1. TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPEC™-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

2. EPEC  - Oncology Education in Palliative and End-of-life Care - Oncology Module 5: Survivorship Survivorship

3. Objectives l Define cancer survivor. l Identify challenges and barriers for survivors. l Utilize practical interventions to support survivors. l Employ strategies for self-care. l Define cancer survivor. l Identify challenges and barriers for survivors. l Utilize practical interventions to support survivors. l Employ strategies for self-care.

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5. Importance of cancer survivorship l Increasing numbers l Cancer as chronic disease l Public knowledge/involvement l Increasing numbers l Cancer as chronic disease l Public knowledge/involvement

6. Definition of cancer survivor l “Any person living with cancer anytime”  National Coalition for Cancer Survivorship l “Any person living with cancer anytime”  National Coalition for Cancer Survivorship

7. Specific concerns of cancer survivors... l Health insurance l Job loss l Nonmedical costs l Lack of mental health providers l Health insurance l Job loss l Nonmedical costs l Lack of mental health providers

8. ... Specific concerns l Emotional concerns l Fear of abandonment l Physical symptoms l Emotional concerns l Fear of abandonment l Physical symptoms

9. Quality of survival l Symptom control l Respectful care l Maintenance of social role l Contributing to society l Symptom control l Respectful care l Maintenance of social role l Contributing to society

10. Physicians and the emotional environment l Emotional connectedness l “Cheerleader” role l Guilt l Reimbursement issues l Emotional connectedness l “Cheerleader” role l Guilt l Reimbursement issues

11. Survivor goals – diagnosis l Acute disequilibrium l Find “best” care l Physician role – focus on clear plan l Acute disequilibrium l Find “best” care l Physician role – focus on clear plan

12. Survivor goals – treatment l Complete treatment l Maintain independence l Physician role  Prevent/treat side effects  Provide information l Complete treatment l Maintain independence l Physician role  Prevent/treat side effects  Provide information

13. Survivor goals – remission l Redefine “normal” l Psychosocial rehabilitation l Reinvest in life l Physician role  Manage fear of recurrence l Redefine “normal” l Psychosocial rehabilitation l Reinvest in life l Physician role  Manage fear of recurrence

14. Survivor goals – recurrence/advancing cancer l Maximize sense of control l Realign relationships l Utilize palliative care/hospice l Physician role  Clarify plan  Communicate honestly l Maximize sense of control l Realign relationships l Utilize palliative care/hospice l Physician role  Clarify plan  Communicate honestly

15. Recurrent / advancing disease... l Physician communication l Listen l Tell patients and families what they want to know l “There’s always something to do” l No abandonment l Physician communication l Listen l Tell patients and families what they want to know l “There’s always something to do” l No abandonment

16. ... Recurrent / advancing disease l Physician communication l Tell the truth l Manage symptoms l Involve patient/family in decision process l Present new advances l Refer as appropriate l Physician communication l Tell the truth l Manage symptoms l Involve patient/family in decision process l Present new advances l Refer as appropriate

17. Survivor goals – end of life l Maintain dignity l Make community contribution l Control emotions l Find meaning l Obtain best care l Maintain dignity l Make community contribution l Control emotions l Find meaning l Obtain best care

18. Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience.