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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 5  |  Page : 555-559

Empowering Oncology Nurses through Knowledge and Practice to Improve Transitions Following Treatment and Survivorship Care

1 Applied Research and Patient Experience, Cancer Care Alberta, Faculty of Nursing, University of Calgary, Alberta, Canada
2 Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
3 Connect Care Oncology, Alberta Health Services, Edmonton, Alberta, Canada
4 Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

Date of Submission22-Jun-2021
Date of Acceptance28-Jun-2021
Date of Web Publication27-Aug-2021

Correspondence Address:
Margaret I Fitch
Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/apjon.apjon-215

Rights and Permissions

Following cancer treatment, individuals can be left with physical, emotional, and practical consequences which influence their quality of life. Cancer survivors frequently require added knowledge and skills to handle the demands of everyday living after treatment. Oncology nurses are in an ideal position to address the needs of cancer survivors. This article describes an online interactive workshop for oncology nurses to introduce Canadian data on unmet needs of cancer survivors, highlight the contribution oncology nurses can make to survivorship care, and introduce a self-learning resource for survivor care. Didactic presentations and small group discussions were used and feedback from participants was positive. Online learning can be an effective approach for learning with international nursing colleagues and could be utilized for nurses with limited access to cancer nursing education.

Keywords: Cancer survivors, interactive online learning, oncology nursing role in survivorship, survivorship

How to cite this article:
Watson L, Maheu C, Champ S, Fitch MI. Empowering Oncology Nurses through Knowledge and Practice to Improve Transitions Following Treatment and Survivorship Care. Asia Pac J Oncol Nurs 2021;8:555-9

How to cite this URL:
Watson L, Maheu C, Champ S, Fitch MI. Empowering Oncology Nurses through Knowledge and Practice to Improve Transitions Following Treatment and Survivorship Care. Asia Pac J Oncol Nurs [serial online] 2021 [cited 2021 Sep 23];8:555-9. Available from: https://www.apjon.org/text.asp?2021/8/5/555/324781

  Introduction Top

The cadre of cancer survivors is growing and anticipated to exceed 20 million worldwide by 2025.[1],[2] A diagnosis of cancer and its treatment can leave survivors with physical, emotional, and practical consequences which influence their quality of life.[3],[4] For many, living with the aftermath of treatment can be likened to living with the ongoing impact of a chronic illness.[5],[6] Frequently, individuals require added knowledge and skill to handle the demands of everyday living after treatment for cancer. Oncology nurses are in an ideal position to address the needs of cancer survivors and prepare them for the transition to the posttreatment phase of their experience with cancer.

This article is based on an interactive workshop provided for the International Cancer Nursing Conference held virtually in February 2021. The purpose of the workshop was to share the results of a national survivor study completed in Canada and explore the role oncology nurses could play in high-quality survivorship care. We also wanted to profile a new resource for oncology nurses regarding survivorship care which had been developed by the Canadian Association of Nurses in Oncology (CANO/ACIO). We included both didactic presentations and interactive discussions about survivor case studies. Below, we will highlight the content shared at the workshop and the resulting feedback from participants.

  Didactic Presentation: Understanding the Experience of Canadian Cancer Survivors Top

With the growing cadre of cancer survivors, understanding the nature and impact of consequences from the diagnosis and treatment is growing, and survivorship support is being seen as an imperative for oncology nurses.[7],[8],[9],[10] Although not all survivors experience challenges at the time of treatment completion, a sizeable proportion have ongoing difficulties and report profound effects on their quality of life.[3],[4]

Planning of survivorship care in our country required a deeper understanding of the experiences of survivors as they transition from the completion of their primary cancer treatment into the survivorship phase of their journey. In 2017, the Canadian Partnership Against Cancer undertook a national survey to understand the experiences of cancer survivors 1–3 years following treatment. The intent was to provide the basis for actionable recommendations on integrating cancer survivorship care, ultimately improving the experiences of survivors.

The full description and rationale for the transitions survey is reported in a previous publication.[11] In brief, the survey, Experience of Cancer Patients in Transition Study, was mailed to a randomly selected sample of 40,790 cancer survivors from across ten Canadian provinces. The eligibility criteria included adult survivors (age 30+ years) of breast, prostate, colorectal, or melanoma diseases with no metastatic spread, and selected hematological (e.g., Hodgkin's lymphoma, diffuse B-cell lymphoma, acute myelogenous leukemia, and acute lymphocytic leukemia) cancers, as well as adolescents and young adults (AYAs, 18–29 years) with all nonmetastatic cancer types except testes, where metastatic disease was included. These groups were most apt to be followed in community settings by primary care teams.

A total of 13,258 individuals responded to the survey, 20% of whom were AYAs.[11] Most were breast (28%), prostate (23%), and colorectal (20%) survivors. Sixty percent were 65+ years. Similar patterns existed for the adult and for the AYA groups. The most prevalent concerns reported by respondents were fatigue (67%) in the physical domain and anxiety/worry/fear of cancer returning (68%) in the emotional domain. Twenty-two percent reported concerns about worry regarding return to work or school.

