Beth Goings, RN, NP. Cancer Survivorship, Preventative Care and Screening. Sacred Encounters Perfect Care Healthiest Communities

Transcription

1 Beth Goings, RN, NP Cancer Survivorship, Preventative Care and Screening Sacred Encounters Perfect Care Healthiest Communities

2 What is Survivorship An individual is considered a survivor since the time of diagnosis, through the balance of his or her life. (NCCN 2017). Care should include: Prevention of new or recurrent cancer Assessment of late physical and psychosocial effects Other health maintenance and preventative care

3 Preventative Health Flu Vaccine yearly Pneumococcal vaccine > 65 yrs old Td/Tdap booster every 5 yrs. HPV for survivors through age 26 Colonoscopy Mammograms Pap smears PSA levels

4 Preventative Health Weight Management Nutrition Exercise Stop Smoking / Vaping Limit Second Hand Smoke Limit Alcohol Intake Limit Stress Supplemental Use

5 Recommend Sources of Dietary Components: Fat Plant Sources (such as olive or canola oil) Avocados Seeds and Nuts Fatty Fish Carbohydrates Fruits Vegetables Whole Grains Legumes Protein Poultry Fish Legumes Low-fat dairy foods Nuts Currently there is no consensus either refuting or supporting the role of soy foods in cancer control. Thus, moderate consumption (3 or fewer servings per day) of soy foods is considered prudent.

6 Principles of Anthracycline-Induced Cardiac Toxicity Cancer treatments can result in diverse cardiovascular issues. These guidelines focus specifically on heart failure or cardiomyopathy that may arise from anthracycline therapy. Other systemic therapies may also cause cardiomyopathy (eg, HER2-targeted therapies), and some of the concepts presented in these recommendations may apply to these other cardiomyopathies.

7 Anthracycline-Induced Cardiac Toxicity Continued Anthracycline-induced heart failure may take years or even decades to manifest. If detected early, anthracycline-induced heart failure may be responsive to cardioprotective medications, although prospective studies evaluating these medications are lacking. Having a history of anthracycline exposure plus additional cardiovascular risk factors increases the risk of developing cardiomyopathy and heart failure. For these guidelines, the panel has placed an emphasis on early recognition and prevention of clinical heart failure, as well as early treatment of patients at risk with appropriate cardioprotective medications to prevent cardiac remodeling over time.

8 Anthracycline-Induced Cardiac Toxicity Continued For high-risk survivors, the panel emphasizes the need for a thorough clinical screening for heart failure within one year after completion of anthracycline therapy. The panel recommends echocardiograms as the preferred imaging modality, when imaging is performed.

9 Screening for Second Cancers Screening for second primary cancer should be shared between the PCP and Oncologist Some patients have genetic susceptibility and need more careful surveillance (BRCA1/ Lynch Syndrome) Referral for genetic counseling Treatment related subsequent primary cancer depends on type of treatment patient underwent (Chemotherapy : which type; Radiation: location)

10 Case Study 28 year old treated for HD with Mantle radiation In 1991 In late 40s/ early 50s has a MI in Yosemite while hiking with family Pt now at 58 has a Hx of Aortic stenosis, CAD, S/P MI Pt does have a family Hx of heart disease In late summer 2017 develops a cough, goes back to oncologist who gets a CT chest, a lung nodule is seeing and decides to follow up, it continues to grow a PET/CT is done Bx reveals a lung cancer, subsequent EBUS shows reactive cells Pt goes to surgery and is found to be a stage IIIA lung cancer who now needs chemo and radiation adjuvantly Multidisciplinary team approach

11 Treatment Related Effects Mood Anxiety/ Depression Sleeping patterns Worries/Fears Nervous Difficulty concentrating Post-Traumatic Stress Disorder Flashbacks Fear of dying Fatigue Onset/History of fatigue Alcohol/Substance abuse Pain Anemia Medications Sleep disturbances

12 Treatment Related Effects: Menopause Related Symptoms Females Vaginal dryness Urogenital complaints Lack of libido Fatigue Hot Flashes Mood disturbances Cardiovascular disease Bone Health Males Lack of Libido Erectile Dysfunction Gynecomastia Hot Flashes Depression/ Mood Disturbances Cardiovascular disease Bone Health

13 Treatment Related Effects Pain Quality and intensity/ Trigger Is pain new or chronic Non Pharmacological treatment: Heat/ cold/ massage/ TENS Pharmacological treatment: non-opioids/ opioids Exercise Fear of recurrence

14 Thank you