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Oncology > Primary Care for Survivors > Flashcards

Flashcards in Primary Care for Survivors Deck (51):
1

Define Cancer Survivor

Anyone who has been diagnosed with cancer from the time of initial diagnosis until the end of their life

2

Types of Sequelae of Cancer Treatment

Physical/Medical
Psychological
Social
Existential & spiritual issues

3

Physical/Medical Sequelae of Cancer Treatment

Second cancers
Cardiac dysfunction
Pain
Lymphedema
Sexual impairment
Infertility

4

Psychological Sequelae of Cancer Treatment

Depression
Anxiety
Uncertainty
Isolation
Altered body image

5

Social Sequelae of Cancer Treatment

Changes in interpersonal relationships
Concerns regarding health or life insurance
Career issues
Return to school
Financial burden

6

Existential & Spiritual Sequelae of Cancer Treatment

Sense of purpose or meaning
Appreciation of life

7

How many pediatric cancer survivors experience at least 1 late effect?

2/3 or 66%

8

Why is there a need for a systemic plan for lifelong surveillance?

Incorporate risks based on therapeutic exposures, genetic predisposition, health-related behaviors, & co-morbid health conditions

9

What components should be included in surveillance of survivors of cancer?

Longitudinal care plan
Continuity
Emphasis on the whole person

10

Survivors at Highest Risk for Late Term Effects

Bone tumors
CNS tumors
Hodgkin's lymphoma

11

Late Term Effects with Bone Tumors

Disfigurement & functional limitations caused by amputations & other surgeries
Problems with fertility, heart, & kidney damage & secondary cancers

12

Late Term Effects with CNS Tumors

Cognitive impairment
Short stature
Hearing loss
Problems with balance & coordination
Hypothyroidism
Thyroid nodules
Kidney damage
Secondary cancers

13

Later Term Effects with Hodgkins Lymphoma

Lung damage
Abnormal skeletal growth & maturation
infertility
Hypothyroidism
Increased risk for breast cancer

14

Disabilities Secondary To Pediatric Cancer Treatment

Secondary malignancies
Growth complications
Endocrine complications
Cardiopulmonary complications
Renal complications
Neuropsychological/ psychosocial complications

15

Secondary Malignancies in Pediatric Cancer Survivors

12% within 20 years
Exposure to alkylating agents + radiation most common causes
Genetic & Familial conditions increase risk of retinoblastoma, neurofibromatosis, nevoid BCC, etc.

16

Growth Complications in Pediatric Cancer Survivors

Direct damage to endocrine tissue
Highest risk: ALL, brain tumors, orbital tumors, nasopharyngeal CA with radiation
Children

17

Endocrine Complications in Pediatric Cancer Survivors

Early puberty
Premature close of epiphyses
Thyroid dysfunction: normal thyroxine, abnormal TSH
Gonadal dysfunction: azospermia, low testosterone, delayed sexual development
Ovarian dysfunction: failure to undergo menarche, increased FSH & LH levels, low estrogen
Delayed menses
Risk for early menopause
Pregnancies considered high-risk
Perinatal death or low-birth-weight, premature infants

18

Methods of Causing Cardiopulmonary Complications in Pediatric Cancer Survivors

Bleomycin: pulmonary fibrosis
Nitrosoureas: pulmonary fibrosis
Cyclophosphamide: pulmonary fibrosis
Methotrexate: pulmonary fibrosis
Antracyclines: CHF, arrhythmias
Radiation: increased risk of CAD & chronic restrictive pericarditis

19

Renal Complications in Pediatric Cancer Survivors

Abnormal glomerular filtration rate: cisplatin
Persistent tubular dysfunction: cisplatin
Hemorrhagic cystitis: cyclophosphamide
Fanconi syndrome: ifosfamide

20

Define Fanconi Syndrome

Proteinuria
Glycosuira
Phosphaturia with hypophosphatemia

21

Neuropsychological Complications in Pediatric Cancer Survivors

Highest risk: ALL, brain tumors
Severity: dose, size & location of radiation field, child's age, gender
Main effects: visual processing speed, visual motor integration, sequencing ability, short-term memory

22

Psychosocial Complications in Pediatric Cancer Survivors

Absence from school
Frequent medical appointments
Hospitalizations
Social isolation
Increased sense of physical fragility
Vulnerability manifested by hypochondria or phobic behaviors

23

Medical Goals with Cancer Surveillance

Early recognition & treatment of late effects
Improve QOL
Decrease healthcare costs

