Download Survivor`s Transition From Patient to Survivor: The Transitional

Survivor’s Transition
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From Patient to Survivor: The Transitional Period
Cathaleen Stewart
Western Washington University
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Not much is known about the transitional period from being a cancer patient to a cancer
survivor, when active treatment is no longer needed and a patient is considered disease free.
Emotions run high and there are mixed feelings emerge about no longer being under the watchful
eyes of medical staff. Attempts are made to return to life as normal, but there is a changed sense
of self. The experiences of cancer patients changes them and not all of these changes are positive.
It is estimated that there are 14 million cancer survivors in the U.S. and that number is
expected to rise in the coming years. With the growing number of survivors evidence is
beginning to show both the positive and negative impacts of cancer and its treatment on
psychological well-being. (Smith, Crespi, Petersen, Zimmerman and Ganz. 2010). Completion of
treatment is a milestone in a survivor’s journey, yet it can throw off the equilibrium a patient
maintains during the course of their treatment. They are expected to return to a normal lives,
however, they do not feel normal. As treatment is withdrawn a sense of uncertainty and
vulnerably can set in. (Allen, Savadatti & Levy 2009). Many survivors have found that they did
not comprehend the effect the disease would have on their lives and felt more support was
needed post-treatment verses during treatment. (Hodgkinson, Butow & Hobbs 2007).
It was found that poor perceived social and emotional support, important coping
strategies, was associated with the anxiety and depression in the later months after completion of
treatment. High levels of intrusive thoughts and perceived criticism were also associated with
psychological distress and possible contributed to anxiety levels (Hipkins, Whitworth, Tarrier &
Jayson. 2004). Pain was the most significant risk factor for anxiety whereas fatigue was
associated with depression. Women who had a primary education showed a higher risk for
anxiety while those that were illiterate had a higher risk of depression. The correlation between
anxiety and pain with fatigue and depression suggests that cancer care process should include
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screening for these types of distresses post treatment. (Vahdaninia, Omidvari, & Montazeri.
2009).
The removal of frequent and persistent medical monitoring can also attribute to survivors
feelings of uneasiness and cause undue mental stress in their lives. Interviews conducted with
forty-seven women who had completed treatment for breast cancer twelve months prior indicted
that the transitional period to life without treatment had various emotional and physical
challenges. Some participants describes feelings of anguish and depression, not all of which were
directly related to fear reoccurrence and the loss of medical monitoring. However, these feelings
could be sudden and can be described as an emotional roller-coaster and made adjusting difficult.
(Allen, Savadatti & Levy. 2009) “Survivors reported stress related to monitoring their health,
significant fears of disease recurrence and the need for ongoing reassurance (p. 96).” The fear of
cancer’s reoccurrence tends to be an ever-present factor in survivor’s minds (Hodgkinson, Butow
and Hobbs 2007).
Previous evidenced also suggests that there is a higher risk of psychological distress for
young adult survivors of childhood cancers, such as flashbacks or nightmares, and emotional
numbing along with other PTSD symptoms. Survivors suffered from more psychological
problem overall, but PTSD was associated with persisting fear of dying from cancer or the
perception of the intestacy of the cancer and its treatment. (Rourke, Hobbie, Schwartz, & Kazak,
2007). A person recovering from cancer treatment has a great many supportive needs in regards
to their emotional health, yet as they embark on this transitional time the services that they came
to rely on are no longer available. Families and communities also reduce the amount of support
given at this time because it is believed that it is no longer needed.
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While many families of young people recovering from cancer describe a positive
experience of treatment completion, it is important to remember that families may
‘suffer in silence’ during the off treatment period. They may perceive that medical
staff are busy with the next generation of on-treatment children and can be
reluctant to deflect resources from those families in crisis. (p. 537)
Growing evidence suggest that persons and families actually need the same amount of support in
the transitional period after completion of cancer treatment as the time of diagnoses and
removing support can lead to psychological difficulties (Wakefield, Mcloone, Butow, lenthen &
Cohn. 2013).
Medical providers should evaluate implications of reduced patient monitoring.
“Termination of chemotherapy and cessation of medical consultations increases vulnerability to
anxiety although not to depression. (p.577)” (Hipkins, Whitworth, Tarrier & Jayson. 2004).
