With so much focus on treating cancer, many researchers and clinicians have begun to try and anticipate the needs of survivors, undertaking work that tests whether self-management support interventions are helpful. This effort recognizes that there are skills that could help you take responsibility for the ongoing management of your cancer, as if it were a chronic illness.
A long tradition of self-management interventions have improved patients’ lives as they monitor, cope and live with the waxing and waning symptoms of other chronic illnesses like diabetes, arthritis and asthma. Though cancer doesn’t traditionally fit into this category, theories on how to manage cancer survivorship have been changing because people are now surviving longer than ever before.
Successfully managing cancer survivorship means committing to learning about your cancer, monitoring changes, increasing your confidence, setting goals and developing problem-solving skills. You are not expected to accomplish all this alone. Your health-care providers must also teach you what you need to know, partner with you to monitor for changes, help to increase your confidence to take on these tasks independently, help you set realistic goals and teach you problem-solving skills. This may seem like a lot to take on, but there are some steps you can take to make it easier.
Forming partnerships with health-care providers: By considering cancer a chronic disease, the role of health-care providers becomes that of teacher and partner as well as professional supervisor. Survivors must be able to report accurately the trends and tempo of their disease and make informed choices about treatment.
Using available resources: Many providers alert survivors to community or educational resources but do not teach participants how to use them. Self-management support includes considering how to use resources and helping people seek these out in many ways (via the Internet, library, community agencies and local practitioners).
Problem-solving: In self-management support interventions, patients are taught basic problem-solving skills, including how to define a problem, generate possible solutions, implement solutions and evaluate results. What might that look like concretely? Let’s take lymphedema for instance: after breast cancer, some women experience ongoing lymphedema in their arms. That could lead to an inability to use their arms in daily life. When generating possible solutions, patients might imagine changing the way that they approach tasks that involve the arm in question. Afterwards, they might evaluate whether this worked and if not, might try another approach or seek help.
Decision-making: Cancer survivors must make day-to-day decisions in response to changes in disease conditions. To do this, they must have the knowledge necessary to meet common changes. For example, back pain patients are taught to identify the serious symptoms or “red flags” that require medical attention, such as loss of bladder control. Likewise, survivors can be taught how to monitor symptoms that might mean a recurrence is likely and which provider to go to if they notice those symptoms.
Action planning/taking action: Taking action may seem more like a decision than a skill but, in fact, there are skills involved in learning how to change a behaviour (like increasing your exercise). In order to plan to act, and then actually follow through, you might need to make a short-term action plan and carry it out, focus on a short period of one or two weeks to try it out, make a plan that includes very specific behaviour (for instance, go to the gym on Tuesday at 9:00 a.m. every week), or focus on a realistic or “doable” action, (for instance, walk for 15 minutes).
While this column lays out some of these concepts to help you have a vision for these skills moving forward, the most important step you can take is talking with your health-care providers about moving forward together to manage your survivorship successfully.
