Letter From the Editor, New Beginnings

February 11, 2009

On January 20th, all eyes were on the inauguration in Washington, and most of us felt not only a sense of renewed hope but also some uncertainty about what the future will hold. In many ways, cancer patients also face these dual feelings of hope and uncertainty when treatment ends and they confront the task of finding a “new normal.” Re-establishing routines, relationships, and one’s connection to the world is eagerly wanted, but for some it can be daunting. The impact of cancer on one’s health, daily function, and body image, as well as financial and other concerns, also may present challenges.

On January 20th, all eyes were on the inauguration in Washington, and most of us felt not only a sense of renewed hope but also some uncertainty about what the future will hold. In many ways, cancer patients also face these dual feelings of hope and uncertainty when treatment ends and they confront the task of finding a “new normal.” Re-establishing routines, relationships, and one’s connection to the world is eagerly wanted, but for some it can be daunting. The impact of cancer on one’s health, daily function, and body image, as well as financial and other concerns, also may present challenges.

In this issue, two important articles guide oncology nurses in helping patients to meet and overcome these challenges. Barrera and Demark-Wahnefried discuss critically important nutritional strategies that can promote physical well-being during and after cancer treatment.

Hara and Blum offer insight into the social impact of cancer at the survivorship phase-from changes in interpersonal relationships, to workplace, insurance, legal, and care-access issues-and provide helpful resources. In the same article, oncology social worker and researcher Brad Zebrack, a Hodgkin’s disease survivor, provides a valuable perspective on support of young cancer survivors. As Demark-Wahnefried and Barrera note, the “teachable moment” for offering information about healthy diets and lifestyle behaviors is likely to be at cancer diagnosis, with ongoing support and information needed throughout long-term survivorship, as the benefits of both of these interventions are life-long. As they point out, not only does the cancer and its treatment have an effect on weight and appetite, but one must also take into account comorbid conditions and weight-related problems that cancer survivors share with the general population. Recommended dietary guidelines for cancer survivors, therefore, are similar to those aimed at reducing risk of heart disease, hypertension, diabetes, and other chronic illnesses.

The challenge for survivors and nurses caring for them is the development of successful strategies to overcome common barriers to making real change in dietary and exercise patterns because of fatigue, incontinence, lymphedema, and food intolerances or digestive disorders. Key to success in bringing about lasting change is the ability of the nurse to creatively utilize innovative formats such as telephone counseling, Internet-based information, and mailed printed materials.

In their article, Hara and Blum discuss the social impact of cancer in the survivorship phase, focusing on its effect on relationships and family planning, financial considerations, ‘job lock’ and other workplace and career issues, insurability and legal concerns, and access to care and supportive services.

Using case examples, the authors highlight the differences in the social impact of cancer across the lifespan, and they include useful resources to address the variety of challenges facing survivors of different ages.

These two articles demonstrate the importance of the nurse in caring for cancer survivors and working to assure the best possible future for them. This key nursing role is now supported by the recently launched ONS Survivorship Initiative that has as its goal making survivorship care “every nurse’s responsibility.” Focusing on the domains of healthy living and social support would be a very good start.