A cancer survivorship model for holistic cancer care and research

Sameena F. Sheikh-Wu, Debbie Anglade, Charles A. Downs


Advancements in cancer have increased survival rates leading to a paradigm shift such that cancer is considered a chronic disease, necessitating an evaluation of our understanding of cancer survivorship (CS). For this purpose, a comprehensive literature search was performed, using CINAHL, MEDLINE, and PUBMED from 2000–2021. Drawing from the concepts in the literature, salient factors that affect CS across cancer populations were identified and a proposed model was developed. This paper describes the Cancer Survivorship Model (CSM). The CSM represents predisposing factors for survivors and survivorship’s acute, extended, and long-term phases, influencing factors: treatment and maintenance (medical/psychosocial care), well-being, influencing aspects (life-changing experience, uncertainty, prioritizing life, wellness management, and collateral damage), and social relationship factors that impact survivors’ symptom burdens and overall survivorship experience (health outcomes and quality of life). A case study demonstrates the CSM utility. Future application of the model holds promise for improving the quality of survivorship and informing research and clinical practice to promote and optimize survivors’ outcomes throughout the evolving survivorship.

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American Cancer Society. (2018). Colorectal cancer early detection, diagnosis, and staging. Author.

American Cancer Society. (2019). Cancer Facts & Figures 2019. Author.

American Cancer Society. (2020a). Colorectal cancer rates rise in younger adults. Author.

American Cancer Society. (2020b). Treating colorectal cancer. Author.

Appleton, L., Goodlad, S., Irvine, F., Poole, H., & Wall, C. (2013). Patients’ experiences of living beyond colorectal cancer: A qualitative study. European Journal of Oncology Nursing, 17(5), 610–617.

Ashing, K. T., George, M., & Jones, V. (2018). Health-related quality of life and care satisfaction outcomes: Informing psychosocial oncology care among Latina and African-American young breast cancer survivors. Psycho-Oncology, 27(4), 1213–1220.

Barsevick, A. M. (2016). Symptom clusters. Semin Oncol Nurs, 32(4), 333–333.

Barsevick, A. M., Beck, S. L., Dudley, W. N., Wong, B., Berger, A. M., Whitmer, K., Newhall, T., Brown, S., & Stewart, K. (2010). Efficacy of an intervention for fatigue and sleep disturbance during cancer chemotherapy. J Pain Symptom Manage, 40(2), 200–216.

Brennan, T. A., Egan, K. P., Lindborg, C. M., Chen, Q., Sweetwyne, M. T., Hankenson, K. D., Xie, S. X., Johnson, F. B., & Pignolo, R. J. (2014). Mouse models of telomere dysfunction phenocopy skeletal changes found in human age-related osteoporosis. Dis Model Mech, 7(5), 583–592.

Carver, C. S., & Antoni, M. H. (2004). Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychology, 23(6), 595–598.

Cotrim, H., & Perreira, G. (2008). Impact of colorectal cancer on patient and family: Implications for care. European Journal of Oncology Nursing, 12(3), 217–226.

de Boer, A. G. E. M., Greidanus, M. A., Dewa, C. S., Duijts, S. F. A., & Tamminga, S. J. (2020). Introduction to special section on: Current topics in cancer survivorship and work. Journal of Cancer Survivorship, 14(2), 101–105.

Desai, A., & Gyawali, B. (2020). Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions. EClinicalMedicine, 20, 100269–100269.

Deshields, T., Potter, P., Olsen, S., & Liu, J. (2014). The persistence of symptom burden: Symptom experience and quality of life of cancer patients across one year. Supportive Care in Cancer, 22(4), 1089–1096.

Doble, S. E. & Santha, J. C. (2008). Occupational well-being: Rethinking occupational therapy outcomes. Canadian Journal of Occupational Therapy, 75(3), 184–190.

Doyle, N.(2008). Cancer survivorship: Evolutionary concept analysis. Journal of Advanced Nursing, 62(4), 499–509.

Drury, A., Payne, S., & Brady, A-M. (2017). Cancer survivorship: Advancing the concept in the context of colorectal cancer. European Journal of Oncology Nursing, 29, 135–147.

