We are constantly reminded of the growing number of people who are surviving cancer, and yet there is still a gap in our understanding of what this means in real terms. What does it mean for those affected by cancer? What does it mean in the wider context for health and social care? And what does it mean for cancer nursing?
It is good news that people are living longer, but with previous projected figures suggesting an increase from approximately 2.5 million people in the UK currently living with cancer to 4 million by 2030 (Maddams et al, 2012), action is required if we are to ensure the best support and care possible. van Scheppingen et al (2011) showed that there were ‘meetable’ unmet needs for people with cancer. Pitman et al (2018) reported that approximately 50% of people with a cancer experience psychological distress; depression affects up to 20% of people with cancer, and anxiety affects 10%, compared with figures of 5% and 7% prevalence in the general population. Gaps in services still exist.
There is an urgent need to increase awareness of how people are living beyond cancer—with the ongoing consequences of treatment, for example. This is compounded by advances in treatments, such as anti-cancer immunotherapy where multiple body systems can be affected by treatment. Knowledge sharing between specialist and generalist teams has never been so critical. There is also an urgency around balancing the management of meeting the needs of the increasing numbers of people diagnosed with a cancer while supporting a growing population of people living with, for some, very difficult consequences. The fear of disease recurrence and/or progression is one of the most significant psychological consequences (Crist and Grunfeld, 2013; Lebel et al, 2016).
It is recognised that the status quo of how we provide care and support on the cancer pathway is not sustainable; hence the move towards stratifying needs and follow-up pathways. Roles are changing and while the clinical nurse specialist (CNS) role remains pivotal to good outcomes for patients (Whittaker et al, 2017), to meet the needs of the growing population surviving cancer, exploring new community-based approaches is an option. As the workforce evolves, role clarity is necessary, especially with emerging advanced nurse practitioner and novel healthcare support worker (HCSW) posts in cancer. As the workforce expands, especially in the ‘living with and beyond’ arena, we need to advocate and protect the added value of the CNS. Managing the workforce challenges has seen a change in the skill mix of cancer nursing teams, including increasing numbers of HCSWs. The HCSW role can be an invaluable asset, but clearly defined roles are very important (Cooper, 2019) to ensure that care that needs to be conducted by a nurse is actually conducted by a nurse.
Health economic modelling of the Macmillan One to One/Living With and Beyond Cancer Service in NHS Forth Valley, showed a 4.8% return on social investment in 2017 (Frontline Consultants, 2018). This small team of one whole time equivalent (WTE) band 6, one WTE band 3 and 0.2 band 7, supported 503 referrals in 2019.
As we enter the International Year of the Nurse, let's take this opportunity to raise the profile of cancer nursing and celebrate the valuable contribution that nurses make to those living with and beyond cancer.