Nurses Play An Integral Role in Survivorship Care


Please enjoy the following post by Jeanne Simard, Corporate Vice President of Oncology Rehab Partners. Jeanne was our esteemed guest on RN.FM Radio on August 12, 2013, and we highly recommend listening to her wonderfully informative interview which focused on the specialty area of cancer rehabilitation and prehabilitation.

Rehabilitation has become the standard of care for most patients recovering from serious illness or injury, whether they’re being treated for heart attack or stroke or are under orthopedic care. But what about cancer patients? Until recently, cancer rehabilitation was not available to help survivors suffering from the side effects and aftereffects of treatments. Chemotherapy, surgery and radiation can be devastating to one’s health and well-being. Cancer rehabilitation can address the myriad of physical and emotional issues that can result. Fortunately, cancer rehab is fast becoming a critical part of survivorship care. More and more cancer rehab services are being offered around the country, and survivors are being referred for rehab.

I have cancer survivors in my family, as I am sure many of you do.  I have felt somewhat helpless watching them navigate their “new normal” after treatments. They, and I, were unaware of cancer rehabilitation, which can assist with treatment-related impairments such as chronic fatigue, weakness, chemo-induced neuropathy, chemo brain and hundreds of other impairments that often follow cancer treatments.

Healthcare professionals have spent decades focused on finding ways to cure cancer and extend patients’ lives.  Amazingly, today there are nearly 14 million cancer survivors in the U.S.  There has been much less attention given to survivorship care – to ensuring that survivors heal optimally and return to normal function after treatments. It is now understood that there are hundreds of impairments that patients could potentially face during and following their acute cancer care. But less than 5 percent of patients with treatment-related impairments are receiving cancer rehabilitation care.

The STAR Program® is a model of evidence-based cancer rehabilitation that is being implemented by hospitals and cancer centers around the country. Developed by Dr. Julie Silver, a physiatrist and associate professor at Harvard Medical School, the STAR Program offers clinicians certification in evidence-based cancer rehabilitation.

Most nurses are not trained in nursing school about cancer treatments, treatment-related impairments, how to screen for them, and the rehabilitation care that is available to help patients heal.  In fact, I recently spoke to rehabilitation fellows who completed their class work, and even they had limited education about the impairments related to cancer treatments and about cancer rehabilitation.

The role of the nurse in survivorship care is critical, because survivors are not only being seen in oncology practices. They are being seen across the care continuum, in hospitals and outpatient settings, for medical issues that may or may not be related to their cancer history.  Nurses have a critical responsibility to be knowledgeable in how to recognize treatment-related impairments and understanding that cancer rehabilitation is available and effective in improving survivors’ health-related quality of life (HRQOL).

New research shows that cancer survivors have a significantly lower HRQOL than individuals without a history of cancer. It is often assumed that emotional distress is the reason for this decreased quality of life, due to issues such as fear of recurrence, disruption to the family unit, and financial struggles.  On the contrary, evidence reveals that quality of life issues are more often due to physical rather than psychological impairments.  Studies also demonstrate that physical impairment/disability is one of the leading causes of emotional distress in cancer patients. This is where nurses can intervene.  The majority of these impairments can successfully be treated with cancer rehab. The first and most important step is to screen patients for impairments and then make a recommendation for an evaluation by rehabilitation specialists. The STAR Program has 14 different screening tools that can assist nurses in identifying physical impairments.

Cancer prehabilitation, an emerging medical discipline, is also part of the STAR Program. Offered to patients between the time of diagnosis and the beginning of treatments, prehab can improve patients’ health and stamina and prevent or lessen the severity of anticipated impairments. In the same way that nurses have played an important role in prehabilitation for patients in cardiac surgery, they can play a key role in cancer prehabilitation, helping to identify and address psychological and physical impairments prior to the beginning of acute cancer treatment. Cancer prehab not only impacts patients’ health outcomes, it can affect their treatment options.

Whether during cancer care or in the years that follow, nurses can be extremely influential in improving patients’ quality of life.  Cancer rehabilitation and cancer prehabilitation are not specialties limited to rehabilitation specialists and oncology teams. Nurses caring for patients across the care continuum need to be knowledgeable about this new frontier of cancer care impacting millions.

Learn more about cancer rehabilitation and the STAR Program at

Photo of Ms. Simard by