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

MALE CANCER SURVIVORS 2002

FEMALE CANCER SURVIVORS 2002

SURVIVORSHIP CURVE:

SURVIVAL – TYPES OF CANCER

WHAT SURVIVORS WANT? TREATMENT SUMMARY SURVIVORSHIP CARE PLAN COORDINATED CARE QUALITY 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 PLAN PREVENTION OF RECURRENT CANCER AND NEW CANCERS SCREENING DIET ACTIVITIES SURVEILLANCE FOR CANCER INTERVENTION FOR ACUTE AND LATE EFFECTS OF CANCER AND TREATMENT PHYSICAL, EMOTIONAL, PSYCHOLOGICAL, LEGAL

QUALITY OF LIFE PSYCHOLOGICAL WELL-BEING PHYSICAL SOCIAL SPIRITUAL

PSYCHOLOGICAL FEAR OF RECURRENCE “DEMOCLES SWORD” FEAR OF A SECOND CANCER FEAR OF LATE OR LONG-TERM TOXICITIES ANXIETY, DEPRESSION AND/OR WITHDRAWAL

BARRIERS: FRAGMENTED HEALTH CARE SYSTEM POOR COORDINATION AND DISTRIBUTION OF CARE LOCUS OF RESPONSIBILITY COMMUNICATION VARIATION 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 REDUCTION COMPLIANCE WITH PRESCRIBED THERAPIES MEDICATIONS TAMOXIFEN, AROMATASE INHIBITORS DIET FAT REDUCTION EXERCISE LEVEL AND FREQUENCY OF PHYSICAL EXERCISE NUTRIENTS, VITAMINS VIT D

BREAST CANCER / PYSCHOLOGY PSYCHOLOGICAL DISTRESS LEVELS AND TRANSITIONS RISK FACTORS: PREVIOUS ANXIETY OR DEPRESSION AFFECTED BY SOCIAL AND FAMILY SUPPORT INTERVENTIONS: SUPPORT GROUPS PSYCHOLOGIST RETREATS-HARMONY HILL

LYMPHEDEMA SYMPTOMS: SWELLING OF ARM, CHEST, AXILLARY TISSUES PAIN, PARESTHESIAS, INFECTION, LYMPHATIC DYSFUNCTION RISK: EXTENT OF TREATMENT-SURGERY, RADIATION TREATMENT: MASSAGE MANUAL DRAINAGE COMPRESSION GARMENTS

PREMATURE MENOPAUSE SYMPTOMS: HOT FLASHES, SWEATS, VAGINAL DRYNESS, LIBIDO, URINARY SYMPTOMS, SLEEP AND/OR MOOD DISTURBANCES RISK: CHEMO, AGE, ANTI-ESTROGEN THERAPY THERAPY ESTROGEN REPLACEMENT SUPPORT TIME

OTHER IMPORTANT ISSUES: WEIGHT GAIN OSTEOPOROSIS HEART DISEASE MUSCULOSKELETAL PAIN FATIGUE COGNITION NEUROPATHY

FOLLOW–UP CLINICAL VISIT EACH OF 3 MONTHS, FOR 3 YEARS SUBSEQUENT VISITS EVERY 6 MONTHS FOR YEARS 4-10 TALK, EXAM LABS, MARKER STUDIES IMAGING MAMMOGRAM MRI IN CERTAIN INSTANCES OTHER SCANS

PROSTATE CANCER MOST COMMON CANCER FOR MEN GREAT VARIATION IN TREATMENT OPTIONS SURGERY RADIATION HORMONAL ANTI-ANDROGEN

RECURRENCE RISK: STAGE, AND GRADE LOCAL RECURRENCE VS DISTANT (BONE) SURVEILLANCE FOR RECURRENCE - PSA AND EXAM SECOND CANCER-BLADDER, RECTAL CANCER

TOXICITY SEXUAL DYSFUNCTION BLADDER: INCONTINENCE PAIN URGENCY BOWEL FUNCTION OSTEOPOROSIS SLEEP COGNITION

FOLLOW-UP CLINIC VISIT EVERY 3 MONTHS FOR 2 YEARS WITH EXAM PSA EVERY 6 MONTHS LONG TERM FOLLOW-UP EVERY 6 MONTHS MEDICATION = COMPLIANCE

PREVENTION LIFE-STYLE WEIGHT REDUCTION DIET EXERCISE ANTI-ANDROGEN THERAPY

COLO-RECTAL CANCER SECOND MOST COMMON CAUSE OF CANCER DEATH EASILY SCREENED 80% DIAGNOSED WITH CURABLE STAGES OF DISEASE Stage 1, 2 or 3.

COLO-RECTAL CANCER RECURRENCE-40% RISK BASED ON STAGE AND GRADE SECOND COLON CANCER: RISK-1.5%/5YR ANOTHER CANCER: FAMILY HISTORY GENETICS-FAMILIAL POLYPOSIS, HNPCC

TOXICITY OF TREATMENT BOWEL FUNCTION COLOSTOMY PSYCHOSOCIAL DISTRESS SEXUAL DYSFUNCTION NEUROPATHY

FOLLOW-UP CARE COLONOSCOPY –PRESURGERY, POST- SURGERY EVERY 1-3 YEARS, THEN EVERY 5 YRS LABS-CEA CT SCANS VISITS EVERY 3 MONTHSFOR 2 YEARS THEN EVERY 6 MONTHS FOR 3 YEARS, THEN ANNUALLY

PREVENTION LIFE-STYLE DIET, EXERCISE-SIMILAR STUDIES SUGGESTING BENEFIT ASPIRIN KEEP APPOINTMENTS FOR FOLLOW-UP

CONCLUSION SURVIVORSHIP WILL BE PART OF OUR LIVES EXPECTATIONS FOR GOOD HEALTH CARE SHOULD BE HIGH FOCUS ON USING THE CANCER EXPERIENCE AS A “WINDOW OF OPPURTUNITY” TO HELP DIRECT FURTHER HEALTHCARE