In many countries, cancer is the leading or the second leading cause of death.1,2 The incidence of cancer has continued to increase steadily worldwide throughout the last century. Because of advances in early cancer detection and cancer treatments, the 5-year survival rates of all cancer patients have increased dramatically worldwide. Therefore, it is critical to plan for the future health of today's cancer patients by implementing health promotion interventions during and after treatment.3 The need for health promotion may be even more critical for people with cancer whose quality of life and ability to continue living independently often heavily rely on maintaining their health, which may be significantly compromised by cancer.

Health promotion is defined as a process of enabling people to increase control over and to improve their health4 or activities directed toward increasing the level of well-being and actualizing the health potential of individuals, families, and communities.5 The conventional focus of health promotion on cancer prevention is gradually shifting to a focus on increasing the quality and years of life through a healthy lifestyle.6 In the past, health promotion for cancer focused mainly on cancer prevention, early detection, and actions against cancer, such as cancer screening guidelines, healthy living recommendations for cancer prevention, mammograms for breast cancer screening, human papilloma virus screening for cervical cancer, testing for prostate cancer, prevention of colon cancer, and protection from the sun for preventing melanoma.7,8 There has been a lack of attention on the need for health promotion for people with cancer. Until recently, scholars have advocated the need for health promotion for people with chronic disabling conditions.9 It has become increasingly obvious that the enhancement of health-promoting behaviors is a priority when caring for people with chronic and disabling conditions.10 Cancer is a chronic and disabling disease with a profound impact on all aspects of quality of life for cancer patients. Moreover, cancer patients often develop other chronic conditions attributed to the aging of the population and extension of the lifespan through medical treatments. Cancer patients or survivors are at a high risk of secondary disabilities and secondary cancer. Health promotion should be an essential component of cancer care for all cancer patients. Hence, in Healthy People 2020, increasing the mental and physical health-related quality of life of cancer survivors has been added as a new objective in the Cancer section.

Health promotion is distinct from disease management in cancer care. Disease management in cancer patients refers to interventions or care directed toward controlling and managing cancer. By contrast, health promotion in cancer patients refers to interventions focused on maximizing the health and quality of life. Health promotion interventions focus on enabling cancer patients to take an active role in their healthcare instead of emphasizing the narrow clinical aspects and seeking to control or manage cancer.9 Health promotion incorporates several self-initiated health behaviors and stresses the need to enhance cancer patients' responsibilities and commitments to a healthy lifestyle. In the literature, the behaviors used for health promotion in patients with chronic and disabling conditions include physical activity, stress management, healthy eating, and cultivation of supportive interpersonal relationships that can contribute significantly to the patients' sense of wellness, perceived health, functional status, and quality of life.9

Health promotion for cancer patients involves modifying behaviors to improve health, reduce the risk of cancer recurrence, and improve the overall quality of life.11 Health promotion interventions that focus on cancer patients have not been widely investigated, and studies have revealed that only a small percentage of cancer patients or survivors engage in health promotion behaviors.12,13 A limited number of health promotion interventions for cancer patients has been reported in the literature.14 Emerging evidence from limited research has indicated that health promotion improves quality of life and demonstrated several positive outcomes for cancer patients or survivors,15 such as positive lifestyle changes,16 a decrease in mortality rates among women with breast cancer,17 and improvement in the emotional state and quality of life among lung cancer patients.18

The concept of health promotion provides opportunities and challenges for cancer nurses to work in partnership with other healthcare providers to enhance the health and quality of life of cancer patients. The possibility of various forms of cancer-related disability and altered function may increase the complexity of health promotion for cancer patients. New educational efforts may be required to provide cancer nurses and other healthcare providers with the skills and tools necessary to care for cancer patients with multiple comorbidities and functional limitations to improve health, reduce the risk of cancer recurrence, and improve overall quality of life for cancer patients.

- Chia-Chin Lin, PhD, RN

School of Nursing, College of Nursing

Taipei Medical University, Taiwan

References