Despite having concerns, many respondents did not seek help (ranged from 85% to 37% across concerns).[11] When asked about the reasons for not seeking help with a concern, the most frequent reason given was, “someone told me it was normal and I didn't think anything could be done about it” (50.9% for physical, 33.7% for emotional, and 21.5% for practical). The other frequently cited reasons included, “I did not want to ask,” “I was embarrassed,” and “I did not know services were available to help me.”

For those individuals who did seek help, many reported difficulties in finding relevant assistance (ranged from 21% to 65%).[11] Difficulties happened most frequently for psychosocial and practical concerns. Furthermore, many individuals were not able to differentiate whether their physical symptoms were because of their cancer treatment or from other chronic diseases escalating after the cancer treatment. Some thought their physical issues were simply a result of getting older.

These findings have implications for oncology nurses. Identifying cancer survivors who have concerns and assisting them to connect with relevant resources is critically important. As well, it is important to discuss expectations about survivorship and help the individual understand what might happen and make them aware that there are interventions that can assist them. They do not have to suffer on their own.

  The Important Role Oncology Nurses Play in High-Quality Survivorship Care Top

During diagnosis and treatment, patients are focused on the immediate tasks of grasping the implications of their cancer diagnosis, making treatment decisions, getting through treatment, dealing with anxiety and all the uncertainties, and managing side effects. Despite looking forward to the end of treatment, all these demands leave little room for patients to contemplate life after cancer treatment or understand the long-term implications of cancer. In addition, the end of primary cancer treatment brings forth new challenges for many as they work to adjust to living with changes from the disease and treatment.[12],[13]

As a basis for practice, oncology nurses need to understand the experiences of cancer survivors and the substantial impacts on quality of life which can occur from issues such as fatigue, cognitive changes, lymphedema, pain, emotional distress, impact on work, and financial challenges. Distress can emerge from living with uncertainty, finding “a new normal,” fear of recurrence, and returning to work or school. Many survivors face significant financial challenges and are more vulnerable to health-related issues than are their healthy counterparts.[14]

Oncology nurses play an important role in preparing patients for the transition to survivorship and living life after cancer treatment (CANO/ACIO Survivorship Modules available on the CANO/ACIO website, www.cano-acio.ca). This role can include actions such as:

  • Reviewing survivorship care plans with patients as they approach the end of their primary treatment
  • Educating patients and family members about what to expect and what they can do to manage any late, long-term, and persistent effects and the surveillance plans
  • Facilitating engagement in self-management of long-term effects
  • Helping patients set appropriate expectations
  • Assisting patients and their caregivers to become better equipped to navigate the primary and cancer systems, and advocate for themselves
  • Coordinating care between the cancer professionals and the community care team.

  Dialogue about Case Studies Top

After an overview of the transitions study data and the role oncology nurses can play in survivorship phase, workshop attendees were divided into groups for small group discussions lead by a member of our team. Each group reviewed a different case study that reflected a common survivor challenge: transitioning to survivorship, fear of recurrence, returning to work, and cognitive impairment [case studies in Appendix 1]. The subsequent discussions focused on the context and influencing factors in the survivor situation and how oncology nurses would assess and intervene. Information about appropriate interventions for each of the case studies is depicted in the modules (see CANO/ACIO website for access to modules).

In reporting back to the large group of workshop attendees after the case study review and small group discussions, the following insights were shared.

Patterns and insights regarding survivorship care around the world

Dealing with the aftermath of cancer can be likened to dealing with posttraumatic stress for some individuals; there is little understanding about survivor needs or available resources to support survivors in many countries; often, there is little information available about survivor experiences; social media is gaining in potential both for harm and for offering ways to support survivors; in many settings, community-based advocacy groups are supporting survivors.

Diversity in perspectives about survivors and oncology nurses

The focus on survivorship varies around the world; high-resource countries have a more concerted focus on survivorship, whereas middle-to-low-resource countries are focusing more heavily on the development of palliative care programs (many cancers are diagnosed late and facilities for treatment can be scarce); resources for survivorship and survivorship care models are diverse; some cancer teams follow survivors in the cancer centers while others transition survivors back to primary care settings; nurses are not often able to access programs about cancer nursing care; very few opportunities exist to learn about cancer survivorship for nurses; in some countries, financial issues are a real concern as patients are responsible for paying for their own treatments.

Collective discoveries

When working with survivors, it is important to assess the full context including the family situation; providing information and support about survivorship is clearly a nursing role but can be challenging if there is no education about it for the nurses themselves; there is a need to support family caregivers as well as the survivors.

  Survivorship Self-learning Resource for Nurses Top

The CANO/ACIO recently revised a self-learning resource for oncology nurses regarding survivorship. The resource is a revision of a 2011 resource and includes current evidence regarding cancer survivorship [table of contents in Appendix 1]. In addition to covering evidence for practice regarding physical, emotional, and practical concerns held by survivors, new material has been added on the care of AYAs and older adults with cancer. The 12 modules in this resource are available from the CANO/ACIO website for free to CANO/ACIO members. Workshop participants were offered access to these modules for free. Otherwise, the modules can be accessed by all for a limited fee or free for nurses in low-to-middle-income countries.

