Cancer Survivorship: Does One Size Fit All?

Background and Purpose: Due to successes in early detection and disease management of cancer, there are increasing numbers of cancer survivors in the US and Australia. Cancer survivors are a vulnerable population who face numerous physical, psychological, social, spiritual, and financial issues. Empirical evidence suggests that survivors and their providers are not adequately prepared for the experiences after initial treatment highlighting the need to create or improve existing strategies for survivors. Limited research exists to guide the development of interventions to meet the cancer survivors’ needs. As a result, few interventions have been evaluated for global dissemination. This paper presents the findings of an evaluation of “Moving on…Living Well” (MO…LW), a multidisciplinary patient education program, based in Australia, designed to provide transitional support in the immediate timeframe following completion of active cancer treatment.

Methods: Guided by the Australian National Service Improvement Framework for Cancer and the Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer, this paper investigates whether attendance at MO…LW contributed to meeting the needs of cancer survivors and discusses barriers that contributed to patient participation in the program. Using convenience sampling, 275 patients and their caregivers were identified as eligible to participate. An observational, non-equivalent group comparison design, utilizing post-program evaluations of participants (n=105) and a retrospective survey of all eligible participants (n=196) regardless of their attendance status provided data for this study over a three-year time period. Descriptive and bivariate analyses were conducted to determine differences between the participants and non-participants in the program and understand the needs of cancer survivors.

Results: Overall, more than 50% of participants rated the usefulness and effectiveness of MO…LW as high. Furthermore, 76% indicated that the program had assisted in their transition to survivorship. When comparing attendees to non-attendees, there were no differences in the following needs areas: comprehensive care, information, and relationships. Furthermore, non-attendees noted barriers to attending as perceptions that the MO…LW was a non-core element of care, not needed and a reluctance to engage in further cancer conversations. Despite the lack of differences between the two groups, notable findings from the analyses revealed that both groups wanted more information on alternative and complementary therapies, coordinated and case managed care, managing the fear of recurrence, and decision-making in the context of uncertainty

Conclusions and Implications: Findings suggest that the majority of patients transitioning to survivorship had either felt supported by their health care team or indicated they were self-sufficient in their need for support. Participants in MO…LW were highly satisfied although there were not differences between them and non-attendees. One reason for the lack of statistical difference could be that cancer survivors have differing preferences and levels of needs. This indicates that one size does not fit all when implementing survivorship care in a post-treatment setting. Suggested recommendations include providing survivors with targeted education regarding their follow-up needs. This investigation provides formative data to develop empirically based guidelines to support care delivery to address barriers to provide cancer survivorship services in Australia and the US.