Cancer Rehabilitation and Survivorship: Transdisciplinary Approaches to Personalized Care

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It's a Sign

In 1976, I was a nursing student working my first day on an oncology unit; I had never even heard the term oncology. While on the unit that day, a great controversy occurred: the hospital engineer arrived to install a large metal sign indicating “Oncology Unit.” This hospital had recently decided to create a dedicated oncology floor rather than continue the practice of having patients with cancer scattered throughout the hospital on various units. Contrasting opinions abounded: Should we really put up a sign? Maybe people wouldn’t want to know they had cancer. Maybe nurses wouldn’t want to work in oncology.

The sign was installed and the unit began. A few months later, additional controversial issues emerged: perhaps there should be an outpatient clinic where chemotherapy would be given, and maybe we even needed nurses with special training to administer chemotherapy. The 35-year history since that time has revealed that oncology has indeed become a specialized practice, led by oncology professionals who have diligently forged ahead to pioneer new aspects of care. It was a sign that specialized oncology practice could improve the care of people with cancer.

Another significant memory I have of these earlier years was the common practice of celebrating the day a patient received a final dose of chemotherapy. I was one of the nurses who would join in the celebration, completed often with balloons, a cardboard “crown,” or cake as we celebrated a rare positive moment on our unit. I also remember, after several such celebrations, the first time a patient confided in me that while we were celebrating, she was terrified. She explained that once her treatment ended, there was no plan. She also said she was afraid because now she wouldn’t be coming in to see us or her physician, so how could she possibly know if she was “okay”? Encounters such as this began conversations among many oncology professionals that perhaps the end of treatment signified another challenge for our practice. Our patients were survivors, and survivors needed care. It was a sign, this time not in the form of a metal plaque or a clinic structure but in the form of a patient voice.

In 2006, I had the opportunity to serve on the Institute of Medicine’s Committee on Cancer Survivorship, which resulted in the publication of key reports addressing cancer survivorship in both children and adults. Those reports have triggered enormous attention to the needs of now more than 15 million cancer survivors.

The chapters of this book reflect potential solutions to the many clinical challenges identified in the Institute of Medicine reports. This text addresses the physical, psychological, and practical challenges of surviving cancer, building on a solid foundation of oncology practice. Survivorship is more than delayed toxicities, unresolved symptoms, or heightened risk for recurrence. Survivorship is the all-encompassing experience of having lived beyond those initial words of “you have cancer” and toward a life embracing both the gifts and the burdens of life beyond that diagnosis and treatment. This text is interdisciplinary in its authorship and content, as it should be—indicative of the reality that quality survivorship care will always be interdisciplinary, bringing together the best of all disciplines to address the multidimensional needs of survivors and families.

The book you are holding in your hands at this moment is also a sign. It is a sign that we heard the voice of the terrified woman with the cardboard crown surrounded by the celebrating oncology team and that we have decided to take seriously this critical dimension of oncology we now call survivorship.

Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN
Professor, Nursing Research and Education
Research Scientist, Department of Cancer Control and Population Sciences
City of Hope
Duarte, California