  Discussion Top

Lessons learned and recommendations

The workshop was offered through a virtual platform and provided the opportunity to engage with colleagues in various parts of the world. In turn, this approach facilitated learning about survivorship issues in various countries and understanding more about the variation which currently exists for this phase of cancer care. The participants engaged actively in the small group breakout room discussions leveraging ideas from each other's experiences. Although capacity and knowledge of survivorship care varied across participants, a common thread was recognizing the need for broad access to more oncology-specific education for nurses who care for cancer patients regardless of the phase of their cancer trajectory. Although the transitions study and the survivorship modules originated in the Canadian context, there was agreement about the value added internationally by such digital learning resources.

Overall, the session ran smoothy and there was opportunity for visual and vocal interaction by participants. The virtual nature of the workshop highlighted the incredible opportunity to offer high-quality live interactive learning opportunities across international boundaries, which holds the potential to transform access to such learning activities in low- and middle-income countries. Although this workshop was offered virtually due to the global coronavirus disease 2019 (COVID-19) pandemic, the success of this international interactive workshop could be used to develop other virtual oncology nursing education opportunities that span international borders.

  Conclusions Top

The survivor cadre is growing, albeit at different rates in different parts of the world. Oncology nurses are in ideal positions to assist individuals who have undergone cancer treatment to prepare for and transition successfully to the survivorship phase of their cancer journey. To engage in supporting cancer survivors, nurses themselves would benefit from opportunities to learn more about the survivorship experience and its implication on the long-term quality of life of cancer survivors. In addition, nurses would be best served to learn more on best available evidence to guide their practice in providing long-term surveillance and health maintenance throughout the continuum of cancer care with survivors.

Financial support and sponsorship


Conflicts of interest

All authors were workshop leaders and were all involved in writing portions of the self-learning resource for survivorship introduced during workshop; the resource is an education product of the CANO/ACIO. The corresponding author, Prof. Margaret I Fitch, is the editorial board member of the journal.

  Appendix Top

CANO/ACIO Adult Cancer Survivorship Modules . A self.learning resource for nurses (can be found at https://www.cano.acio.ca)

  References Top

Stout NL, Sleight A, Pfeiffer D, Galantino ML, deSouza B. Promoting assessment and management of function through navigation: Opportunities to bridge oncology and rehabilitation systems of care. Supportive Care Cancer 2019;27:4497-505.  Back to cited text no. 1
Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survival statistics 2019. CA Cancer J Clin 2019;69:363-85.  Back to cited text no. 2
Lerro CC, Stein KD, Smith T, Virgo KS. A systematic review of large-scale surveys of cancer survivors conducted in North America, 2000-2011. J Cancer Survivorship 2012;6:115-45.  Back to cited text no. 3
Molassiotis A, Yates P, Li Q, So WK, Pongthavornkamol K, Pittayapan P, et al. Mapping unmet supportive care needs, quality of life perceptions and current symptoms in cancer survivors across the Asia-Pacific region: Results from the international STEP study. Ann Oncol 2017;28:2552-8.  Back to cited text no. 4
Zuzelo PR. Metastatic breast cancer as a chronic condition: Holistic care considerations. Holist Nurs Pract 2019;33:125-7.  Back to cited text no. 5
McGeechan GJ, McPherson KE, Roberts K. An interpretative phenomenological analysis of the experience of living with colorectal cancer as a chronic illness. J Clin Nurs 2018;27:3148-56.  Back to cited text no. 6
Grant M, Economou D, Ferrell BR. Oncology nurse participation in survivorship care. Clin J Oncol Nurs 2010;14:709-15.  Back to cited text no. 7
Lemonde M, Paymen N. Perceived roles of oncology nursing. Can Oncol Nurs J 2015;25:422-2.  Back to cited text no. 8
Miura A, Matsuda Y, Ogawa I, Takagai J, Hirai K, Hosoda Y, et al. Oncology nurses' recognition of long-term cancer survivorship care in Japan. Asia Pac J Oncol Nurs 2015;2:136-43.  Back to cited text no. 9
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Rosenberg SM, Partridge AH. Looking back, moving forward: The evolution of cancer survivorship care. Lancet Oncol 2017;18:18-9.  Back to cited text no. 10
Fitch MI, Zomer S, Lockwood G, Loucado C, Shaw-Moxam R, Rahal R, et al. Experiences of adult cancer survivors in transitions. Support Care Cancer 2019;27:2977-86.  Back to cited text no. 11
Fitch MI, Nicoll I, Lockwood G. Cancer survivors' perspectives on the major challenges in the transition to survivorship. Patient Educ Couns 2020;103:2361-7.  Back to cited text no. 12
Fitch MI, Nicoll I, Lockwood G. Exploring the impact of physical, emotional, and practical changes following treatment on the daily lives of cancer survivors. J Psychosoc Oncol 2021;39:219-34.  Back to cited text no. 13
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