DuMontier, C., Clough-Gorr, K. M., Silliman, R. A., Stuck, A. E., & Moser, A. (2018). Health-related quality of life in a predictive model for mortality in older breast cancer survivors. Journal of the American Geriatrics Society, 66(6), 1115–1122.

Dunn, J., Ng, S. K., Holland, J., Aitken, J., Youl, P., Baade, P. D., & Chambers, S. K. (2013). Trajectories of psychological distress after colorectal cancer. Psycho-Oncology, 22(8), 1759–1765.

Fan, G., Filipczak, L., & Chow, E. (2007). Symptom clusters in cancer patients: A review of the literature. Current Oncology, 14(5), 173–179.

Farmer, B. J., & Smith, E. D. (2002). Breast cancer survivorship: Are African American women considered? A concept analysis. Oncol Nurs Forum, 29(5), 779–787.

Fessele, K. L. (2017). Financial toxicity: Management as an adverse effect of cancer treatment. Clin J Oncol Nurs, 21(6), 762.

Fessele, K. L. (2019). It is time to ask about financial toxicity. Clin J Oncol Nurs, 23(5), 3A.

Feuerstein, M., Todd, B., Moskowitz, M., Bruns, G., Stoler, M., Nassif, T., & Yu, X. (2010). Work in cancer survivors: A model for practice and research. Journal of Cancer Survivorship, 4(4), 415–437.

Gapstur, R. L. (2007). Symptom burden: A concept analysis and implications for oncology nurses. Oncol Nurs Forum, 34(3), 673.

Geffen, J. R. (2010). Integrative oncology for the whole person: A multidimensional approach to cancer care. Integr Cancer Ther, 9(1), 105–121.

Gonzalez-Saenz De Tejada, M., Bilbao, A., Baré, M., Briones, E., Sarasqueta, C., Quintana, J. M., & Escobar, A. (2016). Association of social support, functional status, and psychological variables with changes in health-related quality of life outcomes in patients with colorectal cancer. Psycho-Oncology, 25(8), 891–897.

Grassi, L., Spiegel, D., & Riba, M. (2017, Dec.). Advancing psychosocial care in cancer patients. F1000Res, 4(6), 2083. https://doi.org/10.12688/f1000research.11902.1. eCollection 2017

Guida, J. L., Holt, C. L., Dallal, C. M., He, X., Gold, R., & Liu, H. (2020). Social relationships and functional impairment in aging cancer survivors: A longitudinal social network study. Gerontologist, 60(4), 607–616.

Halpern, M. T., McCabe, M. S., & Burg, M-A. (2016). The cancer survivorship journey: Models of care, disparities, barriers, and future directions. American Society of Clinical Oncology Educational Book, (36), 231–239.

Han, X., Lin, C. C., Li, C., Moor, J. S., Rodriguez, J. L., Kent, E. E., & Forsythe, L. P. (2015). Association between serious psychological distress and health care use and expenditures by cancer history. Cancer, 121(4), 614–622.

Hebdon, M., Foli, K., & McComb, S. (2015). Survivor in the cancer context: A concept analysis. Journal of Advanced Nursing, 71(8), 1774–1786.

Henshall, C. L., Greenfield, S. M., & Gale, N. K. (2018). Typologies for restructuring relationships in cancer survivorship: Temporal changes in social support and engagement with self-management practices. Cancer Nurs, 41(6), E32–E40.

Huang, W., Yang, L., Liu, Y., Liu, C., Zhang, X., Fu, W., Shi, L., & Liu, G. (2018). Assessing health-related quality of life of patients with colorectal cancer using EQ-5D-5L: A cross-sectional study in Heilongjiang of China. BMJ Open, 8(12).

Jansen, F., van Uden-Kraan, C., Braakman, J., van Keizerswaard, P. M., Witte, B. I., & Verdonck-de Leeuw, I. M. (2015). A mixed-method study on the generic and ostomy-specific quality of life of cancer and non-cancer ostomy patients. Supportive Care in Cancer, 23(6), 1689–1697.

Juul, J. S., Hornung, N., Andersen, B., Laurberg, S., Olesen, F., & Vedsted, P. (2018). The value of using the faecal immunochemical test in general practice on patients presenting with non-alarm symptoms of colorectal cancer. Br J Cancer, 119(4), 471.

