 Every day, oncology nurses provide care to patients who rely on them not only for their physical care, but also emotional and even spiritual care. Close relationships are formed as the oncology nurse cares for these patients and families over a period of time. Many oncology nurses may find themselves unprepared for the emotional challenges that arise in caring for these patients and their families. These emotional issues can include things such as the death of a patient with whom the nurse has developed a close relationship, a moral or ethical dilemma that the nurse has seemingly no control over, or a chaotic family situation in which the nurse’s therapeutic communication techniques have been challenged.

 The oncology nurse may be left feeling physically, emotionally, and spiritually drained.

	Compassion fatigue was first mentioned in relation to professional healthcare in 1992 by Carla Joinson.

 Joinson identified behaviors characteristic of compassion fatigue. These include chronic fatigue, irritability, dread of going to work, aggravation of physical ailments, and a lack of joy in life. Figley

 defined compassion fatigue as a state of tension and preoccupation with the individual or cumulative traumas of clients.

	Oncology nurses expend a tremendous amount of energy and concern over the long term as they care for patients who may or may not recover from their illness. Compassion fatigue may not happen with the care of 1 patient, but the repeated exposure to oncology patients may lead to the condition.

			Receiving unusual amount of complaints from others

			Complaining excessively about administrative functions

			Reoccurrence of nightmares or flashbacks to a traumatic event

			Apathy, sadness, no longer finding activities pleasurable

	We do not want to confuse compassion fatigue with burnout. Very often, the terms are used interchangeably. However, Potter et al

 make the case that while compassion fatigue and burnout are closely related and the definitions can often be ambiguous, the definitions of burnout point to environmental stressors, while the definitions of compassion fatigue address “the relational nature of the condition.” Distinguishing between burnout and compassion fatigue is difficult and controversial. Although burnout often results in less empathic responses to patients, removal from emotion-laden clinical situations, and leaving one’s clinical position, compassion fatigue may result in more emotional giving that ultimately ends with an inability to attain a healthy balance of empathy and objectivity.

	Compassion fatigue can have far-reaching effects. It can affect an entire organization, with increased and chronic absenteeism, increase in workers’ compensation claims, high staff turnover rates, and friction between employees, staff, and management. Since many caregiving institutions are nonprofi ts, they inherit added challenges such as low wages, lack of space, high management turnover rate, and constantly shifting priorities.

	For the oncology nurse, combating compassion fatigue starts with recognizing the symptoms and making changes that lead to a personal transformation. You should have an internal locus of control. Ask yourself, “What can I infl uence?” Develop a personal statement to guide your life, self, and family. Also ask yourself, “Why am I in this profession? What is my mission?”

	Improvement starts with developing your own self-care plan and techniques to incorporate into your life that improve compassion fatigue symptoms. Start with learning mindfulness meditation, an excellent way to ground yourself. Find time to recharge your batteries daily, by committing to exercise and eating healthier. Make it a priority to engage with what you value most, which often means connecting with family and close friends.

	Speaking with managers, peers, spiritual advisors, friends, and family can also help alleviate symptoms.

	When compassion fatigue symptoms become overwhelming, professional assistance may be required, such as seeking out a trained counselor or mental health specialist.

	Kathleen Gamblin, RN, BSN, OCN®, is a thoracic oncology nurse navigator at WellStar Health Systems in Marietta, Georgia.

	Sharon Francz, LPN, BHA, is an oncology nurse navigator and the president and co-founder of the 

National Coalition of Oncology Nurse Navigators (NCONN)

				Aycock N, Boyle D. Interventions to manage compassion fatigue in oncology nursing. 

				Joinson C. Coping with compassion fatigue. 

				Figley CR, ed. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. London: Brunner-Routledge; 1995.

				Potter P, Deshields T, Divanbeigi J, et al. Compassion fatigue and burnout: prevalence among oncology nurses. 

				Pfifferling JH, Gilley K. Overcoming compassion fatigue. 

Articles

Every day, oncology nurses provide care to patients who rely on them not only for their physical care, but also emotional and even spiritual care.

