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31 Cards in this Set
- Front
- Back
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In relation to cancer survivorship, the term "secondary survivors" refers to what population?
A. Anyone who is given the diagnosis of more than one cancer B. someone who recurs with the original primary disease C. a family member who also has cancer D. any member of a social network -- personal or professional -- who is affected by someone's cancer diagnosis |
Answer: D. any member of a social network -- personal or professional -- who is affected by someone's cancer diagnosis
Rationale: Rarely does cancer affect only an individual. Family units, social acquaintances, coworkers, and even health care professionals are affected in multiple ways by someone else's cancer diagnosis. Their issues must also be addressed with appropriate support and resources. |
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"Seasons of Survival," the survivorship model described by Mullan, illustrates
A. the extent that disease has progressed B. an estimate of when death will occur C. a continuum of acute, extended, and permanent stages D. a description of cure |
Answer: Introduced by Mullan and embraced by the National Coalition for Cancer Survivorship, the model of seasons -- or stages of survival -- describe survivorship as a dynamic, evolutionary process that begins at diagnosis and proceeds along a continuum through and beyond treatment, regardless of outcome. This model has helped to identify issues that affect quality of life and longer term survivors and that warrant intervention by the healthcare community and society at large.
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If survivorship is viewed as a continuum, what statement best described the acute stage?
A. the time when symptoms from treatment are most severe B. the stage when the initial diagnosis is made and treatment begins C. The stage when treatment is no longer effective and the prognosis is terminal D. the period of watchful waiting |
Answer: B. the stage when the initial diagnosis is made and treatment begins
Rationale: The acute stage of survival begins at the time cancer is diagnosed and extends through the initial phase of therapy |
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During the acute or immediate stage of survival, survivors would rarely encounter
A. the fear of dying B. nausea and vomiting C. disruption in family and social roles D. delayed effects of treatment |
Answer: D. delayed effects of treatment
Rationale: Delayed or late effects of treatment occur months to years after therapy is completed. |
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Survivors in the extended or intermediate stage of survival are
A. finished completely with all medical treatments B. in remission or receiving maintenance therapy C. considered "cured" of their disease D. undergoing initial therapy |
Answer: B. in remission or receiving maintenance therapy
Rationale: When disease is in remission or survivors have completed the basic, rigorous course of treatment, the extended or intermediate stage begins. They may or may not continue to receive maintenance therapy and will not know for years whether treatment has been successful. |
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Which statement best characterizes someone in the permanent or long-term stage of survival?
A. the survivor is cancer free B. the survivor is guaranteed a cure C. the survivor's cancer status has gradually evolved to where the probability for disease recurrence is minimal D. the survivor has not responded to multiple courses of therapy and is preparing to die |
Answer: C. the survivor's cancer status has gradually evolved to where the probability for disease recurrence is minimal
Rationale: This stage is roughly equated to "cure", yet there is no such thing as a guarantee. Rather than a guarantee of cure, there is a gradual evolution from the extended stage of survival into a period where the likelihood of the disease recurring is sufficiently small that the cancer can be considered permanently arrested. |
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Which of the following best describes symptoms or effects that persist for months or years after therapy is completed?
