2. Cancer Treatment to Survivorship What’s the Plan? Building a Survivorship Plan Rose Bell, PhD (c), ARNP-c, OCN Oncology Nurse Practitioner Genetics Educator Northwest Specialties, Tacoma Wash. Northwest Specialties, Tacoma Wash.

3. Objectives Understand the definition, concepts and stages of the survivor Understand the definition, concepts and stages of the survivor Define the major tasks of the survivor and their anchors and outcomes Define the major tasks of the survivor and their anchors and outcomes Discuss survivorship issues and rationales for building survivor plans Discuss survivorship issues and rationales for building survivor plans Understand the concepts and components of a survivor plan Understand the concepts and components of a survivor plan

4. Survivorship: The definition “to remain alive or in existence” or to “continue to function or prosper” (Merriam-Webster, 2006) “to remain alive or in existence” or to “continue to function or prosper” (Merriam-Webster, 2006) A concept that begins on the day of cancer diagnosis and encompasses changes that occur over a lifetime as a result of the diagnosis (Chen, 2006; Marco, 2004; Dow, 2003; NCCN, 2006 ) A concept that begins on the day of cancer diagnosis and encompasses changes that occur over a lifetime as a result of the diagnosis (Chen, 2006; Marco, 2004; Dow, 2003; NCCN, 2006 )

5. Survivorship-The definition (cont) National Cancer Institute adds; National Cancer Institute adds; The individual, their family and friends

6. Survivor Facts and Figures Past Past - 3 million survivors in 1971 - Present - 10 million survivors in 2008 - Future - Estimates 20 million survivors by 2020 Why? - Aging Population - Better Cancer outcomes - Oncology Nurse and Physician Shortage!!!

7. Stages or Seasons of Survivorship - Acute survival (0-6 months) -Extended survival (active treatment into a period of remission) -Permanent survival (when enough time has passed that recurrence is unlikely) Add revised stages -Relapse

8. Stages or Seasons of Survivorship revisited - Intense initial therapy -Transitional cancer survivorship -Alive and “living with cancer” -Extended survival -Permanent survival (when enough time has passed that recurrence is unlikely) -Relapse

9. Needs of the Survivor (and family) PsychosocialPhysicalSocialSpiritual Family Economic EmotionalInformationalSexualVocational

10. Survivorship Concepts Living With Cancer Distinct from quality of life Distinct from quality of life Identify and integrate a lifelong chronic condition Identify and integrate a lifelong chronic condition A new sense of identity that changes over time A new sense of identity that changes over time Diagnosis can lead to distress for years and is unique to the cancer survivor Diagnosis can lead to distress for years and is unique to the cancer survivor Survivors seldom receive all the information they seek Survivors seldom receive all the information they seek

11. Survivorship Concepts Living With Cancer Cognitive changes affect their lives Cognitive changes affect their lives ■ Assigns new meaning to their lives that didn’t exist previously Ultimately leads to the development of a “New Normal”

12. Major Task Continuity development Continuity development Review of their life Review of their life Make decisions on their future life Make decisions on their future life Future memory construction Future memory construction Goal is to infuse their life experiences with meaning, increasing their identity and retaining “future memory”

13. Anchor Points Developed as a result of becoming a survivor Developed as a result of becoming a survivor may include; CommunityFamilyFriends Religious support

14. Consequences Survivors all reported perceived benefits Survivors all reported perceived benefits Stronger appreciation of life Stronger appreciation of life Positive changes including social and personal relationships Positive changes including social and personal relationships Heightened motivation for health** Heightened motivation for health** Post traumatic growth Post traumatic growth

15. Survivorship Issues Late Effects Late Effects Secondary Malignancies Secondary Malignancies Co morbidities such as diabetes, high blood pressure Co morbidities such as diabetes, high blood pressure Oncology in Primary Care Oncology in Primary Care

16. Medical Management in Survivorship Prevention and wellness Prevention and wellness Surveillance Surveillance Intervention of post treatment Intervention of post treatment effects effects Coordination of care Coordination of care

17. Medical Management of late effects Cardiopulmonary Cardiopulmonary Oral Oral Endocrine Endocrine GI GI GU GU Skin Skin Musculoskeletal Musculoskeletal Nervous System Nervous System Ears, Eyes Ears, Eyes Quality of Life and Psychosocial Quality of Life and Psychosocial

18. Survivorship Plan Components History of Cancer treatment History of Cancer treatment Persistent Effects Persistent Effects Possible Late Effects Possible Late Effects Signs and symptoms to report Signs and symptoms to report Wellness Plan Wellness Plan Future Cancer Screening Future Cancer Screening

19. Survivorship Plan

20. Types of CAM use Potential Benefits DIET- dietary considerations ie a low fat plant based diet, Cancer risk reduction, decreased co-morbidities DIET- dietary considerations ie a low fat plant based diet, Cancer risk reduction, decreased co-morbidities EXERCISE- exercise, weight reduction,cancer risk reduction, decreased co-morbidities EXERCISE- exercise, weight reduction,cancer risk reduction, decreased co-morbidities ELECTROACUPUNCTURE- ameliorated nausea and vomiting ELECTROACUPUNCTURE- ameliorated nausea and vomiting ACUPRESSURE- chemotherapy-related nausea and vomiting ACUPRESSURE- chemotherapy-related nausea and vomiting *ACUPUNCTURE- Possible use for radiation induced xerostomia, Blom,, evidence for hot flashes, fatigue and shortness of breath *ACUPUNCTURE- Possible use for radiation induced xerostomia, Blom,, evidence for hot flashes, fatigue and shortness of breath MASSAGE- anxiety and lymphedema, relaxation, decreased pain and improved sleep MASSAGE- anxiety and lymphedema, relaxation, decreased pain and improved sleep AROMATIC OIL-enhances effects of the massage AROMATIC OIL-enhances effects of the massage BIOFEEDBACK- muscle strengthening in urinary and fecal incontinence and constipation as well as insomnia BIOFEEDBACK- muscle strengthening in urinary and fecal incontinence and constipation as well as insomnia

21. Genetic Considerations in Survivorship

22. I look forward to your questions and comments