1. 2009

2. WHO IS A SURVIVOR? AN INDIVIDUAL IS A SURVIVOR FROM THE TIME OF THEIR DIAGNOSIS THROUGH THE BALANCE OF THEIR LIFE.

3. 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

4. MALE CANCER SURVIVORS 2002

5. FEMALE CANCER SURVIVORS 2002

7. SURVIVORSHIP CURVE:

8. SURVIVAL – TYPES OF CANCER

9. WHAT SURVIVORS WANT? TREATMENT SUMMARY SURVIVORSHIP CARE PLAN COORDINATED CARE QUALITY CARE

10. TREATMENT SUMMARY STAGE OF DISEASE PATHOLOGICAL DIAGNOSIS TREATMENTS – SURGERY – RADIATION – CHEMOTHERAPY

11. 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

12. TREATMENT SUMMARY cont. INFORMATION ON PSYCHOSOCIAL ISSUES-MARRIAGE -PARTNER, PARENTING FERTILITY, SEXUALITY PREVENTION STRATEGIES DISABILITY, WORK, LEGAL ISSUES

13. 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

14. 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

15. QUALITY OF LIFE PSYCHOLOGICAL WELL-BEING PHYSICAL SOCIAL SPIRITUAL

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

17. BARRIERS: FRAGMENTED HEALTH CARE SYSTEM POOR COORDINATION AND DISTRIBUTION OF CARE LOCUS OF RESPONSIBILITY COMMUNICATION VARIATION IN QUALITY

19. 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

20. RISK REDUCTION COMPLIANCE WITH PRESCRIBED THERAPIES MEDICATIONS TAMOXIFEN, AROMATASE INHIBITORS DIET FAT REDUCTION EXERCISE LEVEL AND FREQUENCY OF PHYSICAL EXERCISE NUTRIENTS, VITAMINS VIT D

21. 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

22. 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

23. 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

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

26. 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

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

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

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

30. 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

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

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

33. 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

34. TOXICITY OF TREATMENT BOWEL FUNCTION COLOSTOMY PSYCHOSOCIAL DISTRESS SEXUAL DYSFUNCTION NEUROPATHY

35. 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

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

37. 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