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2009
WHO IS A SURVIVOR?AN INDIVIDUAL IS A SURVIVOR FROM THE TIME OF THEIR DIAGNOSIS THROUGH THE BALANCE OF THEIR LIFE.
THE ISSUE:• CURRENTLY , THERE ARE 10.5 MILLION
SURVIVORS OF CANCER IN THE US TODAY.• COMMON MALIGNANCIES:
– BREAST CANCER– COLORECTAL CANCER– PROSTATE CANCER– HEMATOLOGICAL MALIGNANCIES– GYN/GU CANCERS– MELANOMA– LUNG CANCER
WHAT SURVIVORS WANT? TREATMENT SUMMARYSURVIVORSHIP CARE PLANCOORDINATED CAREQUALITY CARE
TREATMENT SUMMARY• STAGE OF DISEASE• PATHOLOGICAL DIAGNOSIS• TREATMENTS–SURGERY–RADIATION–CHEMOTHERAPY
TREATMENT SUMMARY CONT.
• RECOMMENDED FOLLOW-UP GUIDELINES–FOLLOW-UP VISIT FREQUENCY–TESTS: LAB, XRAY
• INFORMATION ON LATE AND LONG TERM TOXICITY• GENETICS • SIGNS OF RECURRENCE
TREATMENT SUMMARY cont.
• INFORMATION ON PSYCHOSOCIAL ISSUES-MARRIAGE -PARTNER, PARENTING• FERTILITY, SEXUALITY• PREVENTION STRATEGIES• DISABILITY, WORK, LEGAL ISSUES
TREATMENT SUMMARY cont.
SURVIVOR CAN GO ANYWHERE AT ANYTIME AND HAVE THE NECESSARY INFORMATION FOR OTHER HEALTH CARE PROVIDERS
COORDINATION OF CARE AMONG DOCTORS
EMPOWERING TO THE PATIENT
SURVIVORSHIP CARE PLANPREVENTION OF RECURRENT CANCER
AND NEW CANCERSSCREENINGDIETACTIVITIES
SURVEILLANCE FOR CANCERINTERVENTION FOR ACUTE AND LATE
EFFECTS OF CANCER AND TREATMENTPHYSICAL, EMOTIONAL, PSYCHOLOGICAL,
LEGAL
QUALITY OF LIFEPSYCHOLOGICAL WELL-BEINGPHYSICALSOCIALSPIRITUAL
PSYCHOLOGICALFEAR OF RECURRENCE
“DEMOCLES SWORD”FEAR OF A SECOND CANCERFEAR OF LATE OR LONG-TERM TOXICITIES
ANXIETY, DEPRESSION AND/OR WITHDRAWAL
BARRIERS: FRAGMENTED HEALTH CARE SYSTEM
POOR COORDINATION AND DISTRIBUTION OF CARE
LOCUS OF RESPONSIBILITYCOMMUNICATIONVARIATION IN QUALITY
BREAST CANCER• RISK OF RECURRENCE
– MASTECTOMY VS BREAST PRESERVATION• RISK OF SECOND BREAST CANCER
– GENETIC PREDISPOSITION– FAMILY HISTORY
• RISK OF SECOND CANCER• SCREENING
– EXAM– MAMMOGRAPHY– ULTRASOUND, MRI
RISK REDUCTIONCOMPLIANCE WITH PRESCRIBED THERAPIES MEDICATIONSTAMOXIFEN, AROMATASE INHIBITORSDIETFAT REDUCTIONEXERCISELEVEL AND FREQUENCY OF PHYSICAL
EXERCISENUTRIENTS, VITAMINSVIT D
BREAST CANCER / PYSCHOLOGY
PSYCHOLOGICALDISTRESS LEVELS AND TRANSITIONS
RISK FACTORS: PREVIOUS ANXIETY OR DEPRESSIONAFFECTED BY SOCIAL AND FAMILY
