HL10 - Cancer survivorship Flashcards
1
Q
What are the cancer rates and survivorship rates in Australia?
A
- 1 in 2 men and women will be diagnosed by 85
- 165,000 new cases diagnosed per year
- Leading cause of death
- Survival rate increased over past 25 years
2
Q
What is cancer survivorship?
A
- Distinct phase of cancer trajectory
- Experience of cancer diagnosis and treatment well established → acceptance and understanding by family/community
- BUT - experience of surviving illness is poorly understood
- The survivor can fit only into pre-existent and inadequate paradigms of the ‘normal’ OR ‘chronically ill’, into metaphors of the ‘victim’ OR the ‘hero’.”
- In the past, predominant focus of follow-up and surveillance was on detection of cancer recurrence
- => a recent shift from the QUANTITY to QUALITY of SURVIVAL
3
Q
How does cancer survivorship differ in where it begins?
A
- From diagnosis
- After completing primary treatment
- Disease-free for a certain number of years
- Alive 5+ years after diagnosis (long-term survivorship)
Entire cancer continuum from initial diagnosis through the remainder of life
4
Q
How does cancer survivorship impact someones life?
A
- For many survivors life after cancer is good - can be better than before
- BUT - many challenges
- Poorer overall health
- More likely to die from non-cancer causes
- e.g. heart disease
- Have psychological problems
- Psychopathology among a subset of survivors
- 20% depression, 30% anxiety
- Subclinical psychological problems - sitting anxiety
5
Q
What is a common assumption post-cancer? Why is it more difficult?
A
- Common to assume that survivors will return ‘back to normal’ once their health returned post-treatment
- But life is less clear cut after the active phase of treatment
6
Q
What is cancer survival state (CaSS)?
A
- Experience of each cancer survivor is unique but distinct trends and common themes have been observed
- Prof Miles Little and Colleagues (VELIM)
- Used narratives (qual research) to capture the nature of the subjective experience of illness
- Developed a framework to facilitate understanding of survival
7
Q
What is meant by ‘liminality’ in CaSS?
A
- In-between state
- not what you were before the cancer
- not yet‘graduated’ into a new steady state
- = an enduring and dynamic existential process of accommodation and adaptation that the patient experiences during the illness trajectory
- The moment of suspicion of the diagnosis is the moment when one enters CaSS/Liminality
- 3 main components/themes (experienced with varying degrees by most survivors):
- CANCER PATIENTNESS
- COMMUNICATIVE ALIENATION
- BOUNDEDNESS
8
Q
What is “cancer patientness”?
A
- 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: check-ups, side effects, medication, media
- the body becomes a ‘house of suspicion’ and that it is fallible
- Can be become more hypersensitive - believe that slight pain indicates cancer is back
- Some people are overwhelmed or threatened, prefer to not focus on cancer
- Others embrace their new identity of being a cancer survivor
9
Q
What is communicative alienation?
A
- Difficulty communicating what the person experienced
- a state of variable alienation brought about by an inability to communicate the nature of the experience of the illness, its diagnosis and treatment
- Recognition that others cannot share the trauma of the experience
- Support Groups: better communication established with people similar experience
- Existential tension: survivors become ‘compulsory philosophers’
- Strain on relationships
- Distancing and isolation, experienced partly as alienation, partly as a change in needs
10
Q
What is boundedness?
A
- for some, a persistent and heightened awareness of:
- uncertainty of future time
- 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
11
Q
How can survivorship impact identity?
A
- PERSONAL IDENTITY= the sense of being this person, in this body with this story
- DISCONTINUITY in the sense of identity due to cancer, expressed as:
- Discontinuity of memory
- Discontinuity of embodiment
- Existential disruption
- Disruption of the memory of others
12
Q
How can identity be recovered after cancer?
A
- 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
- This may take several tries & that’s NORMAL
- Most survivors will adjust in their own time and their own way
13
Q
What does quantitative research say about survivorship?
A
- Cancer survivors report late effects across a wide range of areas
- Physical, cognitive, psychological, sexual
- Fatigue, pain and anxiety = At least 50% of cancer survivors experience some late effects of treatment
- 47% of cancer patients report financial hardship and difficulties
- Higher financial burden = Poorer quality of life
14
Q
What are the unmet needs of survivorship?
A
- Most cancer survivors are able to overcome these issues in time, but some continue to have unmet needs
- The greatest unmet needs = PSYCHOSOCIAL, rather than physical.
- Most highly endorsed:
- Fear of cancer recurrence
- Uncertainty about future
- Worry about partners, friends, families
- Sexual changes
- Most highly endorsed:
15
Q
What is the fear of cancer recurrence (FCR)?
A
- Some degree of FCR reported by ALL cancer survivors:
- Some FCR: 73%
- Moderate FCR: 49%
- High FCR: 7%
- FCR is often higher in CAREGIVERS than survivors§ ~ 50% of caregivers have moderate-high FCR§ Factors associated with high FCR in carers:
- high FCR in person affected by cancer
- low satisfaction with communication
- family stressors and illness
18
Q
How can these essential elements be achieved?
A
