Cancer: Thinking Beyond the Disease

Increasing attention is now being focused on cancer care as a continuum with expectations for the development and evaluation of a seamless set of medical, psychosocial, and spiritual services that flow from diagnosis through survivorship and end-of-life care.

This focus is now possible because of research advances in cancer diagnosis and treatment, as well as a greater emphasis on quality of life.

To explore the oncology nurse’s role in providing care along this continuum, we are beginning a second series that highlights another distinct phase of care in oncology—cancer survivorship.

Authors Marcia Grant and Denice Economou initiate the cancer survivorship series in this spring issue of ONCOLOGY Nurse Edition by providing an overview of challenges facing the more than 11 million cancer survivors living in the US; summarizing the history of the survivorship movement; and outlining key organizations, directives, and reports seminal in advancing survivorship care.

Grant and Economou discuss ways in which greater attention is being paid to patient needs for education, screening, and guidance on healthy lifestyle behaviors and nutrition; the psychological side effects of treatment; and post-treatment surveillance for late effects.

Then, focusing on specific survivorship issues, Kristin Knight, in a Late Effects Clinic report, describes progressive hearing loss over a 6-year period in a 20-year-old man treated with cisplatin(Drug information on cisplatin) at age 13, noting that “oncology nurses are instrumental in educating families about the risk for hearing loss and the need for ongoing evaluation, and in assisting in coordination of care.”

Debra L. Barton provides an excellent discussion of the pharmacological and nonpharmacological methods that were used to alleviate menopausal symptoms and sexual function problems that were impacting a patient’s relationship with her husband following treatment with tamoxifen(Drug information on tamoxifen) for breast cancer.

Judith A. Shell emphasizes the need for caregivers to communicate effectively with survivors and offer emotional support and practical assistance when psychosocial issues arise. She offers thoughtful guidance for discussing body image concerns with the post-mastectomy patient.

As she aptly notes in her article, “We must persist in our holistic thinking about the woman with breast cancer and continue to extend our efforts beyond the disease itself.”

Along with survivorship care, palliative care, too—now recognized by the American Board of Medical Specialties as an official medical subspecialty—has undergone important changes in philosophy and practice. It has evolved from being thought of as solely focused on end-of-life comfort measures to being utilized as a set of comprehensive symptom management strategies that are provided throughout the care continuum.

In her article, Michelle Gabriel explores key palliative care issues and resources useful for oncology nurses managing newly diagnosed cancer patients. As she points out, palliative cancer care today ensures effective symptom management and best possible quality of life not only in terms of physical health, but also by addressing the psychological, social, and spiritual needs of patients and their families.

As nurses, we have our work cut out for us; however, the challenges ahead are good. We need to act and integrate our new knowledge into daily practice. Our patients are depending on it.

—Mary McCabe, RN, MA
    Editor-in-Chief