Who Addresses Emotional Well-Being of Cancer Survivors?

Though great strides have been made in the last decade in addressing the historic unmet needs of adult cancer survivors, what continues to lag behind is the recognition that survivors can experience ongoing emotional sequelae that interfere with the quality of their survival.

A case in point is the generic template established for the survivor care plan. It has no acknowledgement of the need for an emotional checkup after treatment is completed. The absence of attention to this aspect of survivorship may be related to several factors.

Cancer-specific psychological care may not be available in many communities. There may be a problem with reimbursement for such services. Survivors and their caregivers may be reticent to voice their distress, thinking they may be perceived as complaining or ungrateful. Members of the healthcare team may feel inadequate to address these nonphysiological sequelae, or they may think they are indeed providing the psychological support patients need.¹ In the absence of the oncologist or oncology nurse asking about emotional concerns, the survivor may perceive these issues as unimportant or trivial. What we do know, however, is that cancer is a mind-body phenomenon. The heart and soul are affected by the demands of a life-threatening diagnosis to the same extent as one's bone marrow or heart muscle is.

Psychological issues that evolved during treatment may prevail into long-term survivorship or new issues may surface. Of particular note are the emotional wear and tear related to the fear of recurrence, survivor guilt, work re-entry, marital discord, discrimination and social isolation, financial concerns, and cumulative grief when fellow survivors die. Survivors commonly are left to deal with the affective domain of cancer survivorship on their own. This is in direct contrast to the safety net of support afforded survivors during the active phase of treatment.²

A necessary first step is to increase our awareness about communication surrounding the patient's transition to cancer survivor. Thorne and Stajduhar³ identified five emotional themes representative of the communication environment of survivors during this period. They included feelings of confusion, insecurity, vulnerability, loss, and abandonment. Our appreciation of these reactions warrant increased sensitivity to communication competencies such as attending to cues, giving prior warning, offering advice and guidance around managing relationships, and coping with new anxieties. Basic skills competency offerings can augment our proficiency in these areas. Specialized workshops can engender newfound strength and empower patients and families to address survivor specific coping agendas.⁴

The provision of psychosocial support should not end when treatment does. As life goes on, so do stress, worry, and the surfacing of new emotional problems. Acknowledging the high-tech world in which cancer care is currently rendered, we should consider these avenues of ongoing support now and for the future. The use of telephone and computer support, Skype, and other novel communication technologies should be investigated as to their user-friendly status with survivors. The important thing is not the vehicle but the connectivity the survivor feels with the main conduit of emotional support. Let's think outside the box about how to make survivors emotional distress become our responsibility, too.

References:

1. Forythe L.P., Alfano C.M., Leach C.R., Ganz P.A., Stefanek M.E. & Rowland J.H. (2012). Who provides psychosocial follow-up care for post-treatment cancer survivors? A survey of medical oncologists and primary care physicians. Journal of Medical Oncology, 30(23): 2897-2905.
2. Stanton A. (2012). What happens now? Psychosocial care for cancer survivors after medical treatment completion. Journal of Clinical Oncology, 30, 1215-1220.
3. Thorne S.E., & Stajduhar K.I. (2012). Patient perceptions of communication on the threshold of cancer survivorship: Implications for provider responses. Journal of Cancer Survivorship, 6, 229-237.
4. Butt C.M. (2012). Hope in patients with cancer transitioning to survivorship: The mid-life directions workshop as a supportive intervention. Oncology Nursing Forum, 39(3): E269-E274.