Article

Cancer survivorship: rethinking the cancer control continuum.

National Cancer Institute, NIH/DHHS, Bethesda, MD 20892, USA.
Seminars in Oncology Nursing 09/2008; 24(3):145-52. DOI: 10.1016/j.soncn.2008.05.002
Source: PubMed

ABSTRACT The implications of the changing face of cancer survivors and the survivorship experience for health promotion are explored.
National Cancer Institute and Office of Cancer Survivorship, and research and journal articles.
Health promotion has become one of the most rapidly expanding topics of interest in the broader arena of survivorship research.
Nurses have been vital champions for a holistic or 'whole person' approach to cancer care and are uniquely positioned to play a central role in ensuring that we deliver on the promise of a valued future life for each cancer survivor and family member alive. Promoting healthy lifestyle behaviors is one of those roles.

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    ABSTRACT: Aim: The overall aim was to explore access to and the perception of social support among migrants and non-migrants regarding two different phases in the cancer control continuum: 1) cancer screening and 2) cancer care. Substudy I investigated the role of social support in informal relations for participation in mammography screening (IA) and the perception of social support in informal relations during cancer care (IB). Substudy II explored access to and the perception of social support in formal relations with healthcare professionals (IIA) and cancer patient associations (IIB) during cancer care. Lastly, Substudy III took a methodological approach to exploring the barriers encountered when conducting cross-cultural surveys on cancer wards. Methods: Substudy IA was a registry study utilizing data on 84,489 non-migrant women, 5,484 women born in Western countries other than Denmark, and 5,891 women born in non-Western countries who had been invited to attend at he mammography screening program in Copenhagen, Denmark. The effect of household size on the uptake of mammography screening was estimated adjusted for socioeconomic position, use of primary healthcare services, and hospitalization. Substudies IB and IIA used narrative interviews with 18 adult non-migrant and migrant cancer patients analyzed by phenomenological methods. Substudy IIB used semi-structured telephone interviews with key informants from major cancer patient associations in the Nordic countries (Denmark, Sweden, Norway, Finland and Iceland) analyzed thematically using elements from organizational theory. Lastly, Substudy III used participant observation combined with semi-structured interviews with nurses on cancer wards. This material was analyzed thematically. Results: Substudy IA found the crude Odds Ratio (OR) for non-use of mammography screening to be 1.38 (95% CI, 1.30-1.46) for women born in other-Western countries and 1.80 (95% CI, 1.71-1.90) for women born in non-Western countries compared with Danish-born women. Adjusted OR for non-use among women living within households of 2–4 persons was 0.63 (95% CI, 0.61-0.65) among Danish-born women; 0.60 (95% CI, 0.53-0.69) among women born in other-Western countries; and 0.74 (95% CI, 0.64-0.85) among non-Western women compared with women living alone. Substudy IB found that migrant patients had social networks that were more dispersed than those of non-migrant patients. However, common difficulties in asking for and receiving emotional support were related to cancer being perceived as a fatal disease within informal relations. This led to fear among patients that articulating needs for support would result in loss of normality and non-patient identity. For social support in formal relations, Substudy IIA showed how both non-migrant and migrant patients perceived support given by healthcare professionals as available, empathic and valuable. Prerequisites for provision of support were 1) setting aside sufficient time for the patient to feel safe and able to verbalize emotional concerns, 2) continuity in relationships, and 3) ability to understand the patient’s emotional reactions without creating additional distress. Substudy IIB found that major cancer patient associations in the Nordic countries differed in relation to stage of policy and practices regarding migrant patients. Migrant patients were perceived to face barriers in accessing support within general healthcare services due to language barriers and socioeconomic vulnerability, and needs for services provided by associations were felt to be high. Adaptation of services focused on overcoming linguistic barriers, using pro-active outreach strategies and involving staff with migrant background. Substudy III found cross-cultural surveys on cancer wards using name-based identification of respondents to be inflicted with various difficulties regarding identification of respondents and involvement of nurses due to both external (policy changes, strike among nurses) and internal factors on the wards (heavy workload, lack of time, focus on medical aspects of cancer rather than psychosocial aspects). Conclusion: Although conceptualized and measured differently in the substudies, social support was found to be important for participation in cancer screening and when undergoing cancer care among migrants and non-migrants. Using multiple methods and including a diverse population group elucidated both differences and similarities in access to and perception of social support from informal and formal relations. Although fragile social networks, more common among migrant cancer patients, may have difficulty in providing emotional support, this support can also be lacking in denser social networks. Efforts are needed to show informal relations how they can support the patient throughout cancer care. Support from healthcare professionals is of great importance to patients but may be restricted by organizational and individual factors. Psychosocial interventions offered by cancer patient associations may be another important source of support, but a more systematic approach is needed to facilitate development of policies and practices to make these associations more sensitive to migrants’ needs. Moreover, to gain sufficient knowledge about patient perspectives on living with cancer, the representation of migrant patients in psychosocial cancer research should be increased. This could be achieved by involving healthcare professionals in research, but awareness of the influence of possible external and internal factors and efforts to deal with these factors are fundamental to successfully implementing cross-cultural cancer research in a clinical setting.
    05/2011, Degree: PhD, Supervisor: Allan Krasnik, Tine Tjornhoj-Thomsen

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