THE CANCER SURVIVOR CLINIC: THE FIRST ITALIAN MULTIDISCIPLINARY REHABILITATION PROGRAM FOR CANCER SURVIVORS
Maria Antonietta Annunziataa, Barbara Muzzattia, Katia Biancheta, Lorena Giovanninia, Cristina Aguzzolib, Umberto Tirellic
Centro di Riferimento Oncologico IRCCS – National Cancer Institute – Aviano, Italy a. Unit of Oncological Psychology, Centro di Riferimento Oncologico IRCCS – National Cancer Institute – Aviano, Italy b. Azienda per i Servizi Sanitari n°2 "Isontina", Gorizia, Italy c. Department of Medical Oncology, Centro di Riferimento Oncologico IRCCS – National Cancer Institute – Aviano, Italy
Who are cancer survivors? There is not an unique definition of Cancer Survivorship in the international literature According to our Program, a cancer survivor is an individual who has been diagnosed with cancer but is currently disease free and has not had any active treatment for at least five years
Box 1. QoL in cancer survivorship Physical functioning Often impaired by long term effects (e.g., pain, fatigue, lymphoedema, genito-urinary and excretory dysfunctions, infertility) and/or late term effects (e.g., iatrogenic tumors) Reduction in work (work hours and occupational roles) Neither more health related nor prevention behaviors than general population Psychological functioning Often impaired by fear for a relapse or for a new cancer Often characterized by high levels of emotional distress Correlated with an internal locus of control, adaptive coping strategies, perceived social support Box 2.The sample Social functioning Cancer is a “family” disease: each family member must cope with it Cancer often induces changes in interpersonal relationships
Gender
Why a Clinic specifically devoted to Cancer survivors? Because nowadays the cancer survivorship is a reality for a growing number of persons Because both the cancer and the treatments may have late and/or long term effects that probably impair the survivor’s Quality of life (QoL, see Box 1) Because it is possible that survivors’ needs are quite different from ones of both general population and cancer patients Because to date no systematic attention has been paid to this population
Existential functioning Attitudes and feelings covered by the post-traumatic growth concept
78
Female Males
Marital Status
What is the “Cancer Survivor Clinic”? It is a service specifically devoted to cancer survivors It has been created to determine survivors’ physical and psychosocial needs and to identify the priority actions required to meet them It is multidisciplinary because it employs physicians, psychologists, and nurses; furthermore clinicians with different specialties are involved when necessary It is the first example of this kind of service in Italy It is supported by the Italian Ministry of Health
22
62 Single Married Separated/Divorced Widowed 11 19 8
Age (Mdn) = 56 years (Range: 33-74)
Residence Area
70
Years of survivorship (Mdn) = 9 (Range: 5-20)
North Center South
When did the Clinic activity start? July 2008: start of the activities The program will take three years
9 21
The Clinic main objectives are Evaluation of cancer-related and treatment-related late and long-term medical effects Evaluation of cancer-related and treatment-related late and long-term psychological effects: psycho-emotional, psycho-social, neuropsychological effects Offering support services to the patients Offering support services to survivors’ relatives Providing screening advice to prevent the occurrence of new cancers Contributing to create a “survivorship culture” in the scientific as well as in the general community
Box 3. Medical assessment
Cancer Breast Lymphoma Gastrointestinal Gynecologic Genito-urinary Others
% 35 27 14 14 8 2
It consists in 2 steps I. Clinical interview carried out by an oncologist II. Feedback: mailed at home or discussed vise-a-vise (if necessary further clinical tests are recommended/planned) Main areas of the clinical interview Socio-demographic factors at the diagnosis Risk factors and healthy behaviors at the diagnosis Clinic aspects of the disease at the diagnosis Reproductive anamnesis at the diagnosis Familiarity for cancer at the diagnosis Comorbidities at the diagnosis Followed treatments Relapses or secondary tumors Current socio-demographic factors Current risk factors and healthy behaviors Current clinic aspects of the disease Current reproductive anamnesis Current familiarity for cancer Current comorbidities Current disease condition and contingent treatments
First results After 6 months of activity: 37 patients (see Box 2 for a sample description) have received both a medical (see Box 3) and psychosocial (see Box 4) assessment First patient education handouts have been drawn up (see their front pages in Box 5) The Clinic activity has been presented in several national media (TV programs, newspapers and magazines) A review about the QoL in cancer survivorship is under review (see Box 1 for a summary)
Box 4. The psycho-social assessment
Next objectives Enrolling 200 patients in three years Drawing up a set of guidelines defining cancer survivorship and the best rehabilitative (medical and psychosocial) approach, tailored upon the specific needs of this kind of users Continuing in sensitizing both the general population and health practitioners to this new “health condition”
It consists in 3 steps I. Clinical interview + first part of the psychological assessment carried out by a trained psychologist II. Second part of the psychological assessment filled at home (i.e. self report scales) III. Feedback: mailed at home or discussed vise-a-vise (if necessary further assistance is recommended/planned) Main investigated dimensions QoL Trait and status anxiety Depression Emotional moods Health related concerns Perceived social Support Perceived cognitive functioning Perceived sexual functioning Coping strategies Post-traumatic growth Optimism Locus of control Short-term memory span Working memory Long-term memory Selective attention Divided attention Executive functions Verbal fluency General level of cognitive functioning
Box 5. The Front pages of the first educational handouts about cancer survivorship
Who operate in the Clinic and how contact us?
If you need more details about our project, please contact:
annunziata@cro.it
or visit:
www.cro.sanita.fvg.it/azienda/txt_info _oncomedia_A.html#ora.