1. 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. Education in Palliative and End-of-life Care - Oncology The Project EPEC-O TM

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

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

4. Video

5. Importance of cancer survivorship l  numbers l Cancer as chronic disease l Public knowledge/involvement l  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 Non-medical costs l Lack of mental health providers l Health insurance l Job loss l Non-medical 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 survivor 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 MD role – focus on clear plan l Acute disequilibrium l Find ‘best’ care l MD role – focus on clear plan

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

13. Survivor goals – remission l Redefine ‘normal’ l Psychosocial rehabilitation l Re-invest in life l MD role – management fear of recurrence l Redefine ‘normal’ l Psychosocial rehabilitation l Re-invest in life l MD role – management fear of recurrence

14. Survivor goals – recurrence/advancing cancer l Maximize sense of control l Realignment of relationships l Palliative care/hospice l MD role Clarify plan Honest communication l Maximize sense of control l Realignment of relationships l Palliative care/hospice l MD role Clarify plan Honest communication

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 Truth l Symptom management l Involve patient/family in decision process l Present new advances l Refer as appropriate l Physician communication l Truth l Symptom management l Involve patient/family in decision process l Present new advances l Refer as appropriate

17. Survivor goals – end-of-life l Dignity l Community contribution l Control emotions l Find meaning l Best care l Dignity l Community contribution l Control emotions l Find meaning l Best care

18. EPECEPECOOEPECEPECOOO EPECEPECOOEPECEPECOOO Summary