Self-Care Within Survivorship Care

Upon completion of primary cancer therapy, patients are faced with unique challenges. Twenty years ago, Ward and colleagues¹ stated the following:

The time of transition from active treatment to follow-up has been associated with distress due to the loss of frequent medical monitoring and support, and the shift in responsibility to the individual, resulting in feelings of abandonment, vulnerability and the loss of a ‘safety net’.

As a cancer survivor myself and a family member/secondary cancer survivor, I would clarify that a significant component of the anxiety experienced by patients and families is generated by the distancing from the nurses who served as the primary guides through the distress-laden, highly emotive cancer therapy experience. Their constancy, teaching, and advocacy are sorely missed when active treatment ends.

There is a paucity of information about how cancer survivors manage to live on their own with persistent or new problems following the completion of primary treatment. A myriad of post-therapy sequelae may prevail that are physical (e.g., fatigue), psychological (e.g., fear of recurrence), social (e.g., discrimination), financial (e.g., loss of insurance) and existential (e.g., questioning the nature of suffering) in nature. Little is known about the exact corollaries of these problems, how they are resolved, and how to support survivors who grapple with the daunting task of moving beyond cancer in the absence of sustained support from a professional staff.

Foster and Fenlon² recently discussed the promotion of self-confidence as an essential skill to enhance cancer survivors' self-management throughout the cancer trajectory. Self-confidence is one of five concepts used within the lexicon of self-care management that has relevance to this issue.³ Relatedly, Karnilowicz⁴ suggested that the management of chronic illness is mediated through psychological ownership of illness and ultimately requires this to foster control. This is best cultivated by a collaborative partnership between patients and healthcare providers.

I am a major proponent of making poignant analogies to help us as professional caregivers understand the critical dilemmas our patients, families, and survivors face. Would or could you start and maintain a Pilates or Weight Watchers regimen or run a marathon without the benefit of a coach or instructor? Why, then, would we expect a layperson, thrust within the paradigm of a life-threatening disease, to be able to assume responsibility for effective symptom management and/or the identification of new lifestyle choices in the absence of instruction and mentorship?

As an oncology nurse who works directly with cancer survivors or treats them to ensure long-term survivorship is an option, think about how we must create survivorship programs that give patients and families the tools and resources they need to be successful. What are your thoughts about ways we can enhance self-confidence in our novice survivors?