24

Psycho-Social Goals with Cancer Surveillance

Establish "new normal"
Social life
School & work

25

Surveillance Caveats

Over Screening: undue fear, unnecessary screening, high costs
Under screening: missed late effects, missed early intervention, missed chance to minimize morbidity, long run have higher healthcare costs

26

What every survivor should know

What kind of cancer they had
What kind of chemo they received
What kind & how much radiation they received
Any adjunct therapy
Name of med & rad oncologist

27

Routine Monitoring with CNS Radiation in Pediatric Patients

Growth: height, weight, growth velocity, scoliosis screening, growth hormone testing
Neuro-psych screening yearly

28

Routine Monitoring with Chest Radiation in Pediatric Patients

Thyroid monitoring
PFTs
Cardiac workup for cardiac toxicity
Breast CA monitoring

29

Routine Monitoring with Abdominal/pelvic Radiation in Pediatric Patients

Renal: UA, CMP, eGFR, blood pressure, renal US, cystoscopy
Males: testicular size, semen analysis, testosterone levels, FSH & LH levels
Females: detailed menstrual history, FSH & estrogen levels, uterine US

30

Low Risk for Cardiac Toxicity in Pediatric Patients

Anthracyclines 5 y.o. at treatment

31

Moderate Risk for Cardiac Toxicity in Pediatric Patients

Radiation to chest or neck
Anthracyclines 250-400 mg
Age

32

High Risk for Cardiac Toxicity in Pediatric Patients

Anthracyclines + radiatin to chest
Anthracyclines > 400 mg
Pre-existing cardiac disease + anthracyclines

33

Goals of Follow Up Care in Adults

Prevent premature mortality
Prevent/detect early physiologic or psychosocial sources of morbidity
Management of co-morbidities
Screen for 2nd cancers

34

Surveillance After Breast Cancer

Recurrence
Secondary CA
PE
Psychosocial
Other considerations

35

Recurrence Surveillance After Breast Cancer

Monthly SBE
CBE every 6 months for 5 years then annually
Mammogram annually

36

Secondary Cancer Surveillance After Breast Cancer

Increased risk for ipsilateral & contralateral breast CA, ovarian & colorectal CA

37

PE Surveillance After Breast Cancer

Lymphedema
Premature menopause Osteoporosis
Uterine CA

38

Psychosocial Surveillance After Breast Cancer

Distress about risk of recurrence
Sexuality
Body image
Depression
Anxiety

39

Other Considerations for Surveillance After Breast Cancer

Assess age at diagnosis
Family cancer history
Referral for genetic counseling
Annual pelvic
Screening for colorectal & cervical cancer
Pneumococcal & influenza vaccinations
Assess Psychosocial function

40

Surveillance After Prostate Cancer

Recurrence
Secondary cancers
PE
Psychosocial
Other considerations

41

Recurrence Surveillance After Prostate Cancer

Clinical evaluation
PSA every 6 months for 5 years, then annually
DRE annually

42

Secondary Cancer Surveillance After Prostate Cancer

Increased risk of bladder CA

43

PE Surveillance After Prostate Cancer

Sexual dysfunction
Bowel/urinary incontinence
Radiation proctitis
Diarrhea

44

Psychosocial Surveillance After Prostate Cancer

Depression
Anxiety

45

Other Considerations for Surveillance After Prostate Cancer

Asses age at diagnosis
Family cancer history
Referral for genetic counseling
Colorectal cancer screening
Pneumococcal & influenze vaccinations
Assess psychosocial function

46

Surveillance After Colorectal Cancer

Recurrence
Secondary Cancers
PE
Psychosocial
Other considerations

47

Recurrence Surveillance After Colorectal Cancer

CEA
Clinical exam every 3 months for 2 years, then 6 months for 3-5 years
CT scan every 3-6 months for 2 years, then every 6-12 months for total of 5 years
Colonoscopy after 1 year, then 3 years, then 5 years

48

Secondary Cancer Surveillance After Colorectal Cancer

Colorectal cancer at a different site

49

PE Surveillance After Colorectal Cancer

Ostomy care
Rectal incontinence
Radiation proctitis
Diarrhea
Adhesions

50

Psychosocial Surveillance After Colorectal Cancer

Sexuality
Body image
Depression

51

Other Considerations for Surveillance After Colorectal Cancer

Assess family cancer history for FAP & HNPCC
Refer for genetic counseling & assessment
Breast & cervical cancer screening
Pneumococcal & influenza vaccinations
Assess psychosocial functions