The psychological challenges of cancer can become more evident when treatment is complete. The focus on survival and acute symptom management fades and is supplanted by a re-focus on living with the after-effects of diagnosis and treatment. As well described by Drs. Recklitis, Varela and Bober, worry, anxiety, depression, fatigue, and sexual difficulties are some of the most common and yet sometimes intangible issues faced by survivors. This article provides a valuable conceptual framework and resources for use by nurses and other health care professionals seeing patients during and after their cancer treatment.
Since human beings, by nature, have feelings, and these are good things in facilitating our survival, it can be a challenge to distinguish ‘normal’ distress versus elevated distress that warrants treatment. As the authors note, subclinical distress can respond well to education and support. I find in particular that maximizing the “innate tendency toward competence, autonomy, and relatedness” of individuals is a strategy that can be incorporated into ongoing communication during treatment and emphasized at the completion of treatment. Normalizing an individual’s experience and recognizing his or her competence in managing an unfamiliar situation can make both an immediate and a long-term impact on coping. These strategies can be especially helpful for survivors when we anticipate normal responses and provide resources to contact if survivors find themselves having these ‘normal’ reactions.
As the authors describe, mental health professionals increasingly recognize the value of screening tools for evaluating emotional reactions of patients over time. These standardized measures have cutoff scores that allow quick determination of whether criteria are met that support a recommendation for further evaluation. They are not in themselves adequate for diagnosis of an individual, but they can be instrumental in both knowing that a referral is warranted and in determining directions for further evaluation. Fortunately there are now numerous measures for depression, anxiety, and even cancer-specific distress and worry. Similar measures for screening fatigue and sexual problems are available, although not as widely tested.
Several aspects of this article point out directions that require further exploration as the science and practice of survivorship continue. It is readily apparent in reading the descriptions of research to date and looking at the references, that most defining of needs and testing of treatments for emotional disturbances and fatigue in survivors have been examined after breast cancer. However, more than three-quarters of long-term survivors have been treated for other diagnoses. Treatments, as well as their long-term sexual and psychosocial consequences, vary widely by disease. Obviously, nearly all breast cancer survivors are women. These observations point to a need to better understand how men and patients with other diseases experience their survivorship. Survivorship as a field of research is expanding rapidly, especially in the areas of focus in this article. We are closer to knowing what the issues are that need to be addressed, but we are still some distance from knowing answers to how to sustain a satisfying quality of life in terms of psychosocial outlook, personal energy, and sexuality in the remarkably resilient people we care for.
Financial Disclosure: The authors have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.
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