While definitions of cancer survivorship vary, the National Coalition for Cancer Survivorship in the US considers a person to be a cancer survivor from the time of cancer diagnosis through the remainder of their life.62
The US Institute of Medicine report on Cancer Survivorship62 recommends that health care providers should use systematically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment.62
A range of personal factors can affect someone’s health after treatment for cancer. For example, a recent study reports that lesbian and bisexual cancer survivors were twice as likely to report poorer health outcomes when compared to their heterosexual counterparts.63 Further work is required to elucidate the possible causes behind this discrepancy in self-reported health outcomes.63
Interview two or three people who have had cancer about what the term 'cancer survivor' means to them. Discuss similarities and differences in the meaning of survivorship to people with breast cancer, and the possible reasons for these.
Access Implementing a Survivorship Care Plan for Patients With Breast Cancer.47 Formulate a survivorship care plan for Libby for her short term and longer term health care.
Supportive care needs after treatment has ended
Breast cancer survivors have reported significant, continuing psychological burdens related to altered body image and fear of cancer recurrence.23 Specific emotional issues identified after the experience of cancer involve reflection on values, and challenging assumptions about life, relationships and mortality and sense of personal identity.23
Breast cancer survivors can also continue to experience physical side effects from treatment, even after it has finished. The most common long-term physical effects related to endocrine sequelae of breast cancer treatment are on reproductive, bone and sexual health.64 Other symptoms include fatigue and early menopause.33 The Management of menopausal symptoms in women with a history of breast cancer - clinical practice guideline (2016) outlines evidenced based best practice to assist women to manage the symptoms of early menopause post breast cancer treatment. 67
These long-term treatment effects require attention to reduce the potential significant negative impact on the long-term health and quality of life of women with breast cancer.64
Breast cancer survivors may also have to consider returning to work.65 Individual needs of cancer survivors returning to the workplace will vary, though supportive work environments have been identified as being helpful to this process.65
Cancer Australia website – Life after breast cancer
Libby's story 7: adverse effects
Identify the risk factors associated with the following health issues for people following treatment for breast cancer:
- Menopausal symptoms
- Cognitive changes
- Discuss interventions for minimising the risk from lymphoedema
- Identify appropriate referral points for further information and advice about prevention and management of lymphoedema.
Discuss current evidence regarding interventions for managing menopausal symptoms and cognitive changes experienced by women following treatment for breast cancer.
Reflect on Libby's experiences of being diagnosed with a second primary breast cancer and consider how these experiences may influence her perspectives of health.
Given Libby's treatment history, outline potential health problems she may experience in the short and longer term, providing an explanation for why she is at risk of these health problems.