Adaptation of the Illness Trajectory Framework to Describe the Work of Transitional Cancer Survivorship

Abstract

Purpose/Objectives Although frameworks for understanding survivorship continue to evolve, most are abstract and do not address the complex context of survivors’ transition following treatment completion. The purpose of this theory adaptation was to examine and refine the Illness Trajectory Theory, which describes the work of managing chronic illness, to address transitional cancer survivorship. Data Sources CINAHL, PubMed, and relevant Institute of Medicine reports were searched for survivors’ experiences during the year following treatment. Data Synthesis Using an abstraction tool, sixty-eight articles were selected from the initial search (N>700). Abstracted data were placed into a priori categories refined according to recommended procedures for theory derivation, followed by expert review. Conclusions Derivation resulted in a framework describing “the work of transitional cancer survivorship” (TCS work). TCS work is defined as survivor tasks, performed alone or with others, to carry out a plan of action for managing one or more aspects of life following primary cancer treatment. Theoretically, survivors engage in 3 reciprocally-interactive lines of work: (1) illness-related; (2) biographical; and (3) everyday life work. Adaptation resulted in refinement of these domains and the addition of survivorship care planning under “illness-related work”. Implications for Nursing Understanding this process of work may allow survivors/co-survivors to better prepare for the post-treatment period. This adaptation provides a framework for future testing and development. Validity and utility of this framework within specific survivor populations should also be explored.

The Transition Experience to Breast Cancer Survivorship

“…4,12,[22][23][24]27 Fear of recurrence represents existential concerns, uncertainty related to prognosis, and perceived morbidity associated with advanced disease. Anxiety is closely related to fear of recurrence and follow-up surveillance visits but lack of adequate knowledge to manage symptoms, uncertainty about the predicted recovery trajectory, and information and access to resources will increase a woman's anxiety levels.…”

“…19,21 The expectations for health care providers in survivorship care have been delineated, but to improve health and QOL outcomes for survivors, it is equally important to engage, inform, and support BCS in the transitional survivorship work in the context of their everyday lives. 22,23 The purpose of this article is to review reported concerns and needs of BCS in the transitional phase of survivorship, from curative intent therapy, and describe approaches to quality patient-centered BCS care.…”

Being Prepared: Essential to Self-Care and Quality of Life for the Person With Cancer

“…The stage of awareness in the initial year of the transition to survivorship also reflects a time of changing relationships (Bennion & Molassiotis, 2013). Diminishing social support is experienced from family and friends, contact with healthcare providers is dramatically reduced, and issues related to body image and sexuality begin to emerge, often affecting partner relationships (Allen, Savadatti, & Levy, 2009;Bennion & Molassiotis, 2013;Dow & Lafferty, 2000;Klimmek & Wenzel, 2012;Lethborg et al, 2000;Manne et al, 2006).…”

“…The process of recovery after therapy and transitioning to survivorship requires work (Klimmek & Wenzel, 2012). The majority of patients will cope with the challenges of getting this work done and move on as cancer survivors, often with a positive Note.…”

“…The behaviors associated with this transitional stage include exploration of the meaning and significance of what has occurred, recognizing the reality of living with persistent symptoms, managing symptoms, and facing the challenges of integrating the experience into one's life (Klimmek & Wenzel, 2012;Knobf, 2002). Unlike the first stage of "being focused," this stage is filled with emotions.…”