1. Cancer Survivorship Care
NU 700
November 4, 2011
Abigail L. DeLisa, APRN FNP-BC CWS FACCWS
Concept
Analysis
Presentation
2. What is the Definition
of a Cancer Survivor?
Primary Antecedent
An individual who experiences cancer from the time
of diagnosis throughout the balance of life.
Included in the definition are family, friends and
caregivers.
Ganz (2011), Doyle (2008)
3. Research Interest:
A Growing Population wChronic
Health Care Needs
Since passage of National Cancer Act (1971), the
number of cancer survivors has quadrupled
As of Institute of Medicine (IOM) Report (2006), 10 million
people in the United States (US) were cancer survivors
By 2020, current projections estimate 20 million cancer
survivors in the US
IOM (2006), Erikson, C., Salsberg, E., Forte, G., Bruinooge, S., & Goldstein, M. (2007)
4. Research Interest:
A Growing Population wChronic
Health Care Needs
“Being cancer-free does not mean
being free of cancer effects.”
Dr. Julia Rowland, Director of the National Cancer Institute (NCI),
Office of Cancer Survivorship (2007)
As cited by Mayer, 2011
5. Research Interest:
Survivorship Care
Listening to cancer survivors revealed:
Ambivalence and fear about life after cancer
A lack of an organized way to prepare
patients/families & caregivers for a smooth transition
from acute cancer care to optimal wellness post
cancer
Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011
6. Research Interest:
Survivorship Care
Listening to cancer survivors revealed:
Need to:
Standardize delivery of care and recognize
survivorship as a distinct phase on cancer
continuum
Treat the whole patient, which means palliation of
treatment consequences, not just end-of-life care
Globally raise awareness that Survivorship has
largely been neglected until recently
Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2005, 2006 & 2008, Mayer, 2011
7. Merriam Webster Definition of
Survivorship
1 : the legal right of the survivor of persons having joint interests
in property to take the interest of the person who has died
2 : the state of being a survivor : survival
3 : the probability of surviving to a particular age; also: the
number or proportion of survivors (as of an age group or
population)
First Known Use of SURVIVORSHIP, circa 1625
http://www.merriam-webster.com/dictionary/survivorship
8. Another Definition of Survivorship
According to the definitions of survival or survivorship
in the literature, the predominate association has
been with war.
Holocaust survivors
Survivors of natural disasters
1960’s reference to Survivor after Myocardial
Infarction (MI)
New England Journal of Medicine, 1985, (313, p. 270-273, Jul)
http://journeyingbeyondbreastcancer.com/2010/09/07/defining-cancer-survivorship/
9. Define Concept:
Survivorship Care
Provided to cancer survivors& co-survivors (family,
friends, caregivers)
Multifaceted and interdisciplinary care
Creates long-lasting needs for Survivors returning to
lives after cancer as different people
Optimal time for delivery is around completion or
near completion of acute cancer treatment
Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011
10. Define Concept:
Survivorship Care
4 components of survivorship care
1. Prevention/screening
2. Detection
3. Promotion of healthy behaviors
4. Palliation/care coordination
Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011
11. Define Concept:
Survivorship Care
Empirical Referents
Quality Of Life (QOL) Domains
1. Psychological
2. Physical
3. Social
4. Spiritual
Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011
12. Overview of the Concept:
Survivorship Care
Actions and tools to deliver Survivorship Care as a
Standard of Care
Detailed review written cancer treatment summary
(outlining details of cancer treatments/related
history/complications)
Provision of Survivorship follow-up Care Plan (SCP)
based on National Guidelines
Counseling/education re: long term and late effects
of treatment
Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011,
Ganz & Hahn, 2008, 2011, American College of Surgeons, 2012
13. Overview of the Concept:
Survivorship Care
Actions and tools to deliver Survivorship Care as a
Standard of Care
Post cancer surveillance for recurrence and second
cancers
Offering holistic evidence-based interventions to
modify, stabilize or remove health risks
Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011,
Ganz & Hahn, 2008, 2011, American College of Surgeons, 2012
14. Related Concept:
Cancer Survivorship
Process beginning at diagnosis
Involves uncertainty
Life-changing
Positive
Negative
Unique to individual with some universality
Doyle, pg 499, 2008
15. Concept Analysis: Progress
Aspects of Positive Progress
American Society of Clinical Oncology (ASCO), 2011, National
Meeting
Focus of meeting was Survivorship Care
American College of Surgeons (2011) Standards of Care
Mandate for accredited cancer centers to have Survivorship
Care Program by 2015
Connecticut Regional Cancer meeting at Yale, October 18,2011
Focus on Survivorship and Palliative Care, research and
implementation
16. Concept Analysis: Progress
Aspects of Positive Progress
Understanding the process of living with and beyond
cancer is not likely to be linear and creates opportunities
with polar resolutions
(Mullan, 1985, Jones, 2011)
Pathways correctly Navigated lead to progress
“Caring Begins with Patients”
(Sledge, 2011)
17. Concept Analysis: Barriers
Aspects of Barriers to Progress
Concept of Survivorship Care relatively new and lacks
awareness
Survivorship is part of Cancer Navigation continuum, also
new, care not well standardized
Not all patients embrace or welcome the label, “Cancer
Survivor.”
