Med-Surg · chapter 31 · Cancer
Survivorship
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Cancer as chronic condition
Cancer, in general, is now largely considered a chronic condition to be managed, according to the ACS (2024). Disease can be controlled or described as stable.
Who is in survivorship
Some survivors are completely cancer-free whereas others are living with cancer. Anyone with a history of cancer is considered to be in survivorship (NCI, 2024a).
Provider survivorship challenges
Challenges for health-care providers include understanding the complexity of chronic management, implementing ongoing surveillance and follow-up care, providing support, ensuring care access, and maintaining good communication with the individual and the care team.
Psychosocial survivor needs
Challenges faced by cancer survivors may be psychological, social, emotional, spiritual, or physical. Psychosocial needs include issues with insurance and financial assistance, memory loss, parenting and work guidance, and emotional health.
Physical survivor concerns
Physical concerns include fatigue, physical functioning, weight changes, chemotherapy -induced peripheral neuropathy, cardiomyopathy, and fertility and sexuality concerns.
Late effects risk factors
These late effects vary somewhat according to the type of cancer, its stage, surgical procedures performed, the chemotherapy medications used, radiation therapy and site, use of hormonal or other systemic therapies, and genetic components.
Fear of recurrence
The emotional burden of a cancer diagnosis is significant, often accompanied by a pervasive fear of recurrence. The uncertainty and waiting associated with regular diagnostics can exacerbate this fear, leading to heightened levels of anxiety, depression, and trauma-related stress.
Sexual intimacy teaching
Fatigue is a significant obstacle to maintaining healthy sexual intimacy. Teaching for the patient and the partner is crucial; this includes setting expectations around thoughts of returning to prediagnosis libido.
Fertility preservation care
Treatments such as radical hysterectomy, radiation therapy, and chemotherapy can affect fertility, necessitating discussions about fertility preservation options. Nurses play a crucial role in educating patients about these options, coordinating care, and providing emotional support throughout the decision-making process.
Remission and recurrence
Remission signifies a period when cancer is not detectable or actively growing, whereas control involves managing the disease to prevent its progression or symptoms. However, cancer can return after a period of remission, which is known as recurrence.
Secondary cancer sources
First, factors that contributed to the initial cancer, such as tobacco use, alcohol consumption, or an unhealthy diet and environment, can increase the risk of developing a different type of cancer. Second, cancer survivors may develop a new cancer because of previous cancer treatments.
Exercise and fatigue
In multiple studies, exercise has been demonstrated to be the only intervention that consistently and effectively reduces fatigue and improves overall energy (Campbell et al., 2019; Fabi et al., 2020).
Follow-up teaching
It is essential that the nurse reinforces teaching about follow-up appointments, diagnostic testing for surveillance of ongoing remission or recurrence, medication adherence, side effect management, and when to seek medical attention.
Survivorship care coordination
As with active cancer management, survivorship care requires coordination between oncologists, physical therapists, psychologists, or other specialties and services that are involved in a patient’s ongoing care.
Terms to know
- survivorship
- The term survivorship embraces the reality of individuals living beyond the cancer diagnosis.
- late effect
- A delayed effect, or late effect, of cancer treatment is one that arises months or years after diagnosis and treatment.
- Remission
- Remission signifies a period when cancer is not detectable or actively growing, whereas control involves managing the disease to prevent its progression or symptoms.
- control
- Remission signifies a period when cancer is not detectable or actively growing, whereas control involves managing the disease to prevent its progression or symptoms.
- Recurrence
- Recurrence indicates that the cancer has resurfaced and is no longer under control or stable.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
At a 1000 survivorship visit, a patient reports persistent fatigue and asks what might improve energy. The nurse is documenting a teaching plan. Which entry is best supported by the section?
- Discuss exercise as the intervention consistently shown to reduce fatigue and improve overall energy.
- Discuss acupuncture as the intervention consistently shown to reduce fatigue and improve overall energy.
- Discuss nutritional changes as the intervention consistently shown to reduce fatigue and improve overall energy.
- Discuss massage as the intervention consistently shown to reduce fatigue and improve overall energy.
Answer: Discuss exercise as the intervention consistently shown to reduce fatigue and improve overall energy.
The section identifies exercise as the only intervention consistently shown to reduce fatigue and improve energy. Massage and acupuncture are described as options for symptoms such as pain or nausea, while nutrition is a general health-promotion topic rather than the intervention identified for this outcome.
At 1430, a patient who has completed cancer treatment and is in remission asks what ongoing care will involve. The nurse is updating the survivorship teaching plan. Which entries belong in that plan? Select all that apply.
- Reinforce medication adherence and side-effect management.
- Teach that new symptoms, rather than scheduled surveillance, will determine when diagnostic testing is needed.
- Review the purpose of scheduled follow-up appointments.
- Explain diagnostic testing used to monitor ongoing remission or detect recurrence.
- Omit side-effect teaching from the survivorship plan because cancer treatment has ended.
Answer: Reinforce medication adherence and side-effect management., Review the purpose of scheduled follow-up appointments., Explain diagnostic testing used to monitor ongoing remission or detect recurrence.
The section identifies follow-up appointments, surveillance testing, medication adherence, and side-effect management as ongoing teaching priorities. Relying only on new symptoms replaces the described surveillance approach, and completing treatment does not eliminate the need for side-effect teaching.
At 1530, a patient newly diagnosed with cervical cancer says she has not completed her family planning and asks about delaying treatment to pursue fertility preservation. No decision about treatment timing has been made. Which entry best documents the nurse's plan?
- Coordinate discussion with oncology and fertility specialists about fertility preservation and the risks and benefits of delaying treatment.
- Plan to postpone cancer treatment while fertility preservation is arranged, based on the patient's expressed interest.
- Plan fertility counseling after cancer treatment is completed; focus current teaching on cancer-treatment needs.
- Refer for counseling about family-planning distress; defer discussion of fertility-preservation options.
Answer: Coordinate discussion with oncology and fertility specialists about fertility preservation and the risks and benefits of delaying treatment.
The section calls for coordination among nurses, oncologists, and fertility specialists when patients consider delaying treatment for fertility preservation. That approach supports weighing fertility goals alongside cancer-treatment needs rather than documenting a delay as already decided. Postponing fertility counseling or addressing distress alone leaves the patient's request for guidance about preservation options unaddressed.
Where every quote comes from
Section 31.4 Survivorship of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.