Karimi, M. & Brazier, J. (2016). Health, health-related quality of life, and quality of life: What is the difference? Pharmacoeconomics, 34(7), 645–649.

Khan, N., Rose, P., & Evans, E. (2012). Defining cancer survivorship: A more transparent approach is needed. Journal of Cancer Survivorship, 6(1), 3–36.

Kroenke, C. H., Quesenberry, C., Kwan, M. L., Sweeney, C., Castillo, A., & Caan, B. J. (2013). Social networks, social support, and burden in relationships, and mortality after breast cancer diagnosis in the Life After Breast Cancer Epidemiology (LACE) Study. Breast Cancer Res Treat, 137(1), 261–271.

Kunthur, A., Xiang, Z., Kaur, H., Jewell, S., & Mehta, P. (2015). Updates on cancer survivorship care planning. Federal Practitioner: For the Health Care Professionals of the VA, DoD, and PHS, 32(7), 64S.

Levit, L. A. (2013). Delivering high-quality cancer care: Charting a new course for a system in crisis. The National Academies Press.

McGeechan, G. J., McPherson, K. E., & Roberts, K. (2018). An interpretative phenomenological analysis of the experience of living with colorectal cancer as a chronic illness. Journal of Clinical Nursing, 27(1516), 3148–3156. https://doi.org/10.1111/jocn.14509

Miaskowski, C., Barsevick, A., Berger, A., Casagrande, R., Grady, P.A., Jacobsen, P., Kutner, J., Patrick, D., Zimmerman, L., Xiao, C., Matocha, M., & Marden, S. (2017). Advancing symptom science through symptom cluster research: Expert panel proceedings and recommendations. Journal of National Cancer Institute, 109(4).

Michalos, A. (2014). Well-being. Encyclopedia of Quality of Life and Well-Being Research. Springer.

Mullan, F. (1985). Seasons of survival: Reflections of a physician with cancer. The New England Journal of Medicine, 313(4), 270.

Nam, S. Y., Lee, H., Kim, S., & Lee, R-A. (2018). Factors affecting body image and sexual life for the colorectal cancer patients with stoma. Asian Oncology Nursing, 18(1), 1.

National Cancer Institute. (2018.) Cancer statistics. National Cancer Institute.

National Cancer Institute. (2020a). Cancer survivorship. Office of Cancer Survivorship.

National Cancer Institute. (2020b). Coping with cancer: Changes for the family.

Nightingale, C. L., Rodriguez, C., & Carnaby, G. (2013). The impact of music interventions on anxiety for adult cancer patients: A meta-analysis and systematic review. Integr Cancer Ther, 12(5), 393–403.

Nursing Institute of Nursing Research. (2016). Implementing NINR’s 2011 Strategic Plan: Key themes. https://search.nih.gov/search?utf8=%E2%9C%93&affiliate=nih&query


O’Gorman, C., Stack, L., O’ceilleachair, A., Denieffe, S., Gooney, M., McKnight, M., & Sharp, L. (2018). Colorectal cancer survivors: An investigation of symptom burden and influencing factors. BMC Cancer, 18(1), 1022. https://doi.org/10.1186/s12885-018-4923-3

Oliveira, R. A. A., Conceição, V. M., Araujo, J. S., & Zago, M. M. F. (2018). Concept analysis of cancer survivorship and contributions to oncological nursing. International Journal of Nursing Practice, 24(1).

Palesh, O. G., Collie, K., Batiuchok, D., Tilston, J., Koopman, C., Perlis, M. L., Butler, L. D., Carlson, R., & Spiegel, D. (2007). A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biological Psychology, 75(1), 37–44.

Paskett, E. D., Herndon, J. E., Day, J. M., Stark, N. N., Winer, E. P., Grubbs, S. S., Pavy, M. D., Shapiro, C. L., List, M. A., Hensley, M. L., Naughton, M. A., Kornblith, A.B., Habin, K.R., Fleming, G.F., & Bittoni, M.A. (2008). Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804. Psycho-Oncology, 17(11), 1108–1120.

