Cancer
Cancer Survivor Care
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Cancer Survivor Care
, Cancer Survivor, Childhood Cancer Survivor, Adult Cancer Survivor
See Also
Bone Marrow Transplant
(for related complications)
Childhood Cancer
Breast Cancer Survivor
Prostate Cancer Survivor Care
Melanoma
Non-Hodgkin's Lymphoma
Acute Myeloid Leukemia
Acute Lymphoblastic Leukemia
Hodgkin's Lymphoma
Epidemiology
Adult Cancer survival rates >5 years are high for some common cancers (U.S., 2003-9)
Prostate Cancer
5 year survival: 99.2%
Melanoma
5 year survival: 91.3%
Breast Cancer
5 year survival: 89.2%
Hodgkin
Lymphoma
: 85.1%
(2015) SEER, NCI
http://seer.cancer.gov
Precautions
Childhood Cancer
treatments are associated with a 4-fold increased risk of chronic disease over their siblings
Cancer Survivors have a biological age that is advanced 10-15 years beyond their
Chronological age
Diabetes,
Coronary Artery Disease
,
Hypertension
and
Hyperlipidemia
present in the 30s of Childhood Cancer Survivors
Secondary cancers develop in 20% of Cancer Survivors (related to
Chemotherapy
or radiation)
Alkylating Agent
s and topoisomerase II inhibitors
Associated with aggressive, poor-prognosis
Leukemia
s (typically AML) within 10 years of initial cancer treatment
Radiation Therapy
Tumor development in region of radiation 15-20 years after radiation treatment
Adverse Effects
Survivors of
Childhood Cancer
s
Skin Effects from
Radiation Therapy
Dysplastic Nevi
Skin Cancer
Ocular Effects from Bisulfan,
Corticosteroid
s, Radiation or neurosurgery
Cataract
s
Retinopathy
(
Radiation Therapy
>30 Gy)
Ocular nerve palsy (neurosurgery related)
Auditory Effects from Cisplatin, Carboplatin, Radiation (>30 Gy)
Sensorineural Hearing Loss
Conductive Hearing Loss
(
Radiation Therapy
)
Dental Effects from radiation or early
Chemotherapy
prior to seconday
Dentition
Dental development effects or
Periodontal Disease
Osteoradionecrosis (
Radiation Therapy
>40 Gy)
Cardiovascular Effects
Anthracycline (e.g. doxorubicin, daunorubicin) related
Congestive Heart Failure
(associated with 50% mortality in 2 years after diagnosis)
Cardiomyopathy
Arrhythmia
Radiation Therapy
related
Valvular disease
Coronary Artery Disease
Pericarditis
Pulmonary Effects from radiation, lobectomy or Bleomycin, Busulfan, or nitrosureas (carmustine/BCNU and lomustine/CCNU)
Pulmonary fibrosis
Interstitial pneumonitis
Restrictive Lung Disease
Breast
Effects from radiation
Breast
tissue hypoplasia
Breast Cancer
(
Radiation Therapy
>20 Gy)
Gastrointestinal Effects from laparotomy, radiation (>30 Gy)
Chronic Colitis
Intestinal Stricture
Abdominal adhesions
Fecal Incontinence
Colon Cancer
(
Radiation Therapy
>30 Gy)
Liver
Effects from mercaptopurine, thioguanine,
Methotrexate
or radiation (>30 Gy)
Liver
function abnormalities
Veno-occlusive disease
Hepatic fibrosis
Cirrhosis
Cholelithiasis
Renal Effects from Cisplatin, Carboplatin, Isosfamide,
Methotrexate
, nephrectomy or
Radiation Therapy
Glomerular toxicity
Tubular dysfunction
Renal Insufficiency
Hypertension
Bladder
effects from Cyclophosphamide, isofosfamide, radiation,
Spine Surgery
or cystectomy
Hemorrhagic cystitis
Bladder
fibrosis
Neurogenic
Bladder
Bladder Cancer
(
Radiation Therapy
or cyclophosphamide)
Male reproductive effects from