Rowland, Hewitt & Ganz, 2006, Taplin, Clauser, Rodgers, Breslau & Rayson, 2010
18. Concept Analysis: Barriers
Aspects of Barriers to Progress
Palliative care, a component of Survivorship Care,
also lacks awareness
Currently a linear focus on tools and models of
delivery dominate the conceptual framework
Rowland, Hewitt & Ganz, 2006, Taplin, Clauser, Rodgers, Breslau & Rayson, 2010
19. A Final Thought
Re: Concept of Survivorship Care
Concept clarification provides a heuristic for further
inquiry and a basis for theory generation
Doyle, 2008
20. Questions to the Group
Do you believe the component of care has been
well defined in the concept of Survivorship Care?
Do you think defining the contextual attributes of
Survivorship Care is important in the process of
concept analysis?
21. References
Adler, N. E., Page, A., & National Institue of Medicine (U.S.). Committee on Psychosocial
Services to Cancer Patients / Families in a Community Setting. (2008). Cancer care for
the whole patient : meeting psychosocial health needs. Washington, D.C.: National
Academies Press
Doyle N (2008) Cancer Survivorship: Evolutionary Concept Analysis. Journal of Advanced
Nursing. 62: 499-509. http://www3.interscience.wiley.com/cgibin/
fulltext/119403837/PDFSTART
Erikson, C., Salsberg, E., Forte, G., Bruinooge, S., & Goldstein, M. (2007). Future supply and
demand for oncologists : challenges to assuring access to oncology services. J Oncol
Pract, 3(2), 79-86. doi: 10.1200/JOP.0723601
Ganz, P. A., & Hahn, E. E. (2008). Ensuring quality care for cancer survivors:
implementing the survivorship care plan. Semin Oncol Nurs, 24(3), 208-217
http://www.advisory.com/Research/Oncology-Roundtable/Studies/2011/Delivering-
Sustainable-Survivorship-Care
24. References
M. Hewitt, P. Ganz, Implementing Cancer Survivorship Care Planning: Workshop Summary,
National Academy of Sciences (2007).
http://tinyurl.com/269rlc
M. Hewitt, S. Greenfield, E. Stovall, From Cancer Patient to Cancer Survivor: Lost in Transition.
National Academy of Sciences (2006).
Mullan, F. (1985). Seasons of survival: reflections of a physician with cancer. New England
Journal of Medicine, 313(4), 270-273. doi: 10.1056/NEJM198507253130421
National Cancer Institute: Cancer Survivorship Research Web site.
http://dccps.nci.nih.gov/ocs/
National Cancer Institute, Facing Forward: Life After Cancer Treatment (2006). Accessed
February 13, 2007 from
http://www.cancer.gov/cancertopics/life-after-treatment.pdf
National Cancer Institute, Office of Cancer Survivorship
http://cancercontrol.cancer.gov/ocs/definitions.html
25. References
National Coalition of Cancer Survivorship
http://www.canceradvocacy.org/about/org/history.html
Rodgers B.L. (1989) Concepts, analysis and the development of nursing knowledge: the
evolutionary cycle. Journal of Advanced Nursing 14, 330–335.
Rodgers B.L. (2000a) Concept analysis: an evolutionary view. In Concept Development in
Nursing: Foundations, Techniques and Applications, 2nd edn (RodgersB.L. & KnaflK.A., eds),
WB Saunders, Philadelphia, PA, pp. 77–102.
Victorson D, Cella D, Wagner L, Kramer L & Smith ML (2007) Measuring Quality of Life in
Cancer Survivors. Chapter 6 in Feuerstein M (2007) (ed.) Handbook of Cancer Survivorship
Springer, Bethesda
www.facs.org/cancerprogram/index.html
Zwahlen, D., Hagenbuch, N., Carley, M. I., Jenewein, J., & Buchi, S. (2010). Posttraumatic
growth in cancer patients and partners;effects of role, gender and the dyad on couples'
posttraumatic growth experience. Psycho-Oncology, 19(1), 12-20. doi: 10.1002/pon.1486
