December 2015 Vol 6, NO 6

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Commentary

When Normal Changes

Penny Widmaier, RN, MSN 

Receiving a cancer diagnosis changes the lives of our patients and their loved ones forever. Hearing the spoken word “cancer” creates tremendous fear, panic, confusion, and grief. Patients often report that they envision themselves curled up in bed with tubes coming out of their bodies, bald-headed, and vomiting. They assume they will become an immediate burden to their families. Patients start worrying about how their death will impact their loved ones socially and financially. Others have said that they immediately start funeral planning and “getting their affairs in order,” including updating their will, checking on their life insurance policy, and giving away their possessions.

Basically, patients feel as if they have instantly lost control of their lives and that things will never be normal again. Patients often report feelings of guilt and regret. They search for the “why” of their cancer diagnosis. Smokers who develop lung cancer are particularly plagued with guilt and embarrassment. Patients with breast cancer wonder if their cancer is a result of their birth control pills, hormone replacements, waiting too long to have children, not breastfeeding, too much caffeine, or too little exercise.

In addition to this emotional response, many patients have new physical symptoms related to cancer, including relentless pain. Each patient responds differently, but all are undoubtedly permanently changed. Their normal way of life is gone forever and their “new normal” includes cancer.

Patient navigators can have a positive impact on the cancer journey for patients and their loved ones beginning at the time of diagnosis and continuing through survivorship. In addition to providing education and counseling, navigators are instrumental in reducing patients’ barriers to care and in supporting timeliness in care. As with nursing practice in general, navigators should support and encourage patients to maintain as much of their precancer or “normal” life as possible. Dorothea Orem’s self-care deficit nursing theory describes how patients’ and caregivers’ actions are dependent on one another. The amount of care from a medical provider is dependent on the patient’s ability to manage his or her illness and symptoms.

When typically independent people receive a cancer diagnosis, their ability to manage their lives is temporarily altered. Cancer treatment can be extremely hectic and exhausting. Multiple medical appointments, treatments, and surgeries disrupt the typical routine for patients and their families. Maintaining the ability to care for oneself physically and emotionally is instrumental in achieving optimal outcomes for patients with cancer. Navigators can identify which activities are “normal” for patients and then work toward maintaining these activities while allowing patients to make as many decisions as possible. Including patients in decision-making is a patient right and gives them some sense of control. Although caregivers cannot remove the cancer diagnosis and restore the precancer state for patients, we can counsel, educate, coordinate care, and support patients as they adjust to their new situation.

Not many events during our lives have the power to affect us to the same extent as a cancer diagnosis. Some life-changing events are notorious for having a great emotional impact or causing stress. The purchase of a new home, a job change, divorce, the birth of a child, the death of a child, and the death of a spouse are some milestones topping the stress list. As with some of these events, cancer can shake one’s foundation. Many patients describe feelings of being inside of a tornado or having the carpet pulled out from under them.

Navigators are uniquely positioned to help patients survive the acute phase of cancer and to reach survivorship successfully. A key to contentment after treatment and into survivorship is successfully integrating cancer as a new dimension of one’s life. Embarrassment, regret, and anger must be overcome for a patient to become a new, stronger person. Although cancer is a fact of life, let’s help our patients move on to their “new normal” with strength, perseverance, and pride as their journey leads them into survivorship.

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