Survivorship Clinic Reaches Out

There's good news in cancer research and treatment: patients with cancer are living longer.

Focus article photo

Tara Weatherell (right) has been cancer free since last summer but continues to see nurse Anna Schall (left) for follow-up.

More than 65% now live more than five years beyond their diagnosis, a number that has been steadily increasing for 20 years. While that's great progress, the challenges facing cancer survivors do not end when they walk out of the clinic. Survivors may continue to have unpleasant side effects as a result of treatment. They may feel tired and anxious, or fear the cancer will return. Even the happy event of completing treatment can be fraught with anxiety; after months of constant oversight by a team of specialists, survivors can feel suddenly frightened and adrift without them.

An innovative new Survivorship Clinic at Norris Cotton Cancer Center is reaching out to cancer survivors, and addressing a myriad of immediate and long-term issues related to cancer. Created and run by advanced practice nurses, the clinic serves the needs of anyone whose life has been touched by cancer, whether as a patient, family member, friend, or caregiver. Beginning in June, a multidisciplinary team of nurse practitioners, physical therapists, a nutritionist, chaplain, psychologist and other providers will be available as needed to address the various chronic or severe issues that can arise for survivors, such as nerve pain, osteoporosis, hot flashes, anxiety, depression, sexual dysfunction, and spiritual issues.

The Side Effects of Cancer

At the age of 26, Tara Weatherell was diagnosed with Hodgkins lymphoma after she found a golf ball sized lump under her armpit. She underwent chemotherapy, and lost the long hair that once cascaded down her back, but she's been cancer-free since last summer. Weatherell laughs about the forgetfulness that plagues her now, a side effect of chemotherapy, but she admits to struggling at times.


"Anna talked to me about the things that could happen. She helped me with not just the cancer," says Tara Weatherell (left), with her mother, Sue Rogers.

Weatherell sees Anna Schaal, ARNP, at follow-up appointments and they discuss the anxiety, night sweats and sensitivity in her fingertips that are a problem. "Anna talked to me about all the things that could happen," says Weatherell. "She helped me with not just the cancer." Still, Weatherell has been afraid to grow out her hair, for fear the cancer might return and she'd have to cut it off again.

Nurses in the Survivorship Clinic recognize that even patients like Weatherell, who smiles and jokes easily, can experience physical and emotional side effects as a result of cancer. An important component of what the clinic offers is educational programs and interventional services for smoking cessation, bone health, fatigue, exercise and rehabilitation, intimacy and sexuality, cognitive problems, and other issues, which are scheduled during the clinic.

Any cancer survivor can call the Survivorship Clinic for help. Although a referral from a provider is encouraged, it is not required. "A patient can be seen whenever they need to be seen," emphasizes Karen Skalla, ARNP.

Transitional Care Plan

An important component of the clinic's services is the Transitional Care Plan, a summary of a patient's treatment history (e.g., surgery, chemotherapy, radiation) that serves as a common understanding for patients, their referring provider and primary care physician, as well as any new provider they see in the future. It also lays out a detailed roadmap for follow-up care. "We want patients to know what to look out for," says Skalla. The Transitional Care Plan is currently provided to a subset of patients, but eventually all patients with cancer who come to the Survivorship Clinic and their primary care providers could receive one.

An ongoing research project has demonstrated the success of the Transitional Care Plan with clinicians. "Our survey of primary care providers who have received a Transitional Care Plan shows they're very happy with it," says Ellen Lavoie Smith, PhD, ARNP, director of the Cancer Survivor Program. "It's helping them understand their patients' history better and what their needs are." The Survivorship Clinic also has begun working with the New Hampshire Department of Health and Human Services to assess the needs of cancer survivors throughout the state.

The nurses who envisioned the Survivorship Clinic understand that surviving cancer is not as simple as walking out the door. Nine months after receiving a clean bill of health, Tara Weatherell worries less about her cancer returning, and she's even decided to grow out her hair. As a survivor, she's on the next leg of her journey.

April 26, 2008