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Survivorship Care: How Nurses Can Fill the Gap

DiGiulio, Sarah

doi: 10.1097/01.COT.0000421913.98041.38

In our ongoing series, OT goes in-depth on what needs to change in the cancer care system to better meet the needs of cancer survivors, plus why and how those needs are changing. In this article, oncology nurses explain why and how their specialty may be key to improving the standard of care for survivors.

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Nurses Take the ‘Holistic and Comprehensive’ View of the Patient

Nurse practitioners are well positioned to provide the integrated and long-term follow-up care cancer survivors need, explained Carrie Stricker, PhD, CRNP, a medical oncology nurse practitioner at the Abramson Cancer Center and Clinical Assistant Professor of Nursing at the University of Pennsylvania.

“Oncology nurse practitioners in particular are really focused on symptom management—a big concern for cancer survivors. Models of care led by nurse practitioners are proliferating around the country. … These nurses are trained to be health-promotion focused, taking a more holistic and comprehensive view of their patients.”

If a nurse already knows the patient and has an established relationship, it becomes less labor intensive to provide care over the long-term, she said. “There's now a huge growth in the field of nurse navigation [which focuses on guiding patients through treatment by directing patients to needed resources and referrals].”(See OT's recent series on Patient

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Nurses Can Teach Health Promotion

Nurses have always had a role in teaching patients health promotion—but now they need to do the same thing for cancer survivors, Diane McElwain, RN, MEd, OCN, Oncology Coordinator at York Cancer Center in Pennsylvania, said, speaking at this year's Oncology Nursing Society Annual Congress. “Oncology nurses are trusted, and we need to keep encouraging cancer survivors to maintain healthy behaviors to prevent not only cancer but also other diseases.”

“We are navigators whether we know it or not, regardless of where we work,” she added in a follow-up interview. “And, guiding patients to their principal care providers is part of the total responsibility for the patient's care. … It's up to nurses, like we've always done, to advocate for our patients, and get them involved in other programs that are out there regarding their health. … I'm charging the nurses: Find out what's around you in your own system and see if you can work within it.”

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Nurses Address Quality of Care

New research comparing the effectiveness of nurse-led models of follow-up care for post-treatment survivors with physician-led models found that even though the results for nurse-led models showed no significant differences in quality of life or disease recurrence, there were higher levels of patient satisfaction compared with the physician-led models.

“Patients were often more satisfied with nurse-led follow up care, likely because nurses were spending more time addressing ‘whole-person’ issues in survivorship—and quality of care,” said the lead author, Doris Howell, RN, PhD, the Royal Bank of Canada Financial Group Chair of Oncology Nursing Research and Education at Princess Margaret Hospital and University Health and Associate Professor of the Lawrence Bloomberg Faculty of Nursing at the University of Toronto.

This study (available online ahead of print in the Journal of Cancer Survivorship (DOI: 10.1007/s11764–012–0232-z) included randomized controlled trials conducted between 1999 and 2009.

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Nurses Are Connected

Nurses have the most contact with patients, noted Rhone Levin, MEd, RD, CSO, Oncology Dietitian at St. Luke's Health System in Meridian, Idaho. “They openly discuss problem-solving with patients, and they have more time to spend with patients than physicians do. ... At the clinic, patients put their health in the hands of the doctor, so the clinic should be supporting the physician and supporting the patient in making sure these resources are utilized by both the staff and patients.”

Read more about the system-wide cancer care changes these and other oncology experts suggest need to happen to improve standards of survivorship care in Part I of this series in our 9/10/12 issue.

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A Neglected Part of the Cancer Care Continuum

As Patricia A. Ganz, MD, Professor of Health Services and Medicine at UCLA Schools of Medicine and Public Health and Director of the Division of Cancer Control Research at Jonsson Comprehensive Cancer Center, noted in OT's Sept. 10 issue: “The survivorship care gap stems from the fact that during cancer care, the primary care gets cut out; meanwhile this whole period of very intense medical care is missing from the primary care physician's perspective,” she said.

Ganz was a member of the committee that wrote the Institute of Medicine's landmark From Cancer Patient to Cancer Survivor: Lost in Transition report, which tried to put survivorship issues front and center on the cancer care agenda (OT, 12/10/05 issue). “The report said this was a neglected area of the cancer care continuum and that the millions of people who are living post-treatment without any evidence of cancer really didn't have any guidance or any coordination of their care,” she said. “But now, seven years after the report was released, the challenge has been to develop strategies and models of care to do a better job.”

© 2012 Lippincott Williams & Wilkins, Inc.
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