SURVIVORSHIP - CHI Franciscan Health
Download
Report
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