Two million people in the UK are living with a diagnosis of cancer. Some will have been recently diagnosed, so will be in shock and heading for active treatment; some will be approaching the end of their life; some will have practically forgotten they have had a cancer diagnosis; and others will be living with late effects - the consequences of the disease or its treatment.
More from: Cancer Survivorship
The survivorship agenda is about saying we must help people not just at the time of diagnosis, treatment and end of life but through the whole journey. This help should not be limited to medical issues; it should mean supporting people with any emotional, practical and financial issues their cancer has caused. It is about supporting the whole individual.
Nurses are particularly tuned into this area. They understand that the person is being treated, not just the tumour.
When someone of working age is diagnosed with cancer, their household income typically halves. Nurses often pick up on this, but they don’t - and probably shouldn’t - have detailed knowledge of welfare benefits. However, they should be able to refer individuals for expert advice. Macmillan has been putting such advisory services in place.
Forty per cent of cancer survivors say they feel abandoned when they finish active treatment. They should not feel like this. We need to find ways to support them and their families at this transition point and later on, when some of the late effects of the cancer or its treatment may rear their heads.
‘Forty per cent of cancer survivors say they feel abandoned when they finish active treatment’
The National Cancer Survivorship Initiative (NCSI) in England is considering how people’s needs should be assessed at this transition. This assessment should cover medical need and consequences of cancer or its treatment that may need to be addressed in future - how they could be identified and self-managed as appropriate and how people could get back into the system quickly if necessary.
Nurses responsible for this care planning would also discuss any practical needs a person might have and the impact cancer may have had on their emotional life, finances and ability to work, and refer them to support services.
Returning to work after cancer treatment can be difficult because of fatigue and loss of self-confidence. The NCSI is working with trade unions and employers on supporting people back into work gradually. The average GP sees around eight cancer diagnoses a year, while large HR departments see many more, and have valuable experience to share. Scotland, Wales and Northern Ireland are also addressing rehabilitation and returning to work.
While we know that two million people are living with cancer, we do not know how many have which type, how many have emotional issues or late effects, or how many are well. Research is being conducted in all four UK nations to determine this and the number of people likely to experience some consequences of treatment many years on and need access to services.
For example, the GP research database shows that women treated for breast cancer are more likely to experience cardiac problems later. They need to be informed of this higher risk, so they are aware of symptoms and how to deal with them, and of lifestyle interventions to minimise their risk.
There is no point diagnosing problems if we do not develop solutions. We need to identify interventions that make the difference between people having a good quality of life and being able to self-manage or being in distress, unable to work or perhaps returning to hospital.
We must test, evaluate, prove and roll out existing models of support and care and develop and evaluate new ones to give nurses validated tools, techniques and practices. This will also help ensure uniform access to services in the UK.
We must not underestimate the learning and development that will be required for new models and services. These will create learning needs not only for cancer nurses but also the wider nursing workforce. Macmillan will increasingly be focusing on supporting nurses to develop themselves and their job skills.
Macmillan Cancer Support