Living Well With Cancer Cobie Whitten, PhD Providence Regional Cancer System Gregg VandeKieft, MD, MA Providence St. Peter Hospital
Life isn’t about waiting for the storm to pass . . . It’s about learning to dance in the rain.
Cancer Survivorship: Changing Times• Needs beyond surgery, chemo, radiation• Cancer now a curable disease for some and a chronic illness for others• Patients with terminal disease are also “survivors”• Maintaining a sense of well being and enhancing quality of life is paramount
Who is a Cancer Survivor?Anyone who has been diagnosed with cancer from the time of cancer diagnosis, through the balance of his or her life. Includes those dying from untreatable cancer. Includes family members, friends, and caregivers. Centers for Disease Control and Prevention (CDC)
Estimated Number of Cancer Survivors in the United States from 1971-2008
Why is the number of people alive after diagnosis increasing?• Earlier diagnosis through screening• Aging population• More effective treatment• Prevention of secondary disease and disease recurrence• Decreases in mortality from other causes
End of Active Treatment: Unexpected Stress• Feeling of abandonment• Continued symptoms (e.g., pain, fatigue, anxiety)• Active treatment over fear of cancer resurgence• Confusion about which providers to see for follow-up care
New ACS Guidelinesfor Cancer Survivors
Coping to Live Well with Cancer
LIVESTRONG Essential Elements of Survivorship Care (Sep 2011)Goal: Build consensus on what any effective survivorship program must provide• “Must Have” elements include: – Care plan and treatment summary – Screening for new cancers & surveillance recurrence – Care coordination – Health promotion education – SYMPTOM MANAGEMENT & PALLIATIVE CARE
What are Barriers to Wellness in Chronic Illness?• Current medical model focuses on disease rather than illness – Disease: a medical condition – Illness: the patient’s experience• Curing vs. Healing – Hope as a verb• Clarity of Communication – Confusing terms – Hesitance to speak or hear difficult news
Creating A Patient-Provider Partnership Traditional PartnershipNature of Relationship • Professional in charge • Professional expert in • Patient passive disease • Patient expert in their lifeResponsibility, Goals • Professional dictates Shared decision making: treatment plan • Patient sets goals • Patient “complies” • Professional presents treatment options to help achieve those goalsProblem Solving • Patients presents with • Problems identified “complaint” together based on goals • Professional identifies • Maximize “self-help” and solves problem skills Bodenheimer, et al, JAMA. 2002
Wellness Model: Core Elements• Starts at time of diagnosis• Continuous assessment of QOL and goals• Suggests appropriate interventions for – Symptoms – Treatment – Wellness• Promotes wellness in the face of illness• Provides a survivorship plan
Questions to Consider• What is your understanding of your condition?• What do you expect will happen from here?• When you think about the future, what are you hoping for?• Does anyone else know how you feel?