A. progressive effect B. iatrogenic effects C. erroneous effects D. long-term effects |
Answer: D. long-term effects
Rationale: Long-term effects of cancer and cancer therapy begin during the acute stage and continue indefinitely after treatment ends. Many of these effects gradually subside (e.g., hair regrows), whereas others can become chronic conditions (e.g., neuropathies) |
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Cardiomyopathy, pulmonary fibrosis, and sterility are examples of
A. long-term, late, or delayed effects of cancer therapy B. acute toxicity from cancer treatment C. inevitable side effects from all radiation therapy D. reversible effects once treatment has ended |
Answer: A. long-term, late, or delayed effects of cancer therapy
Rationale: Cardiomyopathy, pulmonary fibrosis, and sterility are late and/or long-term effects of specific cancer therapies that become apparent months to years after therapy completion. These medical problems are due to subclinical tissue or cellular damage during treatment that progress over time. Although these effects are not necessarily inevitable, they are rarely reversible. |
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A 32 year old woman who had received mantle radiation for Hodgkin's disease at the age of 17 asks the oncology nurse why a baseline mammography was ordered? Knowing this history, the nurse explains that
A. this is a mistake, because this survivor is too young for a baseline mammogram and her breasts would be too dense for a definitive procedure B. she should have had a baseline mammogram before treatment began C. the radiation would prevent any cancer from developing D. that follow-up guidelines for young women treated for Hodgkin's disease now suggest a baseline mammogram approximately 10 years after initial therapy because of an increased risk of breast cancer after mantle radiation |
Answer: D. that follow-up guidelines for young women treated for Hodgkin's disease now suggest a baseline mammogram approximately 10 years after initial therapy because of an increased risk of breast cancer after mantle radiation
Rationale: Although the overall risk for second malignancies in general is still relatively low, breast cancer is the most frequently seen second malignancy in young women who were treated with mantle radiation for Hodgkin's disease. Although breast tissue is, in fact, dense in young women, mammography remains the best option for screening at this time. Also, tumors occur as late effects and usually occur more than a decade after initial treatment. |
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Which of the following statements accurately descrbes a psychosocial effect of long-term survival?
A. most cancer survivors have severe and permanent psychological impairment B. after therapy is completed, there is rarely, if ever, any need for continued psychosocial support C. the fear of recurrence may persist for many years after completion of therapy and may range anywhere between a mild or chronic anxiety all the way to disabling fear D. the Damocles syndrome refers to a genetic predisposition |
Answer: C. the fear of recurrence may persist for many years after completion of therapy and may range anywhere between a mild or chronic anxiety all the way to disabling fear
Rationale: Although much of the fear associated with cancer gradually subsides over time, an underlying fear of the cancer recurring can remain for the remainder of life. This is often referred to as the Damocles syndrome (story that describes a guest at a mythologic banquet with all the food and drink he can consume, but with a sword attached by a mere thread dangling over his head). This fear can be triggered at the time of medical follow-up visits, during an anniversary of diagnosis or painful procedures, or at any time a suspicious symptoms arises. Although survivors have varying needs for continued psychosocial support after therapy is completed, few are considered to have overt mental illness because of their cancer diagnosis. |
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Although employment discrimination continues to haunt some survivors, there are laws that offer protection to most people with histories of cancer. When survivors qualify for new jobs, promotions, or retention of existing jobs, current laws
A. are the same laws that protect the mentally and physically disabled B. are legislated only through state government C. apply to private employers only D. have a statute of limitations |
Answer: A. are the same laws that protect the mentally and physically disabled
Rationale: In general, denial of employment to cancer survivors who are qualified for the job solely because of their medical history violates most laws that prohibit discrimination against the handicapped. A handicap may be real or it may be perceived. But most federal laws apply only to employers who receive federal funding. |
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During a follow-up visit, a former client confides that he will soon be laid off from his job and that losing health insurance is his greatest concern. For immediate short-term protection, you inform him that there is a law that mandates certain employers to offer time-limited access to continued insurance coverage. This coverage is available for 18 months for the person losing the job and for 36 months for dependents. This protection is the
A. Social Security Disability Insurance Program B. Consolidated Omnibus Budget Reconciliation Act (COBRA) C. Family and Medical Leave Act (FMLA) D. Americans with Disabilities Act (ADA) |
Answer: B. Consolidated Omnibus Budget Reconciliation Act (COBRA)
Rationale: As long as the employer has 20 or more employees, he must offer access to the group medical coverage for those losing their jobs. During this grace period, the employee will assume the payment of insurance premiums and retain coverage for himself and his family. Social Security Disability Insurance is a monthly stipend that is available 6 months after a person qualifies as disabled. The FMLA offers workers 12 weeks of unpaid leave without losing their jobs. And the ADA offers limited job and insurance protection to persons perceived to be disabled, including those with cancer histories. |
