Essential Components of Survivorship Care

Fran Zandstra,

RN, MBA, OCN

At the 2012 NCCN annual meeting, a panel of oncology nurses discussed the essential components of healthcare for survivors, challenges survivors face, and survivorship program models.

“An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life,” said Fran Zandstra, RN, MBA, OCN, director of the Cancer Survivorship Program at the University of Texas MD Anderson Cancer Center in Houston. “Survivorship care…must be tailored to each person’s tumor, treatment, and health history,” Zandstra added.

According to Zandstra, the four essential components of survivorship care include surveillance for the detection and treatment of late malignancy recurrence; prevention for behavioral lifestyle changes to reduce risk/prevent cancer; intervention for consequences of cancer and its treatment, including medical and psychosocial effects; and coordination between specialists and primary care providers to meet all of a survivor’s healthcare needs.

Joanne Lester, PhD, CRNP, ANPBC, AOCN®

Survivorship presents a multitude of challenges, according to Joanne Lester, PhD, CRNP, ANPBC, AOCN®, a research scientist and oncology nurse practitioner at the The Ohio State University Comprehensive Cancer Center in Columbus. Physical challenges include pain, discomfort, cognitive changes, skin and mucosal changes, bone health, neuropathies, cardiopulmonary challenges, fatigue, sleep-wake disturbances, gastrointestinal and genitourinary symptoms, sexuality and reproductive issues, and lymphedema.

Psychological challenges include anxiety, posttraumatic stress, substance abuse, depression, suicide, spirituality questions, and end-of-life transition.

Practical challenges include personalization of information and care, economic burden, employment, and family-related issues.

Mary S. McCabe, RN, MA

Mary S. McCabe, RN, MA, director of the Cancer Survivorship Initiative at Memorial Sloan-Kettering Cancer Center in New York City, finished the discussion by describing survivorship program models.

A multidisciplinary clinic allows patients to be seen by different providers during one clinic visit and provides a comprehensive approach to survivorship, but the program may be difficult to coordinate and reimbursement for all providers is a challenge.

On the other hand, a disease- or treatmentspecific clinic, one that focuses on one specific disease category or intervention, allows for a focused scope of practice. However, this approach may exclude survivors with the greatest needs.

Other cancer survivorship program models include a consultative service that covers general survivorship care and an integrated care model that involves embedding survivorship into the oncology clinic as part of the function of the treatment team.

In establishing a survivorship program, nurses should determine what type of model might work within their institution, establish simple metrics, get support from leadership and peers, understand what needs to be implemented, and be willing to revise.