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