ESPEN Congress The Hague 2017

Transcription

1 ESPEN Congress The Hague 2017 Hospital discharge: and now? The future of cancer survivors M. Muscaritoli (IT)

2 Hospital discharge: and now? Monday 11 September, 08:30-10:00, room Amazon The future of cancer survivors Maurizio Muscaritoli, MD Department of Clinical Medicine Sapienza, University of Rome I declare I have no conflict of interest

3 The future of cancer survivors Learning objectives: Know the long-term outcomes of surviving cancer patients, including quality of life and nutritional status Know the long-term complications of chemotherapy, radiation therapy and surgery affecting nutritional status, including radiation enteritis, dysphagia and xerostomy Know the principles of nutritional tertiary prevention of cancer

4 Jemal A, et al. J Natl Cancer Inst. 2017;109.

5 Age-standardized mortality rates and recent trends (five years) for the most common cancers by sex Jemal A, et al. J Natl Cancer Inst. 2017;109.

6 Changes in five-year relative survival for select childhood cancers (0 14 years) Jemal A, et al. J Natl Cancer Inst. 2017;109.

7 2. 5-year relative survival of all malignancies diagnosed , stratified by sex in Europe Rowland J at al. Cancer. 2013:

8 Cancer Treatment & Survivorship Facts & Figures

9 Cancer Treatment & Survivorship Facts & Figures

10 Timeline of important events in the evolution of the field of cancer survivorship Rowland et al. Cancer :

11 Cancer survivor : what s in 2 words?

12 «Survival is a much more useful concept, because it is a generic idea that applies to everyone diagnosed as having cancer, regardless of the course of the illness. Survival, in fact, begins at the point of diagnosis, because that is the time when patients are forced to confront their own mortality and begin to make adjustments that will be part of their immediate and to some extent, long-term future» (Fitzhugh Mullan in a New England Journal of Medicine article entitled Seasons of Survival in ). Hebdon M et al. Journal of Advanced Nursing 2015:

13 Wronski S. et al. Psionoclogia. 2015, pp. 7-18

14 Trajectories of someone with cancer Mayer D. Lancet Oncol 2017; e11 18

15 Potential long-term and late effects of treatment and how they affect cancer survivors: Several domains are involved Cognitive impairment Pain Bowel or bladder dysfunction Psychosocial issues Fatigue Role disruption Economic problems Sleep problems Sexual dysfunction Social isolation Cancer survivor Loss or change in employment status Osteoporosis Hot flashes Spiritual issues Struggle for meaning Fear of recurrence Anxiety or depression Peripheral neuropathy Lymphoedema Modified from:jacobs L. et al. Lancet Oncol 2017;9-29

16 Additional Medical Care Expenditures and Use Among Survivors of Cancer With Chronic Conditions Additional Lost Productivity and Source of Lost Productivity Among Survivors of Cancer With Chronic Conditions Guy PJ et al. Clin Oncol 2017:

17 Long-term complications of chemotherapy, radiation,surgery Summary of Potential Long-Term and Late Effects of Head and Neck Cancer and its Treatment by Treatment Type Cohen EEW, et al. CA Cancer J Clin 2016;

18 Cohen EEW, et al. CA Cancer J Clin 2016;

19 Cohen EEW, et al. CA Cancer J Clin 2016;

20 It is recommended that primary care clinicians should refer HNC survivors for a nutritional intervention in order to: a) Achieve a dietary pattern that is high in vegetables, fruits, and whole grains and low in saturated fats, sufficient in dietary fiber, and avoids alcohol consumption b) Address nutrition related challenges i.e. eating issues, swallowing problems, and pain management to maintain a healthy weight for those at risk for cachexia. c) Limit consumption of high-calorie foods and beverages and increase physical activity to promote and maintain weight loss Cohen EEW, et al. CA Cancer J Clin 2016;

21 Chue H et al. Annals of Pediatric Endocrinology & Metabolism 2017:

22 Vascular toxicity and long-term cardiovascular complications of anticancer therapy Svilaasa T. et al. Thrombosis Research 2016;109 S118

23 Patients who have undergone pancreatic resection are at risk for many nutrition-related comorbidities, including: Effects on gastrointestinal and hepatic function Glucose control Bone health Micronutrients status The standard of care for these patients should include monitoring and evaluating these nutrition problems with the goal of promoting long-term disease free survival. Little research currently exists that examines these comorbidities in this patient population Until this research gap is addressed, clinicians have few options other than to consider research focused on nutrition-related problems in similar populations. Petzel M. et al. Nutr Clin Pract 2017

