There are nearly 17 million survivors of cancer in the United States, making it likely that primary care nurse practitioners (NPs) will be involved with the long-term care for these patients. To optimize care, NPs should be familiar with the components of survivorship care, available resources, and potential challengers or barriers to care, Karol Huenerberg, MSN, FNP-BC, APNP, AOCNP, said in a poster session at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).
The 5 principal components of survivorship care include the prevention of new cancers, surveillance for recurrence, assessment of cancer treatment effects, interventions for treatment effects, and coordination of health care among multispecialists, according to Huenerberg, who is an NP in radiation oncology at UW Health in Madison, Wisconsin.
Although some cancer treatment-related physical side-effects are short term and resolve after treatment, “other physical side effects are more long term and persist for months or even years after treatment,” explained Huenerberg.
“The psychosocial effects such as fear of recurrence can be long lasting and may intensify with any health care encounter. Validating those concerns promotes a positive provider-patient relationship. Encouraging regular cancer screenings and promoting healthy lifestyles can decrease the risk of a cancer recurrence or the development of a new cancer,” Huenerberg said.
“Almost every primary care NP has cared for cancer survivors. Unfortunately, patients become so involved with their cancer specialists they forget to address primary care issues,” commented AANP 2021 meeting attendee Mary Koslap-Petroco, DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing in Stony Brook, New York. “Many cancer survivors are faced with managing their cancer as a chronic illness. This project [by Huenerberg] provides primary care NPs with a paradigm to follow up on cancer care issues while still addressing primary care for primary care NPs.”
Lingering Treatment Effects
Cancer survivors may present with lingering treatment effects such as fatigue, pain, sleep disorders, lymphedema, gastrointestinal dysfunction, endocrine imbalances, cardiovascular disease, sexual dysfunction, or cognitive challenges. These common symptoms should be evaluated by the NP and appropriate referrals for behavioral therapy, for physical therapy, or to a specialist should be made.
Huenerberg added that “long-term survivorship care can depend on the type of cancer the patient had. For instance, genitourinary, gastrointestinal, or sexual complications can persist for those who have been treated for breast, prostate, other genitourinary, and gynecological cancers. Psychosocial effects tend to be more patient-specific.”
Cancer survivors may be grappling with more than just fear of cancer recurrence. Other psychological concerns may include spiritual issues, economic difficulties, anxiety, and/or depression. The NP can help patients deal with these concerns or refer them to the appropriate specialist.
Nurse practitioners who see cancer survivors should familiarize themselves with National Comprehensive Cancer Network Survivorship Guidelines, American Society of Clinical Oncology Clinical Practice survivorship guidelines and adaptations as well as the patient-specific survivorship care plan. Huenerberg emphasized that “NPs should absolutely update themselves regularly about survivor care with continuing education. There are many journal articles on the topic of survivorship care.”
According to Huenerberg, NP should recommend that their cancer patients engage in 2.5 hours of moderate physical activity weekly; consume a diet high in fruits, vegetables, whole grains, legumes, and low in saturated fats; limit alcohol consumption to 1 to 2 glasses per day (depending on gender); avoid smoking; and follow cancer surveillance guidelines.
Using a comprehensive and thorough approach to caring for survivors of cancer will enhance the patient-NP relationship.
Huenerberg KJ. Management of the cancer survivor in primary care. Presented at: 2021 American Association of Nurse Practitioners National Conference; June 15-20, 2021. Poster 68.
This article originally appeared on Clinical Advisor