Alkylating Agent
s, radiation, surgery
Arrested
Puberty
Hypogonadism
Infertility
Erectile Dysfunction
Female reproductive effects from
Alkylating Agent
s, radiation, surgery
Arrested
Puberty
Premature
Menopause
Infertility
Uterine vascular insufficiency (
Radiation Therapy
)
Vaginal stenosis (
Radiation Therapy
)
Endocrine effects from radiation (pituitary, neck),
Thyroid
ectomy
Growth Hormone Deficiency
Precocious Puberty
Hypothyroidism
Thyroid Nodule
s and
Thyroid Cancer
Hypoprolactinemia (radiation >40 Gy)
Central
Adrenal Insufficiency
(radiation >40 Gy)
Gonadotropin deficiency (radiation >40 Gy)
Hyperthyroidism
(radiation >40 Gy)
Diabetes Mellitus
(full body or abdominal radiation)
Musculoskeletal effects from
Corticosteroid
s,
Methotrexate
Osteoporosis
Osteonecrosis
Musculoskeletal effects from
Radiation Therapy
Radiation induced
Fracture
s (>40 Gy)
Scoliosis
or kyphosis
Secondary musculoskeletal cancers
Reduced function or uneven growth
Neurologic effects from
Methotrexate
or cytaribine (doses >1000 mg/m2), radiation or neurosurgery
Cognitive deficits, IQ Effects and
Learning Disorder
s
Leukoencephalopathy
Cerebrovascular Disease
(neck or upper chest radiation)
Brain Tumor
s
Peripheral Nervous System
effects from vincristine, vinblastine, cisplatin, carboplatin or
Spine Surgery
Peripheral Neuropathy
Immunologic effects from radiation to
Spleen
, or splenectomy
Asplenia
References
(2009) Pediatrics 123(3): 906-15 [PubMed]
Management
Monitoring
See
Breast Cancer Survivor
See
Colorectal Cancer
See
Prostate Cancer Survivor Care
See
Melanoma
See
Non-Hodgkin's Lymphoma
See
Acute Myeloid Leukemia
See
Acute Lymphoblastic Leukemia
See
Hodgkin's Lymphoma
Prevention
Coordinate care between primary care and oncology
Survivorship care plan
Summary of treatment history and future plan as created by cancer care team
Outlines long-term adverse effects and surveillance for complications, recurrence, secondary cancers
Offers recommendations on prevention, maintenance of well-being, and information on legal protections
Cancer Survivors can benefit significantly from more vigilant primary care and preventive care
Cancer Survivors are less likely to be counseled on
Tobacco Abuse
, diet and
Exercise
Grunfeld (2006) 24(6): 848-55 [PubMed]
Cancer Survivors are less likely to have had
Influenza
screening, lipid screening or
Cervical Cancer Screening
Earle (2004) Cancer 101(8): 1712-9 [PubMed]
Cancer Survivors have increased mortality from associated comorbid conditions
Cancer Survivors with diabetes have a 40% increased all-cause mortality over those without diabetes
Barone (2008) JAMA 300(23): 2754-64 [PubMed]
Obtain a
Family History
Consider
Genetic Counseling
for the Cancer Survivor (and their children, siblings) if
Family History
positive
Screen for psychosocial conditions
Major Depression
Anxiety Disorder
Insomnia
Fatigue
'
Cognitive Impairment
Resources
Survivorship Guidelines Website
http://www.survivorshipguidelines.org
Survivorship (NCI)
http://www.cancer.gov/about-cancer/coping/survivorship
References
(2009) Pediatrics 123(3): 906-15 [PubMed]
Bhatia (2012) Pediatrics 130(6): 1141-3 [PubMed]
Kattlove (2003) CA Cancer J Clin 53:172-96 [PubMed]
Wilbur (2015) Am Fam Physician 91(1):29-36 [PubMed]
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