Nursing Leadership in Survivor Care

While many oncology nurses have heard of survivor care plans, their details remain obscure. Ms. Houlihan has presented an excellent composite overview of what survivor care plans entail and the barriers limiting their use. In particular, these include the need to access information from numerous providers, time constraints related to plan completion, lack of third party reimbursement for follow-up, and the absence of evidence-based guidelines dictating essential components of surveillance and intervention.

The Institute of Medicine report published in 2006 speaks to the newness of definitive care planning for the future of adult survivors. Yet, this is not the case in pediatric oncology, for which patients’ needs throughout extended survival have been chronicled and addressed. Lessons learned from the experiences of intervening with childhood cancer survivors, developed into guidelines by the Children’s Oncology Group, can be applied to the adult survivor paradigm. Information technology to enhance communication between disciplines and across settings can be replicated. Use of flash drives to download treatment summaries and details of the patient experience (eg, complications and special needs) would facilitate information-sharing.

At this juncture in the evolution of survivorship care planning, oncology nurses have the opportunity to delineate limitations in medically prescribed templates of care. Missing from existing exemplars is attention to psychological, social, financial, and work-related indices of adult survivorship. Ms. Houlihan targeted the critical issue of who will provide and assume responsibility for survivorship care. Oncology nurses, experienced in choreographing diverse care needs of patients during active treatment, have the unique skills and capacity for critical thinking needed to assume this important role. Yet any attempt to engage in this effort must be accompanied by a well-defined plan to investigate outcomes and benefits derived from nursing interventions with survivors.

Importantly, in her article the author has brought attention to policy implications of survivorship care planning. Recent legislative initiatives could be enhanced by the oncology nurse lobby, as first-hand accountants of survivor experiences. Without question, oncology nurses are pioneers in the field of cancer survivorship, but it is now time for us to pursue a leadership role in creating roadmaps for the adult survivor’s journey beyond cancer. More than two decades ago, Swiss oncology nurse Rosetta Poletti made a poignant statement which still rings true today, namely that “The goal of cancer nursing should be to help the patient be a fully functioning person first, and a cancer patient second.” Kudos to Nancy Houlihan for helping us in this quest.