There is a lack of guidelines when it comes to standard of care for adult cancer survivors, and it is time to start thinking about establishing such guidelines, according to nurse practitioner Richard Boyajian, who is the clinical director of adult survivorship at Dana-Farber Cancer Institute, Boston, Massachusetts. He said establishing appropriate guidelines could potentially reduce morbidity and mortality.
“Posttreatment standards of care are something that I am a big believer in,” said Boyajian. “We know that on-treatment is a very well-tuned machine, especially in radiation oncology where things are really run very well and very systematically. The problem is when the patient finishes treatment, and that is when the wheels basically fall off the cart.”
He said most cancer patients are just told to come back in a few months to see if their disease has returned after completing treatment. Instead, he said, better treatment plans are needed. Boyajian said that there is no standard approach to posttreatment care today. Boyajian presented an educational session on adult cancer survivors entitled “Adult Cancer Survivors: One Size Does Not Fit All” at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO), held in October 2011 in Miami Beach, Florida. He said establishing posttreatment management guidelines for cancer survivors can help empower patients and their families. In addition, such guidelines could be designed to improve coordination of care and communication. He said that ultimately this entire issue is about improving quality of life and potentially reducing morbidity and mortality.
“The nurses as usual need to do a lot of the work to get this done. Survivorship is not something that a lot of physicians are that interested in. There are select handfuls of physicians who have an interest, but the nurses seem to be the passionate ones about survivorship, and what I am trying to do is give them a framework to create these standard guidelines within their own practice,” explained Boyajian.
Currently, Boyajian does not expect that there will be national guidelines developed. He said there are not enough evidence and research studies on which to base recommendations. However, Boyajian said cancer patients cannot wait until research studies are completed. “So, I am a big believer in consensus guidelines at your institute. It doesn’t matter if you are at a private practice or a major cancer center,” said Boyajian in an interview with The Oncology Nurse–APN/PA. “Basically, you need to set up guidelines for your practice on how you will follow an individual patient.”
He said that in 1971 there were about 3 million cancer survivors, but today there are more than 12 million. Boyajian said a patient diagnosed with cancer at age 35 may have a cumulative risk of a solid cancer of 36% by the age of 75. Boyajian said oncology nurses need guidelines or a blueprint to follow so they know what they can and should be doing for cancer survivors after treatment. He said patients need to be properly assessed for their individual risks and then managed appropriately by a team of healthcare providers.
Boyajian said this issue is only starting to come to the forefront, and he hopes that there will be a grassroots effort that comes from oncology nurses to establish guidelines at their individual healthcare centers. “With the aging of the baby boomers, there are going to be more cancer patients and there is not going to be enough providers,” said Boyajian. “So, as the number of survivors grows, they are taking up more and more of the providers’ time. There needs to be a way to transition these patients off the physicians’ schedule.” He said that is where oncology nurses can play a central role and help improve survivorship care.
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