Tenets of Counseling Cancer Survivors During Remission

Paola Rossi, MD

Survivorship conversations should be patient-centered and focused on empowering the patient to take hold of their care, according to experts.

Cancer survivors can reduce their risk of recurrence by adopting a healthy lifestyle, eating a diet filled with vegetables and whole fruits, and exercising, according to the American Cancer Society. However, counseling patients throughout survivorship requires more than reminders of physical health exams and the benefits of a nutritious diet, explained Paola Rossi, MD, and Adrienne Vazquez-Guerra, APRN.

Adrienne Vazquez-Guerra, APRN

Both Rossi and Vazquez recently presented on cancer recurrence risks and resources as part of the 2023 Sylvester Cancer Survivorship Symposium. In an interview with Oncology Nursing News, they recounted the key things for nurses to know about counseling cancer survivors.

“We empower patients to be a participant in their care, and their journey of life—whatever that looks like for them,” Vazquez-Guerra explained, adding that this can look different for each patient. For instance, one week she might meet with a patient who eats healthy, does not drink alcohol, and does not smoke, so lifestyle factors might not be as heavy of a focus of conversation for them. However, if she meets with a patient with lung cancer who regularly smokes, cessation will be a big focus.

During her visits with patients, she emphasizes the importance of regular check-ups and screenings. She ensures that her patients are not just checking in with her oncologist but with their primary care provider, and that they are receiving regular vaccinations and other important health measures.

Reducing the Risk of Recurrence

Rossi shared that some of the relationships she has forged with her patients have allowed to help advocate for their health in the survivorship setting. For example, one of her previous patients asked if Rossi would conduct her primary care appointments since when she completed active treatment. Rossi realized that her patient was prediabetic and needed to change her diet and exercise more; however, she was worried about how her patient would take the news.

To her surprise, her patient practically laughed. After enduring chemotherapy and various other anticancer treatments, implementing a diet was more than feasible, she told Rossi.

“She said, ‘I gave my body, so many chemicals and so many bad things,’” Rossi recalled. “You are telling me that I am going to nourish my body with new things, and you think that change is difficult?”

Today, this patient has really changed their diet and her glucose levels are nearly perfect, which will significantly reduce her risk of recurrence, according to Rossi.

“She is an example of how you can change your life and really be healthy,” Rossi recalled. "She was overweight, but her body mass index and body composition has totally changed. It was her success. She made it happen.”

As Rossi explained, it is important that providers are clear with survivors about the potential of recurrence and encourage them to do everything in their power to reduce their risk.

“Don’t shy away from those tough conversations,” Rossi said. “We always want a success story. We don’t want that cloud over our consult, and we want to focus on the positive,” she said, noting that there are ways to reframe the risk of recurrence in which the patient still feels in control. She often will highlight the lifestyle changes which can help reduce their risk.

“I always bring it [with] a positive,” she said, “[I say] OK, there is a chance of recurrence, we know that X amount for this cancer can come back, [but] let’s talk about what we can do to reduce our risk.”

Addressing Questions of Mental Health

Vazquez-Guerra emphasized the importance of looking at the whole person when engaging in a survivorship care visit.

She shared an example of a lymphoma survivor who had completed treatment about a year prior to them meeting. When reviewing her history and previous medical visits, Vazquez-Guerra noticed that depression was an issue that this individual had been working through.

“So I talked to her a little bit about it,…and I asked her, point blank, ‘I see here that it's noted that you've had some depression, and that your primary care ordered you some medication, can you tell me a little bit about that?’” Vazquez-Guerra recounted. “She went on to tell me that, yes, she did try a medication that helped her a little bit, but she ran out and her primary care said that he wouldn't reorder it until she saw [a] specialist. And she didn't know where to go or who could help her with that.”

The two continued to discuss this reality, and Vazquez-Guerra further discovered that her patient, who works with children with autism as a behavioral specialty, was struggling to get to work because her depression was so severe.

“I was like, wow this is such an important job, and for her to feel like she did not have the energy to get out of bed and do something [shows] how impactful this was in her life.”

Vazquez-Guerra referred her patient to social work and counseled her about the resources available within their institution—she was interested in meeting with a psychiatrist. By the end of the day, the social worker had called her, and by the end of the week, she had an appointment scheduled with the psychologist.

“If we do not know that patients need the support and help, we can't help them,” she said, “but once we do, if we're able to find the resources, and we build your team to be able to support them, I think that's meaningful, and that makes a difference in itself.”

Key Takeaways

With any aspect of survivorship, it is important to ensure that patients understand the why behind the recommendations their care team is prescribing.

“It's not just giving them the prescription, saying ‘you are due for your mammogram and then saying, all right, I will see you back with your results,’” Vasquez-Guerra explained. “It is taking the time to explain to them, what is involved, what are the ’pros,’ what are false negatives?

“As health care providers, from the RN to the MD level or beyond, we really need to do a good job of explaining what a cancer screening test is, what it means, and what comes after.”

Reference

Can I do anything to prevent cancer recurrence? American Cancer Society. Accessed November 29, 2023. https://www.cancer.org/cancer/survivorship/long-term-health-concerns/recurrence/can-i-do-anything-to-prevent-cancer-recurrence