The number of cancer survivors is increasing, thanks to progress in early detection and treatment. Ruth McCorkle, PhD, RN, from Yale University, and her collaborators reported that self-management is an increasingly important part of cancer care. The traditional paradigm is “doctors' orders”--that is, health care providers do the work and patients comply. However, this is not practical for long-term management, as insurance coverage limits time spent with providers.
The Institute of Medicine identified six phases of cancer care in its 2005 report, From Cancer Patient to Cancer Survivor: Lost in Transition. These six phases comprise a cancer care continuum of prevention, early detection, diagnosis, treatment, survivorship, and end-of-life care. McCorkle explained that we need new models to enable cancer care providers to form partnerships with patients and families. She reviewed the medical literature on programs for self-management, with positive results for the following interventions:
1. Pro-self, designed by oncology nurse researchers to deal with common cancer symptoms.
2. Self-Help Intervention Program (SHIP), for women with breast cancer.
3. Standard Nursing Intervention Protocol (SNIP), for older post-surgical cancer patients.
4. Nurse-Assisted Symptom Management (NASM) and Automated Telephone Symptom Management (ASTM), to reduce symptoms of chemotherapy.
5. Enhancing Connections (EC), to help mothers with breast cancer take care of their young children.
6. Family involvement, Optimistic attitude, Coping, effectiveness, Uncertainty reduction, and Symptom management (FOCUS), for women with advanced breast cancer and their families.
Electronic communication can make the job easier for both patients and providers. Dr. Andrew J. Vickers and colleagues at Memorial Sloan-Kettering Cancer Center of New York and the University of California, San Francisco, developed a framework for transferring information over secure email. The system is called Self-Assessment and Management (SAM). Vickers and coworkers identified three problems with traditional management of cancer survivors:
1. Patients typically do not know how they are doing.