24 Quality of life in cancer survivors Mayer D. Lancet Oncol 2017; e11 18

25 Quality of life in survivors Høxbroe Michaelsen S.H. et al. European Journal of Cancer 2017: 91e102

26 Box plots of FACT-F total scores in study sample (sex and type) compared with general population and healthy population Jones JM. et al. J Cancer Surviv 2016: 51 61

27 Rosenberg SM. The Lancet Oncology 2017 data suggest that tailored intervention to patient needs, and targeting of populations at the greatest risk of problems in cancer survivorship are more likely to show effectiveness than generic, not tailored interventions, or intervening among those already receiving the care and support they need... A consensus exists surrounding the need for more research, increased collaboration, renewed attention to the needs of survivors that are too frequently overlooked, and a push for improvements in how we implement models of care and interventions, with incorporation of robust evaluations to measure programme effectiveness.

28 Mouroutia N. et al. Maturitas 2017, in press.

29 Marian MJ. Nutr Clin Pract 2017

30 Cancer patients should be encouraged to obtain micronutrients and phytonutrients associated with a reduced risk for cancer by consuming a prudent diet rich in fruits, vegetables, legumes, nuts, and seeds, and avoiding processed and fast foods. Living a healthy lifestyle has been associated more with a reduced risk for developing cancer and other chronic diseases than using dietary supplements Marian MJ. Nutr Clin Pract 2017

31 Arends J, et al. Clin Nutr. 2017:11-48

32 NUTRITION WHAT DO CANCER SURVIVORS NEED? Recognizing a cancer diagnosis as a teachable moment National Comprehensive Cancer Network Weight Management Achieve and maintain a healthy body weight throughout life a. Pay attention to calories consumed vs. calories expended b. Achieve and maintain normal BMI c. Weigh oneself weekly to monitor weight loss/gain Nutrition Maintain a healthy diet high in fruits, vegetables and whole grains and low in red/processed meat, sugars and fats Minimize alcohol intake: a. Limit to one drink per day for women and two per day for men Physical Activity Engage in physical activity regularly a. Avoid inactivity, engage in general physical activity daily (taking the stairs, parking in the back of parking lot) b. Strive for at least 150 min of moderate or 75 min of vigorous activity per week (spread out over the week) Smoking Avoid tobacco products NCCN Clinical Practice Guidelines in Oncology: Survivorship Version I. 2015

33 Conclusion: Physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancer other than breast cancer were also included, physical activity was associated with reduced BMI and body weight, increased peak oxygen consumption and peak power output, and improved quality of life. Fong D. et al. BMJ 2012;344:e70

34 LaVoy E. Exerc Immunol Rev ; 22:

35 LaVoy E. Exerc Immunol Rev ; 22:

36 Tertiary prevention of cancer: breast cancer Dieli-Conwright C et al. Curr Breast Cancer Rep (2016) 8: ;

37 Tertiary prevention of cancer Lifestyle recommendations Dieli-Conwright C et al. Curr Breast Cancer Rep (2016) 8: ;

38 Hewitt M, Greenfield S, Stovall E, eds. From cancer patient to cancer survivor: lost in transition. Washington, DC: The National Academies Press, 2005.

39 Survivors needs Focus of care shifts over time based on survivors needs Mayer D. Lancet Oncol 2017; e11 18

40 Alfano C.M. et al. JNCI J Natl Cancer Inst 2014: 106:dju287

41 Follow-up care of cancer survivors Risk-stratified and shared care model In this model, cancer care is delivered at any timepoint along the continuum by diff erent providers on the basis of risk category and patient and provider preferences and skillsets Risk-stratified model of the National Cancer Survivorship Initiative This model is developed by the National Cancer Survivorship Initiative in the UK using patient-reported outcome measures integrated into ehealth platforms to help risk stratify patients. Jacobs L.A. et al. Lancet Oncol 2017; 18: e19 29

42 Information needs of cancer survivors largely unmet Keegan THM, et al.j Cancer Surviv :

43 Conclusions: While cancer incidence has remained fairly constant during the recent years, cancer mortality has decreased In turn, the number of people who has survived cancer is steadily increasing Needs of cancer survivors are well defined, but are also complex, with numerous barriers to provision of care for these needs Indeed, despite being the main aim of cancer cure, the return to normal life in survivors is rarely accomplished, both on a psychological and physical level Available data suggest that the emerging needs of this growing population are yet largely unmet and deserve focussed attention, investments and further research.

44 FINAL CALL INVITATION Supporting survivorship: Life after diagnosis and post-treatment care of head and neck cancer patients Lunch event organised by the European Cancer Patient Coalition (ECPC) and hosted by MEP Lieve Wierinck (ALDE, Belgium) 18th September Location: European Parliament, Members' Salon, ASP Floor 0 Rue Wiertz 60 Brussels