Long-Term and Late Effects of Cancer Treatment: What Oncology Nurses Should Know

Darcy Burbage, DNP, RN, AOCN, an Oncology Clinical Nurse Specialist, joined Cancer Nursing Today to discuss what oncology nurses and advanced practitioners should know about recognizing and managing long-term physical, cognitive, and emotional side effects in survivors of cancer.
“Each time we meet with a survivor … we assess them for the long-term and late effects, both the physical and psychosocial,” Burbage said. “There are many evidence-based, tested tools that are available to oncology nurses to provide that assessment and help us help our patients.”
Burbage spoke about the most common long-term and late effects of cancer treatment that she sees in survivors, which include fatigue and cognitive changes. It’s important to recognize that long-term and late effects may vary based on the cancer treatment type and modality, she said.
“Based on what we assess with our patients, we’re linking them to rehabilitation services, if they need a plan to help manage lymphedema, help manage fatigue, if they have some range of motion that they haven't got back,” Burbage said.
It’s critical for oncology nurses to continue assessing and monitoring patients throughout survivorship and use evidence-based resources to help address these long-term and late effects.
“The Oncology Nursing Society has a survivorship learning library, which has a lot of great resources for nurses to educate ourselves so we can help educate our patients,” Burbage said. “The National Comprehensive Cancer Network has a whole guideline on survivorship as to what needs to be assessed.”
In addition to these resources, Burbage also highlighted resources from the American Cancer Society and the National Cancer Society that are available to help educate nurses and patients.
Beyond the physical effects, Burbage explained that oncology nurses should also be aware of the mental health and psychosocial considerations surrounding survivorship.
“Fear of recurrence is so prevalent,” Burbage said. “Regardless of the type of cancer that you've had, the type of treatment, at some point, you're going to experience that fear; if it's at the end of treatment, if it's before an additional test or follow-up appointment.”
For example, many survivors of cancer report experiencing “scan-xiety” as they await imaging results, Burbage explained.
“As a clinician, we think 24 to 48 hours isn't that long, but it's forever for a survivor waiting to hear if their cancer is returned or if they're clear for another several months,” she said.
She recommends letting survivors know about the expected timeframe to get results back and if the results will be delivered via phone or a patient portal. It’s also important to communicate what the anticipated course of action might look like, and tell them that “depending on the results, we may want to see you, we may add more tests, but don't worry, we're going to walk you through it, [with] whatever those results may be,” Burbage said.
Beyond that, it’s also important to let survivors of cancer know that their treatment team is still there to support them throughout survivorship.
“I want them to feel comfortable and know that I still work for them,” Burbage said. “I want to be available and to help them whatever side effect they're experiencing, whatever question that they may have.”
Oncology nurses and advanced practitioners can also continue to help survivors navigate the healthcare system, she said.
“Now that individuals have more than just a primary care provider—in some cases, they may have a surgeon, a radiation oncologist, a medical oncologist—a lot of questions I get are, ‘Who do I call, which provider?’” Burbage said. “Sometimes I'll say, ‘Just call me. Let's walk through these symptoms you're having, and we'll figure out what is going on and get you to the right provider; as a nurse, I may know a back way to get you in a little sooner.’ That's what I usually share.”