What clinicians need to know about cancer survivors' approaches to self-management

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By Cathy Henshall, Senior Nursing Research Fellow, Faculty of Health and Life Sciences, Oxford Brookes University, and Nicola Gale, Senior Lecturer, Health Services Management Centre, University of Birmingham

With more people surviving cancer than ever before we need to focus on how to support cancer survivors to live well post-cancer. For some cancer survivors, the chronic nature of some of the side-effects from cancer and its treatment can be debilitating and exhausting, resulting in assaults to their physical, psychological and emotional health and wellbeing.

Self-management practices, such as exercise, diet, psychological therapies, complementary and alternative medicine (CAM), spirituality and religion and support groups, can be used to support cancer survivors to engage with lifestyle activities that may bring about improvements to their quality of life and wellbeing.

My Doctorate research identified cancer survivors’ patterns of self-management practices over time, from pre-diagnosis, through treatment and into survivorship and explored their reasons for using different self-management practices at different stages along their cancer pathway. From the findings, seven points became clear and these are helpful for clinicians to understand. 

1. Self-management practice uptake increases in survivorship compared to pre-diagnosis or during treatment for cancer. Using self-management practices can benefit cancer survivors for a range of reasons, providing useful coping mechanisms post-cancer. Exercise is the most popular self-management practice, with benefits including gaining fitness and strength post cancer, providing mind and body relaxation, increasing social interactions, ameliorating long-term treatment side effects, promoting self-esteem and improving body image.
2. Self-management practice uptake is lowest during treatment. This is likely to be because cancer patients lack the energy to undertake many self-management practices during treatment. Clinicians and policy-makers need to explore the types of self-management practices that might be best suited to cancer patients who are undergoing grueling treatment regimes.
3. Age, ethnicity, gender, cancer type and treatment type all influence cancer survivors’ uptake of different self-management practices. This has implications for clinical practice, suggesting that specific self-management practices can be targeted at individual cancer survivors, to account for these socio-demographic factors. This could be done through the provision of a holistic needs assessment which takes into account the social, physical, emotional and psychological needs of individuals living with cancer, to match their needs with appropriate self-management practices and interventions.
4. Cancer survivors treated with chemotherapy are more likely to undertake self-management practices than those who are not. This suggests that self-management practices provide particular benefit to cancer survivors who have undergone chemotherapy. Chemotherapy patients may have a greater need to utilize self-management practices to manage the long-term side effects from their treatment. This could be due to the wide-ranging and long lasting side effects that chemotherapy can induce.
5. Cancer survivors who believe they have more control over their health outcomes use more self-management practices than those who believe their health outcomes are beyond their control. This suggests that cancer survivors who take more responsibility for their health are more motivated to use self-management practices to try to bring about health benefits.
6. ‘Normal’ life post cancer can take time to get used to. Whilst some cancer survivors are keen to get rid of cancer and return to life as it was before, for others this can be hard to do. Physical and mental changes to the body can leave some people reeling from the after effects of their cancer and treatment, which can be hard to adjust to. Whilst some find this search for normality chaotic and unsettling, others view it as a ‘wake up call’ that allows them to reassess and re-establish what is important to them in their new lives. Self-management practices can be useful mechanisms for helping cancer survivors to establish a new normal in their lives post cancer.
7. Social support is vital. Positive relationships with friends and family can be crucial in helping cancer patients fight cancer, providing them with a reason to live and a purpose in life, even in the darkest throes of illness. Those with the greatest levels of social support may be more proactive in seeking out self-management practices such as diet and exercise to help them return to health and fitness, whilst those who feel more isolated and alone are more likely to seek psychological support.

Much has been made of the necessity of self-management for people with long-term conditions to reduce the burden on healthcare systems. As cancer increasingly becomes accepted as a chronic condition, the management of cancer survivors in an increasingly stressed healthcare system necessitates effective self-management strategies. These insights can help providers and commissioners of healthcare develop such effective strategies.

Cathy Henshall (neé Shneerson) is a Senior Nursing Research Fellow in the Faculty of Health and Life Sciences at Oxford Brookes University. Her main research interests include cancer survivorship, self-management in chronic illness and maternity care.

Nicola Gale is a Senior Lecturer at the Health Services Management Centre, at the University of Birmingham. Her main research interests are healthcare workforce and professions, and patient experience of illness.