Strategies for caring for the well cancer survivor

[lankisterguy]

Surveillance of existing cancer, management of treatment-related adverse effects, and screening for second cancers are key to the care the Family physician (FPs) should provide.

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J Fam Pract. 2018 October;67(10):624-628,630-635

Author(s): Michael J. Arnold, MD, CDR, USN; Courtney Saint, DO, LT, USN; Andrea Ochab, DO, LT, USN

Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Cancer survivors represent a rapidly increasing population (USA statistics below).

In 1971, there were 3 million cancer survivors, this number increased to 15.5 million in 2016 and will reach 20 million by 2026.1 TABLE 1 shows the percentage of survivors by type of cancer. Cancer survivors tend to be older, comprising nearly 1 of every 5 people older than 65 years.

The Institute of Medicine (IOM) identified 3 key characteristics of cancer survivors:

• Trajectories of survivorship are variable; many cancer patients have periods of relative health between episodes of their disease.

• Survivors require careful cancer monitoring; in addition to the risk that their primary cancer will recur, they have an elevated risk for another, second cancer.

• Both cancer and its treatments increase the risk of other medical and psychiatric problems.

Family physicians (FPs) have optimal skills for navigating the chronic risks and health concerns of the well cancer survivor. This article reviews the primary care management of the functional cancer survivor, focusing on the management of chronic conditions and preventive care.

Survivorship follows any of 6 paths

Cancer survivorship is increasing in importance as treatment has steadily reduced mortality. Six trajectories of cancer survivors have been identified:

• living cancer-free after treatment with minimal effects

• living cancer-free but suffering serious treatment complications

• Suffering late recurrence

• Developing a second cancer

• Living with intermittent cancer recurrences

• Living with cancer continuously.

Only patients in the last 2 groups are likely to be managed primarily by oncologists

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Manage the effects of both the cancer and the treatment

Medical issues faced by cancer survivors are familiar to FPs, but there are some specific recommendations regarding evaluation and treatment that stand in contrast to what would be considered for a healthy, or non-cancer, patient. For example, each chemotherapeutic agent has characteristic adverse effects;

TABLE 7 lists the principal adverse effects of common agents and recommendations for testing when these problems develop. Common long-term problems in cancer survivors include fatigue, chronic pain, cognitive dysfunction, psychiatric illness, and cardiovascular disease. Although these symptoms and manifestations are common, the physician must be careful: New or changing symptoms could signal the spread or recurrence of disease. Fear of recurrence can lead patients to exaggerate or minimize symptoms.

Len

[AussieNeil Partner Founder Admin]

The table is not only informative in showing the relative 5 year survival times for common cancers, but also the relative rarity of leukaemia.

Great information, even though it is hard to fit the concept of being a cancer survivor when we haven't necessarily had treatment!

Neil