Compassion Fatigue: When Caring Takes Its Toll

Breast cancer and its treatment present many personal and physical challenges. Much like the variations in their individual diagnoses, each individual patient will likely have vastly different recovery goals after treatment, with varying physical, psychological, social, and spiritual objectives. Additionally, for each person, the transition from active treatment to survivorship occurs; however, the pace is often much slower than individuals are prepared to handle.

	Whether it is oral or intravenous chemotherapy, radiation, or surgical intervention, treatment involves actively fighting the cancer. This offers a level of comfort, as patients are constantly checking in with physicians and nurses. The interactions provide reassurance that either the treatment is progressing or the cancer is gone.

	When the treatment phase ends, the emotional ramifications of what one has been through may cause a flood of emotions in the newly “cancer-free” individual. Questions arise such as, “Will the cancer return?” and “How will I know if the cancer returns?” Patients eagerly anticipate the completion of treatment; however, the end of treatment does not always bring them comfort. Transitioning from active treatment to one’s “old” life leaves many patients feeling lost and in a constant state of waiting for “what’s next.”

	The Breast or Oncology Nurse Navigator (ONN) can be instrumental to ensuring that a patient transitions from active treatment to becoming a “survivor thriver.” From the time of engagement, the navigator is “hand in hand” with the patient, identifying obstacles and barriers that may derail a successful completion of treatment and transition to survivorship. This is the navigator’s role and area of expertise.

	As with any relationship, communication is essential to a successful navigator-patient relationship. Navigators can be instrumental in educating patients and helping them develop a survivorship care plan. These individualized survivorship blueprints should start as soon as a patient is diagnosed with cancer.

		Complete history of cancer treatment from time of diagnosis to end of active care. This background should include type of surgery, chemotherapy and radiation regimens, as well as names of healthcare providers and treatment facilities.

		Prevention and screening schedule for recurrent and new cancers

		Education guidelines for the patient on how to recognize latent physical and psychosocial effects of cancer treatment

		Surveillance schedule frequency (follow-up visit schedule), including coordination between the patient’s primary care providers and specialists

		Intervention care plan for cancer recurrence

		Resources and support services available to the patient and family/caregiver in her community

	Survivorship care plans consider the patient’s life before cancer, the treatment prescribed and completed, and how to integrate this plan into the patient’s “new” life. Being a survivor is a continuum of cancer care.

Facing Forward: Life After Cancer Treatment

National Coalition for Cancer Survivorship

	Recently, patient navigation has become a focus in healthcare. The reason for the surge in patient navigation is the increased fragmentation of how healthcare is delivered. The complexity of navigating healthcare facilities, increase in available treatment options, decrease in participating specialty providers, and struggling economy have further complicated the process of completing treatment and entering survivorship.

	The good news is breast cancer care has had a patient navigation standard since 2009, when the National Accreditation Programs for Breast Centers (NAPBC) instituted this mandate. The American College of Surgeons Commission on Cancer will soon be adding a new standard on patient navigation so that all patients, regardless of their cancer diagnosis, will have the benefit of a navigator throughout cancer treatment. The Institute of Medicine’s 

 report stressed that all cancer care should provide and ensure appropriate psychosocial health services, facilitate effective communication, identify each patient’s psychosocial needs, design and implement a plan that links the patient with needed psychosocial care, coordinate biomedical and psychosocial care, engage and support patients in managing illness, and systematically follow up on evaluating and adjusting this plan.

	Individuals may benefit from a navigator at any stage of cancer treatment. Patients with breast cancer who have not been connected to a navigator may locate one by contacting their oncologist or cancer center and asking if they have a Breast Cancer Navigator, Patient Navigator, or ONN on staff. Patients can also locate an ONN by visiting the Patient page at 

 and seeing if there is a navigator located near them.

	Sharon Francz, LPN, BHA, is an oncology nurse navigator and the president and co-founder of the National Coalition of Oncology Nurse Navigators (NCONN).

	Institute of Medicine. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: National Academies Press; 2007.

The Breast or Oncology Nurse Navigator (ONN) can be instrumental to ensuring that a patient transitions from active treatment to becoming a 'survivor thriver.'

Sharon Francz, LPN, BHA

Articles

Compassion Fatigue: When Caring Takes Its Toll

Navigating Transition: Treatment to "Survivor Thriver"