Rasmussen, S., Larsen, P. V., Søndergaard, J., Elnegaard, S., Svendsen, R. P., & Jarbøl, D. E. (2015). Specific and non-specific symptoms of colorectal cancer and contact to general practice. Family Practice, 32(4), 387–394.

Reese, J., Handorf, E., & Haythornthwaite, J. (2018). Sexual quality of life, body image distress, and psychosocial outcomes in colorectal cancer: A longitudinal study. Supportive Care in Cancer, 26(10), 3431–3440.

Rowland, J. H., Gallicchio, L., Mollica, M., Saiontz, N., Falisi, A. L., & Tesauro, G. (2019). Survivorship science at the NIH: Lessons learned from grants funded in fiscal year 2016. J Natl Cancer Inst, 111(2), 109–117.

Rutherford, C., Müller, F., Faiz, N., King, M.T., & White, K. (2020). Patient-reported outcomes and experiences from the perspective of colorectal cancer survivors: Meta-synthesis of qualitative studies. Journal of Patient-Reported Outcomes, 4(1), 27–27.

Sanford, S. D., Beaumont, J. L., Butt, Z., Sweet, J. J., Cella, D., & Wagner, L. I. (2014). Prospective longitudinal evaluation of a symptom cluster in breast cancer. J Pain Symptom Manage, 47(4), 721–730.

Sanford, S. D., Zhao, F., Salsman, J. M., Chang, V. T., Wagner, L. I., & Fisch, M. J. (2014). Symptom burden among young adults with breast or colorectal cancer. Cancer, 120(15), 2255–2263.

Seely, D., & Ennis, J. (2018). Whole person integrative cancer care in action – An overview of its implementation and patient related outcomes. International Journal of Whole Person Care, 5(1). https://doi.org/10.26443/ijwpc.v5i1.136

Sheikh-Wu, S. F., Downs, C. A., & Anglade, D. (2020). Interventions for managing a symptom cluster of pain, fatigue, and sleep disturbances during cancer survivorship: A systematic review. Oncol Nurs Forum, 47(4), E107–E119.

Sheikh-Wu, S. F., Kauffman, M. A., Anglade, D., Shamsaldeen, F., Ahn, S., & Downs, C. A. (2021). Effectiveness of different music interventions on managing symptoms in cancer survivors: A meta-analysis. European Journal of Oncology Nursing, 52, 101968–101968.

Shockney, L. D. (2015). The evolution of breast cancer navigation and survivorship care. Breast Journal, 21(1), 104–110.

Siegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019. CA Cancer J Clin, 69(1), 7–34.

Siminoff, L., Thomson, M., & Dumenci, L. (2014). Factors associated with delayed patient appraisal of colorectal cancer symptoms. Psycho-Oncology, 23(9), 981–988.

Stark, L. L., Tofthagen, C., Visovsky, C., & McMillan, S. C. (2012). The symptom experience of patients with cancer. Journal of Hospice & Palliative Nursing, 14(1), 61–70.

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 71(3), 209–249.

Susan Love Research Foundation. (2018). Collateral damage: An overview. https://www.drsusanloveresearch.org/videos/collateral-damage-overview

Tantoy, I. Y., Cooper, B. A., Dhruva, A., Cataldo, J., Paul, S. M., Conley, Y. P., Hammer, M., Wright, F., Dunn, L. B., Levine, J. D., & Miaskowski, C. (2018). Changes in the occurrence, severity, and distress of symptoms in patients with gastrointestinal cancers receiving chemotherapy. J Pain Symptom Manage, 55(3), 808–834.

Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 Well-Being Index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167.

Wang, A. W., & Hoyt, M. A. (2018). Benefit finding and diurnal cortisol after prostate cancer: The mediating role of positive affect. Psycho-Oncology, 27(4), 1200–1205.

World Health Organization. (2020). WHOQOL: Measuring quality of life. In Health Statistics and Information Systems.

Wood, K. S. (2018). Transition to cancer survivorship: A concept analysis. Advances in Nursing Science, 41(2), 145–160.

Woźniak, K., & Iżycki, D. (2014). Cancer: A family at risk. Przegląd Menopauzalny, 13(4), 253–261.


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