While attending an academic meeting in Beijing, I spoke with a head nurse of a large hospital that has a very good reputation for the treatment of breast cancer. She told me that there are more than 500 patients with breast cancer receiving oral chemotherapy every year in her ward. In contrast to her previous years of experience, she now finds that hair loss is the major reason for first-diagnosed women to want to end chemotherapy. "Can you believe that?" she said quietly and repeatedly, "Hair loss, instead of other life-threatening complications, is the last straw that breaks a breast cancer patient's back and makes patients realize in despair that they are PATIENTS WITH CANCER for real."

I can imagine the complete sadness and even despair in patients when they first see the lost hair. Hair is a strong symbol of patient identity and immediately signals the beginning of a very different life. Many patients report that when they were told about having a cancer, they did not quite accept the diagnosis until symbolic changes appeared. Symbols besides the first time of losing hair include the first time they found that their child turned to other family members or friends instead of them for help with homework, the first time a colleague or leader removes job responsibilities and assigns them to someone else, and the first time they realize others have become unusually nice and polite. What follows is a deep realization of having a new life. This is a most vulnerable moment of having to give up a former life and having to start a new and feared life.

Because of this new life, a newly diagnosed patient is in some ways like a newborn who says goodbye to a familiar former life to begin an unknown future. To acknowledge and then live with cancer is likely a painful growth process that every single cancer patient has to face. Highest-quality cancer nursing care anticipates this painful growth process and indeed helps ensure positive outcomes. It is an important task for oncology nurses to help patients with cancer experience painful growth as smoothly as is possible. Such care includes anticipating and giving attention to vulnerable moments, to sensitive symbols, to showing compassion, and to protecting dignity and self-esteem based on professional and personal knowledge.

In order to help patients achieve growth that reflects physical and mental harmony while living with cancer, oncology nurse researchers are called to conduct more studies about growth and symbols. Research should be done to depict and assess the features and characteristics of this kind of growth process, figure out the typical symbols, find the different needs during different periods, identify and predict relatively homogeneous subgroups of patients with cancer based on their patterns of coping behavior, capture growth trajectories over time, explore and explain living experiences, and to test specific supportive interventions to help patients go through difficult times and other aspects of this growth process. Let's do this together and as immediately as is possible.

My best to you,

Changrong Yuan, PhD, RN

Editorial Board Member, Cancer Nursing

School of Nursing

Second Military Medical University

Shanghai, China