SUPPORTINTERVENTIONS:
SUPPORT GROUPS PSYCHOLOGISTRETREATS-HARMONY HILL
LYMPHEDEMASYMPTOMS:
SWELLING OF ARM, CHEST, AXILLARY TISSUES
PAIN, PARESTHESIAS, INFECTION, LYMPHATIC DYSFUNCTION
RISK: EXTENT OF TREATMENT-SURGERY,
RADIATIONTREATMENT:
MASSAGEMANUAL DRAINAGECOMPRESSION GARMENTS
PREMATURE MENOPAUSESYMPTOMS:
HOT FLASHES, SWEATS, VAGINAL DRYNESS, LIBIDO, URINARY SYMPTOMS, SLEEP AND/OR MOOD DISTURBANCES
RISK: CHEMO, AGE, ANTI-ESTROGEN THERAPY
THERAPYESTROGEN REPLACEMENTSUPPORTTIME
OTHER IMPORTANT ISSUES:WEIGHT GAINOSTEOPOROSISHEART DISEASEMUSCULOSKELETAL PAINFATIGUECOGNITIONNEUROPATHY
FOLLOW–UP CLINICAL VISIT EACH OF 3 MONTHS, FOR
3 YEARSSUBSEQUENT VISITS EVERY 6 MONTHS
FOR YEARS 4-10TALK, EXAMLABS, MARKER STUDIESIMAGING
MAMMOGRAMMRI IN CERTAIN INSTANCESOTHER SCANS
PROSTATE CANCERMOST COMMON CANCER FOR MEN
GREAT VARIATION IN TREATMENT OPTIONSSURGERYRADIATIONHORMONAL ANTI-ANDROGEN
RECURRENCERISK: STAGE, AND GRADELOCAL RECURRENCE VS DISTANT (BONE)
SURVEILLANCEFOR RECURRENCE - PSA AND EXAM
SECOND CANCER-BLADDER, RECTAL CANCER
TOXICITYSEXUAL DYSFUNCTIONBLADDER:
INCONTINENCEPAINURGENCY
BOWEL FUNCTIONOSTEOPOROSISSLEEPCOGNITION
FOLLOW-UPCLINIC VISIT EVERY 3 MONTHS FOR 2 YEARS WITH EXAM
PSA EVERY 6 MONTHSLONG TERM FOLLOW-UP EVERY 6 MONTHS
MEDICATION = COMPLIANCE
PREVENTIONLIFE-STYLE
WEIGHT REDUCTIONDIETEXERCISE
ANTI-ANDROGEN THERAPY
COLO-RECTAL CANCERSECOND MOST COMMON CAUSE OF CANCER DEATH
EASILY SCREENED80% DIAGNOSED WITH CURABLE STAGES OF DISEASEStage 1, 2 or 3.
COLO-RECTAL CANCERRECURRENCE-40% RISK BASED
ON STAGE AND GRADESECOND COLON CANCER: RISK-
1.5%/5YRANOTHER CANCER:
FAMILY HISTORYGENETICS-FAMILIAL POLYPOSIS, HNPCC
TOXICITY OF TREATMENTBOWEL FUNCTIONCOLOSTOMYPSYCHOSOCIAL DISTRESSSEXUAL DYSFUNCTIONNEUROPATHY
FOLLOW-UP CARECOLONOSCOPY –PRESURGERY,
POST-SURGERY EVERY 1-3 YEARS, THEN EVERY 5 YRS
LABS-CEACT SCANSVISITS EVERY 3 MONTHSFOR 2
YEARS THEN EVERY 6 MONTHS FOR 3 YEARS, THEN ANNUALLY
PREVENTIONLIFE-STYLE
DIET, EXERCISE-SIMILAR STUDIES SUGGESTING BENEFIT
ASPIRINKEEP APPOINTMENTS FOR FOLLOW-UP
CONCLUSIONSURVIVORSHIP WILL BE PART OF OUR
LIVESEXPECTATIONS FOR GOOD HEALTH CARE
SHOULD BE HIGHFOCUS ON USING THE CANCER
EXPERIENCE AS A “WINDOW OF OPPURTUNITY”TO HELP DIRECT FURTHER HEALTHCARE