org/-/media/files/quality-programs/cancer/coc/2016-coc-standards-manual_interactive-pdf.ashx

5. Optimal resources for cancer care: 2020 standards. Updated Febuary 2021. Accessed November 1, 2021. https://www.facs.org/-/media/files/quality-programs/cancer/coc/optimal_resources_for_cancer_care_2020_standards.ashx

6. Blaes AH, Adamson PC, Foxhall L, Bhatia S. Survivorship care plans and the Comission on Cancer standards: the increasing need for better strategies to improve the outcome for survivors of cancer. JCO Oncol Pract. 2020;16(8):447-450. doi:10.1200/JOP.19.00801