A Challenge of Survivorship—Healing the Mind and Spirit

Helping cancer patients to recover and heal goes beyond managing physical consequences of treatment. Mental scars from the cancer experience can run deep. Patients often face profound psychological, spiritual, and emotional challenges as they navigate difficult treatments—and then, if all goes well, move into long-term follow-up. Fortunately, new research insights in psycho-oncology continue to advance our ability to provide the best psychosocial care through education, targeted interventions, and community services.

In this issue, Recklitis and colleagues discuss common psychological challenges cancer survivors may experience after treatment, including depression, anxiety, fatigue, and sexual dysfunction. They review common risk factors for these conditions and recommend optimal ways that nurses and other medical providers can assess psychosocial functioning during a clinic visit. They also offer guidance on accessing resources and educational information, and on making an appropriate referral when psychological issues are identified.

Ongoing physical health problems (eg, comorbidity, pain, and medical late effects), they point out, can impede psychological adjustment to cancer survivorship. A reduced ability to care for themselves can heighten patients’ feelings of vulnerability, and coupled with other practical concerns (employment, insurance issues, etc.) can increase feelings of anxiety. Recklitis et al. also note that cancer survivors may be at higher risk of depression than people not affected by cancer, and that in some cases treating depression (as well as addressing medication effects and physical conditions) can alleviate fatigue.

As they emphasize and as described in this issue’s Patient Information insert, however, fatigue in cancer patients—which can last for months to years after cancer treatment—may not be resolved with interventions to reduce depression. Research has shown that fatigue can be improved through a variety of strategies, including scheduled activity and rest periods, and, if medically appropriate, regular exercise training.

In Late Effects Clinic, Sheila Santacroce discusses post-trauma symptoms (PTS) in cancer survivors. PTS can be considered self-protective responses to the trauma of cancer diagnosis and treatment, characterized by re-experiencing, avoidance/numbing, and hyperarousal behaviors. However, persistence of a number of symptoms beyond 1 month or evidence that they are causing clinically significant distress or impaired function is suggestive of post-traumatic stress disorder (PTSD). Santacroce details symptoms that may commonly occur with PTS/PTSD and provides insight into pre-existing and other factors (eg, trauma predating the cancer diagnosis, inadequate social support) that may put patients at greater risk for this psychological late effect of cancer and its treatment. She notes the points at which nursing assessment, supportive discussion, education strategies, and referral to specialist care may be of particular benefit.

We know that, for better or worse, cancer changes lives forever and in a multitude of ways. Taken together, these articles highlight the expanding critical role that nurses play in patients’ personal journeys toward regaining “wholeness” of body, mind, and spirit.