1. “Living Your Best After Cancer: You and Your Primary Care Doctor Working Together" Mary Helen Hackney, MD
Associate Professor of Hematology/Oncology at VCU Massey Cancer Center
Specialist in treatment for all stages of breast cancer
Treats cancer of all types through Massey’s Rural Cancer Outreach Program
Teaches residents and health professionals about prevention, long-term patient management and survivorship issues.

2. Virginia Commonwealth University
Living Your Best After Cancer: You and Your Primary Care Doctor Working Together
Mary Helen Hackney, M.D.
Massey Cancer Center
Virginia Commonwealth University

3. DO NOT SMOKE

4. Who…. Over 10.1 million cancer survivors
Increasing priority of many groups including the American Society of Clinical Oncology (ASCO)
Be your own advocate

5. Taking Care of Yourself
Establish a relationship with a general medicine physician

6. Taking Care of Yourself
Know how your cancer was treated
Chemotherapy drugs
Radiation therapy
Share the information with any new health provider
Ex. Bleomycin may affect lungs during anesthesia even years out

7. Taking Care of Yourself
Establish good health habits
Weight control
Exercise
No tobacco
No or moderate alcohol

8. Testing Different cancers have different follow up care guidelines
Know which apply to you
ASCO developing guidelines
Routine CT scans or PET scans are not indicated for all cancer

9. The Annual Physical Controversial: probably needs to be more directed
Know your family history: not just cancer but other diseases (cholesterol, heart disease, diabetes, etc.)
What should the physical include?
Exam, lots of questions, medication review
Selected tests

10. Family History
Will help your physician know when to start certain types of screening
Example
Lynch Syndrome/Hereditary Nonpolyposis Colorectal Cancer: colon & ovarian cancer
Diabetes in family will prompt more interest in weight control

11. Do Not Smoke

12. Assessing the Risk Family genetics
BRCA 1 and 2 (also ovary, male breast cancer, prostate, colon ca)
P53 (Li Fraumeni) (breast ca., brain ca., adrenal ca, sarcoma, leukemia)
PTEN (Cowden’s) (thryoid ca., hamartomas, prostate ca, breast ca.)
Ataxia telangectasia-life time risks increased for heterozygotes (autosomal recessive)(breast cancer)

13. Breast Exam and Mammography
Start at age 40 and then yearly
Start earlier if family history of breast cancer or chest irradiation
Self breast exams monthly while in 20s
Medical professional exam every 3 yrs in 20s, then yearly
If you are a breast cancer survivor, guidelines are different

14. Colonscopy (colon cancer screening)
Start colonoscopy for screening at age 50
Follow studies will be 3-10 years depending on results
Start screening earlier if family colon cancer history or personal history of ulcerative colitis, Crohn’s or polyp history
Less use of stool testing, barium enema, sigmoidoscopy

15. Gynecology Evaluation
PAP smears recommended every three years if normal
Hysterectomy for benign cause: no need for PAP smear
HPV testing: new and under development
If ovaries remain, then need bimanual exam
If you have a cancer history, guidelines are different

16. Blood Tests Tumor Markers
Ca 125
Not indicated for screening
Trial underway to assess role in high risk women
PSA (prostate specific antigen)
Controversial: start at age 50, yearly. Start earlier if family history or African American
There is no perfect blood test to screen for cancer

17. Other Blood Tests Cholesterol, lipid panel Kidney and liver function
Esp. if over 50, diabetic, family history, overweight
Kidney and liver function
Suggested for specific situations e.g. on cholesterol medications, diabetes, etc.
Complete blood count with white cells, red cells and platelets

18. Other Health Maintenance….
Ophthamology
Many drugs and radiation can affect eyes
Cataracts may worsen

19. Other Health Maintenance….
Vaccinations
Pneumovax every 5 years after splenectomy or if over 60
Tetanus
Hepatitis if appropriate
Additional vaccinations if bone marrow transplant

20. No Tobacco

21. Continuing Health Maintenace….
Dentist
Many drugs affect gums and teeth
Good oral hygiene important during and after treatment
Bone density
Many chemo drugs affect bones
Every 2 years
Exercise, calcium, consider bisphosphonates

22. Taking Care of Your Health
Exercise
Weight Control
No tobacco
Limit/moderate alcohol consumption
Know your past treatment history and risks of future problems

23. Future….
Development of programs to provide easy to use/portable information packets tailored to specific disease treatments
May be in a electronic format
Development of tailored treatments to reduce risks of long term sequalae
Increasing number of websites, journals and information venues providing guidance on good health for survivors

24. Surviving…Living…
10 million and more…..
Thank you!