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After experiencing cancer, many survivors critically examine their lives, search for meaning, and feel an increased appreciation for life. This can best be described as
A. positive, spiritual transformation, or existential effect that is an individual and personal reaction to having cancer B. an impossibility, because nothing good can come from a diagnosis of cancer C. a warning sign that further psychologic therapy is needed D. feelings experienced by all survivors regardless of outcome |
Answer: A. positive, spiritual transformation, or existential effect that is an individual and personal reaction to having cancer
Rationale: Experiencing a life-threatening illness often heightens the desire to personally evaluate priorities and search for meaning throughout difficult times. Whereas some survivors become more religious, others may feel a deepened sense of spirituality or transformation. yet this hardly describes everyone's experience with cancer. Because this is a very personal reaction to a difficult diagnosis, there can be many negative effects as there are positive. |
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Mrs. P. is having a difficult time going to her breast cancer support group. Although she is doing well and is free of disease 2 years after completing treatment, she feels sad and despondent when she sees others suffer or die of the same illness she had. She asks herself why she is alive and doing well when so many others are not. This phenomenon has been described as
A. posttraumatic stress disorder B. acute reactive syndrome C. bipolar disorder D. survivor's guilt |
Answer: D. survivor's guilt
Rationale: Survivor's guilt is a normal reaction to surviving a life-threatening illness and is often triggered by a return to the clinic, hospital, or support group. Survivors can compare themselves to others with recurrent disease or to those who have died, and this can provoke mixed reactions and guilty feelings about doing well. |
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Which statement best describes the current state of long-term follow-up care for adult cancer survivors in the United States?
A. all long-term survivors are seen in specialty follow-up clinics for the rest of their lives B. although pediatric survivors undergo follow-up for indefinite periods f time in long-term survivor specialty clinics, adult cancer survivors rarely have access to this type of oncology follow-up C. adult survivors are eligible to be seen in follow-up clinics after being free of disease for 5 years D. primary care physicians are best prepared to identify oncology-related follow-up problems |
Answer: B. although pediatric survivors undergo follow-up for indefinite periods f time in long-term survivor specialty clinics, adult cancer survivors rarely have access to this type of oncology follow-up
Rationale: Standardized guidelines for the follow-up care of adult cancer survivors are rare. Transfer back to primary care is decided on a case-by-case basis by either the referring oncologist or the insurance plan. Primary care physicians and other medical specialists see more long-term cancer survivors than oncologists, even though there are few guidelines to help with assessing long-term and late effects of cancer. |
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As survivors near the end of their initial treatment, how can the oncology team help the survivor transition to completing therapy and entering the extended stage of survival?
A. establish a time for an exit interview so that the health care team can help the survivor and family develop a plan of action for what life will look like after the initial treatment is completed B. encourage the survivor to try to forget the past painful months and get on with life once therapy is completed C. discuss the risks of recurrence with the family so that the survivor does not worry D. have a party or ceremony to celebrate the end of treatment |
Answer: A. establish a time for an exit interview so that the health care team can help the survivor and family develop a plan of action for what life will look like after the initial treatment is completed
Rationale: An exit interview will help develop a plan as to what life will look like after treatment is completed and, it is hoped, reduce some of the unknowns. The plan could include information about wellness promotion along with disease identification. This might include education on prevention and early detection, timelines for follow-up, identification of risk factors, and assessment of symptoms and recurrence. Honesty and education will prepare the survivor and family members for life after treatment. |
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The Americans with Disabilities Act is one of the first laws to offer protection against discrimination to cancer survivors. Although not perfect, this law best describes protection for which of the following?
A. survivors who have noticeable amputations only, such as leg amputations B. survivors who have disabilities that were identified before the cancer diagnosis C. survivors with mental health problems D. survivors who work for employment agencies, labor unions, local and state government offices, or private employers that have 15 or more employees |
Answer: D. survivors who work for employment agencies, labor unions, local and state government offices, or private employers that have 15 or more employees
Rationale: The Americans with Disabilities Act was enacted to expand coverage originally offered by the Federal Rehabilitation Act. Unfortunately, everyone is still not guaranteed protection by these combined acts. |
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Assessing the risk or probability for recurrence of disease and long-term and late effects would ideally happen within what context?
