One of my many assigned tasks as a cancer nurse navigator is to work on survivorship programming, and provide survivor care plans. To be honest, this is one of my favorite parts of my job. However, I often feel that I lack the knowledge about what long-term issues survivors may face.
There are the usual and obvious issues, like the cardiac effects of Adriamycin. Often though, there are things that go overlooked as part of the new normal or as part of getting older. I wanted to know more.
So after doing a little research, hoping to find some sort of continuing education focused on survivorship, I found the Survivorship Training and Rehabilitation (STAR) course from Oncology Rehab Partners, founded by Dr. Julie Silver, who is an assistant professor at Harvard Medical School, and a survivor of breast cancer. Feeling that there was a large gap in her post-treatment care, she worked to develop evidence-based methods of assessing and treating physical limitations that result from cancer treatment.
It's relatively new on the cancer scene, but with so much focus on survivorship care, it fills a gap that is certainly needed. The program offers certifications for individuals as well as entire departments. It is a 10 module self-paced online course. It took me the full two or three hours per module, and even though I have finished, I know I'll have to review it multiple times and read the more than 1,000 articles that are referenced over a much longer period of time. It also includes assessment tools, and guides you through the process of making a thorough assessment of survivor needs.
I was very impressed with the amount of research that went into the course. I felt like I learned so much, and only touched the surface of what I could learn. One of the big obstacles to any sort of rehabilitation and therapy after cancer treatment is reimbursement. The STAR program focuses on problems and interventions that are reimbursable. I have often heard that we should be concerned about healthcare dollars. But let's face it, cancer patients are surviving for years now. If we ignore their minor impairments that are interfering with quality of life now in favor of sparing healthcare dollars, we will pay for it later. These minor impairments can become major disabilities that cost more in the long run. Optimizing survivors' qualify of life also helps those survivors become productive members of the community, successfully returning to their jobs and family lives.
Survivorship care plans are a huge undertaking, and a non-reimbursable one at that. It's difficult when the healthcare field puts the cart before the horse: You must do this, the patient needs it, but there is no ability to fund it.
For now, I intend to use this newfound knowledge to build a better care plan, raise my awareness, and my patients' awareness of what long-term needs they may have, and do my best to meet them. Survivorship care plans take a lot of time, and some people have said that we should make them short and simple treatment summaries. But to truly address survivor needs, we can't design them based on our convenience. They need to be an effective, thorough product, something that we can be proud of producing, and that can truly serve a purpose for the patient. I am hopeful that my STAR certification will help me do that.
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