Transcript SURVIVORSHIP - CHI Franciscan Health

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