Given that cancer is predominantly a disease that occurs in the later decades of life, integrating gerontology and oncology knowledge is critical. Not only cancer treatments but supportive care therapies may affect seniors differently than middle-agers. For some cancers, like prostate, watchful waiting may be the better course of action. Issues faced by seniors include multiple co-morbidities, symptom management, survivorship, psychosocial needs, financial concerns and family support issues.
Evidence-based Care and CER
As it is with health care in general, providing care that is evidence-based is integral to cancer care. Five years ago, ONS undertook the development of a resource for nurses that identified the level of evidence for nursing interventions specific to an oncology nursing-sensitive patient outcome. The Putting Evidence into Practice (PEP) initiative was initially launched in card form and is now in book form with resources for 16 nursing-sensitive patient outcomes. The results of comparative effectiveness research (CER) will influence a broad range of diseases. In cancer care, the cost of treatment often exceeds insurance coverage for those who have insurance and devastates many families’ finances. CER should produce critical evidence when there is more than one treatment choice.
Given the chronic nature of many cancers, attention to survivorship issues has gained increased national attention. Managing a person’s cancer extends far beyond the acute phase, and coordination of resources and a follow-up plan are necessary. People with cancer not only need to understand their diagnosis and treatment, they also need to know potential long-term effects, recommended cancer screening and recurrence surveillance, and the schedule for tests and exams. In addition to the medical issues faced by a long-term survivor, other challenges include medical insurance access, emotional well-being, work opportunities, and family stress. Who follows the long-term patient survivor is a possible dilemma. Although the patient may no longer need the expertise of an oncologist and could be followed by a primary care physician, transitioning away from the cancer setting can be difficult. An emerging trend is the development of survivor clinics managed by oncology nurse practitioners.
In cancer care delivery organizations, the patient navigator is a newer role. Originally conceptualized by Dr. Harold Freeman, the navigator was a layperson from the community who helped people navigate the complex health care system to receive the care they need. Other versions of the role have developed. All aim to assist patients through the numerous potential barriers, including access to care, financial concerns related to treatment and transportation, and language and cultural issues. Nurses who were formerly care coordinators or case managers are transitioning to navigators. Social workers also are filling the navigator
role. Although this trend began within cancer care, it is now present in other chronic disease specialties as well.