Ongoing medical advising can be helpful in the transitional period of survivors.
The provision of care within a caring environment was considered Survivors
unanimously reported a need for ongoing information tailored to their needs and
the needs of their families. They wanted to feel part of the health care team and to
make decisions in conjunction with the team. essential, as was acknowledgment
of the broader impact of cancer on their lives…“They tell you that you are OK,
and think you will just go on your own merry way, like it hasn’t had the most
massive impact on your life.” (p. 96)
Disease-free cancer survivors have unique needs, yet these needs often go unaddressed. Whereas
patients are focused on “getting through it,” the completion of cancer treatment can bring
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confusion over how they should feel about their experience (Hodgkinson, Butow & Hobbs
2007).
The families of cancer survivors also can experience difficulties. After the completion of
treatment and the withdrawal of support from doctors and social workers, the family of a
survivor is the main emotional support. This can be burdensome because family members are
often going through emotional distress from the process themselves (Wakefield, Mcloone,
Butow, Lenthen & Cohn. 2013) The partners of survivors experience difficulties of various
kinds--strong emotions in regards to witnessing a loved one suffer from the disease can be
traumatizing. Partners also live with the stress and fear of the reoccurrence of cancer and the fear
of losing a loved one. Some also report a sense of hopelessness in not being able to assist their
partner when it came to physical changes and trouble with not knowing how to support them.
The research concluded that there is a need for follow-up services for cancer survivors and their
partners to address the different concerns that come along with survivorship (Hodgkinson,
Butow & Hobbs 2007).
There is a lot of fear in survivors in regards to the reoccurrence of cancer, but there is
also a lot of stress from the metal toll that treatment takes and the almost sudden absence of
medical monitoring. Survivors will often suffer from adverse effects, such as depression and
anxiety from the pressure they feel to return to a normal life after treatment because it is
something that many of them are not sure how to accomplish. It is important to understand that
after a patient finishes treatment and is considered a survivor that this does not mean that they
have no more need for support medically, socially, or emotionally. Survivors are often expected
to be thankful that their treatment is over and it is assumed that they will lead richer fuller lives
because of their experiences, but this is not always the case. Further research is needed in this
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area to determine what can be done to help this population have a better quality of life, by
reducing negative psychological effects and providing new kinds of support that is currently
missing from after cancer care process.
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References
Allen, J. D., Savadatti, S., & Levy, A. G. (2009). The transition from breast cancer 'patient' to
'survivor.'. Psycho-Oncology, 18(1), 71-78. doi:10.1002/pon.1380
Hipkins, J., Whitworth, M., Tarrier, N., & Jayson, G. (2004). Social support, anxiety and
depression after chemotherapy for ovarian cancer: A prospective study. British Journal
Of Health Psychology, 9(4), 569-581.
Hodgkinson, K., Butow, P., Hobbs, K. M., & Wain, G. (2007). After Cancer: The Unmet
Supportive Care Needs of Survivors and Their Partners. Journal of Psychosocial
Oncology, 25(4), 89-104. doi:10.1300/J077v25n04-06
Rourke, M. T., Hobbie, W. L., Schwartz, L. A., & Kazak, A. E. (2007). Posttraumatic stress
disorder (PTSD) in young adult survivors of childhood cancer. Pediatric Blood and
Cancer, 49(2), 177-182. doi:http://dx.doi.org/10.1002/pbc.20942
Smith, S. K., Crespi, C. M., Petersen, L., Zimmerman, S., & Ganz, P. A. (2010). The impact of
cancer and quality of life for post-treatment non-Hodgkin lymphoma survivors. PsychoOncology, 19(12), 1259-1267. doi:10.1002/pon.1684
Vahdaninia, M., Omidvari, S., & Montazeri, A. (2010). What do predict anxiety and depression
in breast cancer patients? A follow-up study. Social Psychiatry And Psychiatric
Epidemiology, 45(3), 355-361. doi:10.1007/s00127-009-0068-7
Wakefield, C. E., McLoone, J., Butow, P., Lenthen, K., & Cohn, R. J. (2013). Support after the
completion of cancer treatment: Perspectives of Australian adolescents and their families.
European Journal Of Cancer Care, 22(4), 530-539. doi:10.1111/ecc.12059