26 Cancer Survivorship Flashcards
What are the varying definitions of when survivorship starts?
- From diagnosis
- After completing primary treatment
- Disease-free for a certain number of years
- Alive, 5+ years after diagnosis
What are the three stages of survivorship?
- Acute survival (< 1-year post-diagnosis)
- Extended survival (1-3 years post-treatment)
- Permanent survival (3+ years)
Survivorship is a distinct phase of the cancer trajectory
What are the common experiences of cancer survivorships?
Those who become ill can expect acceptance and understanding -> until recently, the experience of surviving illness has been poorly understood
In the past, the predominant focus of follow-up and surveillance was on the detection of cancer recurrence. What has been the recent shift?
A recent shift from the QUANTITY to QUALITY of survival
What are the challenges of cancer survivorship?
For many survivors, life after cancer is as good - sometimes better than before but yet, for many others there are challenges
Compared to the general population, cancer survivors have:
- Have poorer overall health
- Are more likely to die from non-cancer causes e.g. heart disease, lung and digestive orders
- Have psychological problems e.g. psychopathology among a small subset of survivors; subclinical psychological problems
What is a common assumption of survivors?
That they will return ‘back to normal’ once their health returned post-treatment. But, life after cancer/treatment may be more difficult and is less ‘clear cut’ than active treatment
What is the qualitative research in cancer survivorships?
Cancer Survivorship State
Identifying Disruption
What is quantitative research in cancer survivorships?
Psychological outcomes and unmet needs
What is are the experiences of those in Cancer Survival State (CaSS)?
Experience of each cancer survivor is unique, however distinct trends and common themes have been observed
How did Miles Little discover Cancer Survival State?
Used narratives (qualitative research) to capture the nature of the subjective experience of illness
Developed a framework to facilitate understanding of survival
- In-between state
- Not what you were before the cancer
- Not yet “graduated” into a new steady-state
What are the three main components of CaSS?
- Cancer patientness
- Communicative alienation
- Boundedness
Describe the cancer patientness component of CaSS?
An ongoing identification and recognition of oneself as a cancer patient, regardless of the time since treatment and of the presence or absence of persistent/recurrent disease
Expressed in various ways
- Some dwell on how everyday life changed irreversibly
- Regular reminders via check-ups, side effects, medication, media
- The body becomes a house of suspicion
Some people are overwhelmed or threatened
Others embrace their new identity of being a cancer survivor
Describe the cancer patientness component of CaSS
An ongoing identification and recognition of oneself as a cancer patient, regardless of the time since treatment and of the presence or absence of persistent/recurrent disease
Expressed in various ways
- Some dwell on how everyday life changed irreversibly
- Regular reminders via check-ups, side effects, medication, media
- The body becomes a house of suspicion
Some people are overwhelmed or threatened
Others embrace their new identity of being a cancer survivor
Describe the communicative alienation component of CaSS
A state of variable alienation about by an inability to communicate the nature of the experience of the illness, it’s diagnosis and treatment
=> Strain on relationships
=> Recognition that others cannot share the trauma of the experience
- Support groups: better communication established with people with similar experience
- Existential tension: Survivors become ‘compulsory philosophers’
- Distancing and isolation: experienced partly as alienation and partly as a change in needs
Describe the boundedness component of CaSS
A persistent and heightened awareness of
- Uncertainty of future time (fear of cancer coming back)
- Constraints on social/working roles
- Limitations in the freedom to use space
=>Some perceive that their restricted lives made them part of a community of disadvantaged people
What is personal identity?
The sense of being this person, in this vody with this story
How is extreme experiences of cancer which produces a discontinuity in the sense of identity expressed as?
- Discontinuity of memory
- Discontinuity of embodiment
- Existential disruption
- Disruption of the memory of others
How do cancer survivors recover their identity?
(what is important to me now? what gives my life meaning?)
=> Recovering earlier (pre-diagnosis) identity may not be possible
=> Change in identity can be hard for others to understand
=> Finding a new normal: reconstructing loss as change without denying the loss (which may take several tries, that’s normal)
=> Most survivors will adjust in their own time and their own way
What kind of late effects do cancer survivors report issues in?
- Physical (e.g. fatigue, chronic pain)
- Cognitive (e.g. memory, learning)
- Psychological (e.g. fear of recurrence, mood impairment)
- Sexual/fertility (e.g. dyspareunia, erectile dysfunction, grief)
- Social (e.g. changed relationships with partner/family/friends
- Existential (e.g. re-evaluating/changed values, goals, outlook on life)
What are the most commonly reported problems of cancer survivors who experience some late effects of treatment?
Depression, pain & fatigue
What is the financial burden of cancer patients?
Poverty is an unrecognised late effect of cancer - with a disproportionate impact on those already disadvantaged
=>Cancer survivors are more likely to be unemployed than healthy controls
=> Cancer patients are 2.5 times more likely to go bankrupt (than controls)
=> High financial burden associated with poorer quality of life even when adjusting for income, employment, comorbidities or disease status