A. at a late effects clinic or long-term follow-up visit, ideally by a health care team that would include the oncology nurse B. at an internal medicine office C. at a family practice office D. no need to assess unless there are symptoms that may be related to the primary disease or treatment |
Answer: A. at a late effects clinic or long-term follow-up visit, ideally by a health care team that would include the oncology nurse
Rationale: As greater numbers of survivors live longer after diagnoses of cancer, risks for problems related to their initial disease or therapy increase. Ideally, specialized clinics with professionals dedicated to assessing this every-increasing population would be able to monitor long-term survivors, identify risks and early problems, and educate about prevention and control measures within an atmosphere of wellness. |
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A 52 year old breast cancer survivor who was treated 12 years ago has moved to your area and comes to your oncology clinic for the first time. With this introductory history, which type of information would be LEAST important for you to begin your assessment?
A. type and date of surgical procedures, including pathology reports and diagnostic indicators B. specific therapies, including chemotherapy drugs and radiation fields, doses, and dates C. Her willingness to be a community advocate D. financial status |
Answer: C. Her willingness to be a community advocate
Rationale: During the initial assessment, it is imperative that a medical history be as specific as possible to develop a follow-up surveillance and wellness plan. Also, insurance or method of paying for care is extremely important. After the initial health and financial assessment is concluded, you can then inquire as to her interest in doing community advocacy or volunteer work. |
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Free of disease ______ years from diagnosis or from completion of therapy = cancer survivor
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5 years
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Survivorship issues also affect persons other than the diagnosed client -- family members, significant others, friends, coworkers, health care professionals, social support networks. These supporters can also be considered _______ ________.
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Secondary survivors
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What is the "season's of survival"?
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a dynamic model of life after a cancer diagnosis that consists of three stages -- acute, extended, and permanent stages of survival
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What is the acute stage in the "season's of survival"?
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Begins at the moment of diagnosis and extends through the initial treatments.
Individuals may be dealing with the following: a. Acute or potential losses b. Fear of dying or impending death c. acute side effects from treatment D. disruption in family and social roles |
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What is the extended stage in the "season's of survival"?
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Follows the completion of the initial treatmnet. Individuals may be in remission or receiving maintenance therapy, or their condition may be terminal
Individuals may be dealing with the following: a. severing of treatment-based support systems b. feeling ambiguous about the joy of being alive and feeling fear of recurrence or fear of death c. adjusting to physical or psychosocial compromise d. reintegrating and re-organizing individual and family concerns e. isolating the individual because of external or self-imposed forces f. seeking community-based support systems |
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What is the permanent stage in the "seasons of survival"?
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Gradual evolution to a time of diminished probability for disease recurrence. If cancer is arrested permanently, some survivors may be considered "cured".
Individuals may be dealing with the following: a. discrimination in the workplace b. procurement or maintenance of adequate insurance coverage c. adaptation to the physical and psychosocial changes resulting from disease d. treatment for long-term or late effects of disease and therapy |
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________ can occur in any one of the stages in "seasons of survival" and should be included as an integral component of the survivorship continuum.
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Death
it could also be seen as another stage in the "seasons of survival", i.e. the final stage of survival |
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Effects of survival can be categorized as...
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physiologic
psychologic social spiritual |
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Physiologic effects of survival include
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recurrence of disease
second malignancies functional changes - lymphedeam, neuropathies, fatigue cosmetic changes - ostomies, amputations, hair loss/thinning system specific effects (ex. cardiomyopathy, pleural effusions, nephritis, bowl adhesions/obstructions, sterility, impotence) |
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Psychologic effects of survival include
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fear of recurrence
heightened sense of vulnerability recurrent episodes of anxiety (during follow up or cancer anniversaries) ambivalence about health care follow-up (ranging from hypochondriacal obsession to complete avoidance) changes in body image or self concept |
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What are the social effects of survival?
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social stigma associated with external sources (shunning by others) or internal sources (isolation)
difficulties with transition from sick role to previous roles or to new roles and responsibilities inconsistent perceptions of state of health employment related problems |
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What are the spiritual effects of survival?
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changes in life priorities and values
deepening sense f spirituality (with or without organized religion) expressed concerns about quality of life increased self-love or self-acceptance increased passion or zest for life ambivalent feelings about occasional periods of depression survivor's guilt |
