+

Cancer Survivorship; Beyond TreatmentMFA Thriving After Cancer (TAC) Adult and Pediatric Cancer Survivorship Clinic C. Tilley 9.2015

+Related Articles

Care of the Adult Cancer Survivor (ACP) http://annals.org/article.aspx?articleid=1695248

Differences Between Primary Care Physicians’ and Oncologsts’ Knowledge, Attitudes and Practices Regarding the Care of Cancer Survivors (JGIM) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235622/pdf/11606_2011_Article_1808.pdf

+Many of us are Cancer Survivors 14.5 million US cancer survivors alive as of Jan.1, 2014

1

Estimated incidence of cancers diagnosed in the US in 2015 is 1,658,000

Estimated deaths due to cancer in the US in 2015 is 589,430.

1 in 3 people will be diagnosed with cancer; 68% will be 5 years survivors2

GWUH diagnoses around 120 new cases of cancer each month

1. ACS Facts and Figures 20152. Siegel, Naishadham, & Jemal.2013 CA:Ca J.Clin 2013; 63.11-30v

+Who is a Survivor?

According to the National Coalition for Cancer

Survivorship and the NCI Office of Cancer Survivorship a

person is a cancer survivor “from the time of cancer

diagnosis and through the balance of his or her life.

Family members, friends, and caregivers are also

impacted.”

http://cancercontrol.cancer.gov/ocs/statistics/definitions.html

+Pearls to remember about

cancer survivors:

The experience is not over when the treatment is over

For many people the end of treatment is the start of a new and different beginning fraught with anxiety, symptoms, fear of recurrence, deconditioning and debt

Most people have a changed perspective on life and relationships after being treated for cancer

Many people struggle with survivors guilt

Many people re-experience the discomfort they felt when they got diagnosed every time a friend, family member or neighbor is diagnosed with cancer

+ www.gwdocs.com/cancer-survivorship-clinic

+

What is Survivorship Care?

+

Hewitt, Greenfield, & Stovall (2005). From Cancer Patient to Cancer Survivor: Lost in Transition. The National Academies Press: Washington, D.C.

+Institute of Medicine

In 2006 the IOM published a seminal report titled From Cancer Patient to Cancer Survivor; Lost in Transition

Identified gaps in coordinated and comprehensive care

Called for care plans to be delivered to all people treated for cancer

Called for improved care delivered to patients post treatment

Hewitt, Greenfield, & Stovall (2006). From Cancer Patient to Cancer Survivor: Lost inTransition. The National Academies Press: Washington, D.C. (p. 151).

+American Society of Clinical

Oncology (ASCO)

Landmark report in 2014: The State of Cancer Care in America

Emphasized: providing quality and coordinated cancer care

Described projected significant increase in number of new cases of cancer with the aging population (42% increase by 2025)

Described the projected) shortage of oncologists (projected deficit of 1,487 physicians over next 10 years)

Recommended new quality driven care delivery models and payment models

ASCO The State of Cancer Care in America: 2014

+National Comprehensive Cancer Network (NCCN)

Standards for Survivorship Care version 1.2015

1. Prevention of new and recurrence cancers and other late effects

2. Surveillance for cancer spread, recurrence, or second cancers

3. Assessment of late psychosocial and physical effects

4. Intervention for consequences of cancer and treatment (eg., medical, symptoms, psychological distress, financial and social concerns)

5. Coordination of care between primary care providers and specialists to ensure that all of the survivor’s health needs are met.

+

What does this mean for clinical care?

+

What are the unique needs of cancer survivors?

+

Physical Concerns Emotional Concerns Practical Concerns

Energy 59% Fear of recurrence

80% School 73%

Concentration 55% Grief and identity

60% Employment 45%

Sexual functioning

46% Personal appearance

62% Debt 27%

Neuropathy 42% Family member risk

51% Insurance 18%

Pain 34% Sadness and depression

51%

Lymphedema 23% Personal relationships

31%

Incontinence 22% Social relationships

29%

LIVESTRONG (2010). How cancer has affected post-treatment survivors: A LIVESTRONG Report, 2010. Assessed online March 1, 2015.

