From Survivorship to End-of-Life Care

Betty R. Ferrell, PhD, RN


November 10, 2017

Delores needs care provided by the oncology team whom she has trusted over the years. They are aware that her experiences as a cancer survivor will influence how she copes during end-stage disease. Although it will be important to develop realigned goals and hope consistent with the reality of her disease, it is also important for her clinicians to provide honest information to protect their longstanding relationship and help Delores prepare for the future. It is always a good idea to involve palliative care staff soon, to help manage symptoms and transition goals of care, but the responsibility rests first in her oncology care providers as Delores makes the critical change from thriving cancer survivor to terminal illness. And although Delores may need the support of chaplaincy in facing the end of life, at this critical time she needs the physician and nurse with whom she is already familiar to provide information related to her disease, prognosis, and treatment options.

The field of oncology has made major advances in a relatively short span of time, even though there is much more to be done to effectively treat cancer as a common cause of death. Advances in therapy, genetic testing, targeted agents, supportive treatments, and many other factors have now resulted in a unique population of cancer survivors.[1,2]

Many people are diagnosed with cancer and make a consistent decline toward the final stage of illness, such as those diagnosed with late-stage pancreatic cancer. Yet for many people, the trajectory of cancer is characterized as a prolonged experience of recurrences and remissions, learning to live with constant treatment and a false sense that the progress in oncology now means that there is always another treatment and continued hope for survival.[3,4,5]

As illustrated in this case, long-term cancer survivors transitioning to terminal illness will require unique care, based on their experiences. Palliative care should be integrated across the disease continuum, and when long-term survivors make the transition to end-of-life care, it is important for their oncology clinicians to work closely with the palliative care team.

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