Navigating Transition: Treatment to "Survivor Thriver"

Breast cancer and its treatment present many personal and physical challenges. Much like the variations in their individual diagnoses, each individual patient will likely have vastly different recovery goals after treatment, with varying physical, psychological, social, and spiritual objectives. Additionally, for each person, the transition from active treatment to survivorship occurs; however, the pace is often much slower than individuals are prepared to handle.

Whether it is oral or intravenous chemotherapy, radiation, or surgical intervention, treatment involves actively fighting the cancer. This offers a level of comfort, as patients are constantly checking in with physicians and nurses. The interactions provide reassurance that either the treatment is progressing or the cancer is gone.

When the treatment phase ends, the emotional ramifications of what one has been through may cause a flood of emotions in the newly “cancer-free” individual. Questions arise such as, “Will the cancer return?” and “How will I know if the cancer returns?” Patients eagerly anticipate the completion of treatment; however, the end of treatment does not always bring them comfort. Transitioning from active treatment to one’s “old” life leaves many patients feeling lost and in a constant state of waiting for “what’s next.”

The Breast or Oncology Nurse Navigator (ONN) can be instrumental to ensuring that a patient transitions from active treatment to becoming a “survivor thriver.” From the time of engagement, the navigator is “hand in hand” with the patient, identifying obstacles and barriers that may derail a successful completion of treatment and transition to survivorship. This is the navigator’s role and area of expertise.

As with any relationship, communication is essential to a successful navigator-patient relationship. Navigators can be instrumental in educating patients and helping them develop a survivorship care plan. These individualized survivorship blueprints should start as soon as a patient is diagnosed with cancer.

Survivorship care plans should include:

1. Complete history of cancer treatment from time of diagnosis to end of active care. This background should include type of surgery, chemotherapy and radiation regimens, as well as names of healthcare providers and treatment facilities.
2. Prevention and screening schedule for recurrent and new cancers
3. Education guidelines for the patient on how to recognize latent physical and psychosocial effects of cancer treatment
4. Surveillance schedule frequency (follow-up visit schedule), including coordination between the patient’s primary care providers and specialists
5. Intervention care plan for cancer recurrence
6. Resources and support services available to the patient and family/caregiver in her community

Survivorship care plans consider the patient’s life before cancer, the treatment prescribed and completed, and how to integrate this plan into the patient’s “new” life. Being a survivor is a continuum of cancer care.

Resources for Survivors:

CancerCare©

1-800-813-HOPE (4673)

www.cancercare.org

Cancer Support Community

1-888-793-9355

www.cancersupportcommunity.org

Facing Forward: Life After Cancer Treatment

www.cancer.gov

Living Beyond Breast Cancer

1-888-753-LBBC (5222)

www.lbbc.org

National Coalition for Cancer Survivorship

1-888-650-9127

www.canceradvocacy.org

Recently, patient navigation has become a focus in healthcare. The reason for the surge in patient navigation is the increased fragmentation of how healthcare is delivered. The complexity of navigating healthcare facilities, increase in available treatment options, decrease in participating specialty providers, and struggling economy have further complicated the process of completing treatment and entering survivorship.

The good news is breast cancer care has had a patient navigation standard since 2009, when the National Accreditation Programs for Breast Centers (NAPBC) instituted this mandate. The American College of Surgeons Commission on Cancer will soon be adding a new standard on patient navigation so that all patients, regardless of their cancer diagnosis, will have the benefit of a navigator throughout cancer treatment. The Institute of Medicine’s Cancer Care for the Whole Patient report stressed that all cancer care should provide and ensure appropriate psychosocial health services, facilitate effective communication, identify each patient’s psychosocial needs, design and implement a plan that links the patient with needed psychosocial care, coordinate biomedical and psychosocial care, engage and support patients in managing illness, and systematically follow up on evaluating and adjusting this plan.

Individuals may benefit from a navigator at any stage of cancer treatment. Patients with breast cancer who have not been connected to a navigator may locate one by contacting their oncologist or cancer center and asking if they have a Breast Cancer Navigator, Patient Navigator, or ONN on staff. Patients can also locate an ONN by visiting the Patient page at www.nconn.org and seeing if there is a navigator located near them.

Sharon Francz, LPN, BHA, is an oncology nurse navigator and the president and co-founder of the National Coalition of Oncology Nurse Navigators (NCONN).

Reference:

Institute of Medicine. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: National Academies Press; 2007.