LIVESTRONG survey n2099

+ACS Study of Cancer Survivors

n 5000

Description Somewhat of a Problem (%)

A Severe Problem (%)

Less physically able to have sexual intercourse 30.1 17.2

Feeling fearful that my illness will return 53.8 14.5

Fatigue, loss of strength 52.7 12.8

Concern about relapsing 53.8 10.9

Sleep difficulties 42.7 10.1

Stein K, Smith T, Kim Y, et al. The American Cancer Society’s Studies of Cancer Survivors: the largest, most diverse investigation of long-term cancer survivors so far. Am J Nurs. 2006; 106(3):83-85.

+Guidelines & Resources

+Survivorship Information for

Patients

+Survivorship Guidelines for

Providers and Patients

+Cancer Rehab

an essential piece of cancer care; currently underutilized

+Diet & Exercise Guidelines

+Weight Management After Cancer

+

Possible Late Effects of Cancer Treatment

+Late Effects of Chemotherapy

Fatigue

Cardiomyopathy

Depression

Peripheral Neuropathy

Infertility (adults)

Renal toxicity

Mild cognitive changes

Gonadal failure / dysfunction

Osteonecrosis

Dental abnormalities

Loss of BMD; risk of osteopenia

Secondary cancers (AML, myelodysplasia, bladder cancer)

+Late Effects of Surgery

Pain

Loss of range of motion

Loss of function

Altered appearance

Loss of sensation

Lymphedema

Scarring / strictures / obstruction

+Late Effects of Radiation

Altered appearance

Pain

Pneumonitis

Scar tissue

Increased risk of secondary cancer (breast, skin, sarcoma)

Increased risk of Cardiovascular disease

Lymphedema

Thyroid dysfunction

Incontinence

Erectile Dysfunction

Neurocognitive deficits

Dental abnormalities

Cardiac toxicity

Reduced BMD/ scoliosis /kyphosis

Secondary cancers in area of radiation

+Late Effects of Hormone Therapy

Loss of libido

Depression

Loss of Muscle

Loss of bone density

Vaginal Dryness

Arthralgias

Hyperlipidemia

Cataracts

Blood clot

Uterine Cancer

Weight gain

+Emotional and Practical Late Effects Fear of recurrence

Depression

Anxiety

Changed and/or strained relationships

Altered outlook on life

Change of sexual function

Debt

Loss of income/job

Lack of ability to work or return to work

+

How does the clinic work?

+MFA’s Survivorship Clinic Goals

Thoroughly address question and concerns each patient has regarding life after cancer treatment

Provide evidenced based symptom management of the various physical and emotional long term and late effects of cancer treatment

Ensure each patient understands what the appropriate cancer surveillance recommendations are for them

Educate each patient about their potential long term risks due to their treatment and how to minimize their risk through healthy lifestyle choices and habits

Educate residents and other healthcare workers about the unique needs of cancer survivors

Coordinate care and communicate immediate patient issues and potential late effects of treatment to PCP and entire treatment team through verbal communication and by sharing the survivorship the care plan

+What Patients Say About The

Survivorship Clinic “very helpful and comforting. I was able to get a little more

organized and gained a good understanding of what I need to do.”

“extremely helpful. After a long time and being a multi-cancer survivor this program opened up my life again. This program has caused me to reach out even more for what I need to go forward. Thank you.”

“very informative. You really care about the patients. It’s obvious!”

“informative, helpful, not scary or overly intrusive. Responsive to my questions and friendly!!”

“exceptional. I was able to talk about my concerns. The team was very personal. They gave me helpful guidelines for my diet. I think every survivor should participate.”

+To Learn More

Cancer Survivorship E-learning Series for Primary Care Providers https://cancersurvivorshipcentereducation.org/Home_Page.html

Cancer Survivorship Training for Healthcare Professionals http://www.cancersurvivorshiptraining.com/

Cancer Survivorship in Primary Care: Resources for Primary Care Providers http://cancerpcp.org

City of Hope’s Preparing Professional Nurses for Cancer Survivorship Care http://www.cityofhope.org/survivorship-training-course-for-nurses

ASCO Survivorship Compendium and Tools http://www.asco.org/practice-research/cancersurvivorship