Late Effects Of Cancer Treatment

Transcription

1 Late Effects Of Cancer Treatment Dr Chrissie Hunt Macmillan GP Jessica Jones Macmillan Clinical Transformation Lead

2 Some people think oncologists are evil

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4 The good Cure Longer life Improve symptoms from the cancer post traumatic emotional growth

5 The bad We don t have any nice treatments All treatments may cause damage to normal tissues All treatments carry a risk Some people have worse problems than others There must be a treatment which doesn t cause these side effects Er why must there be? I wouldn t have had the treatment if I had known hindsight is so wonderful If I knew the winning numbers of the next lottery

6 The Ugly Cancer has higher incidence among poor and elderly Cancer patients have high rates of comorbidity

7 Cancer treatment can affect everything Emotional Neuropsychological Social Financial Physical Ongoing treatment Late effects Risk of second cancer

8 Emotional Fear of recurrence/death Anxiety Depression Body image issues

9 Neuropsychological Chemobrain After treatment for brain tumours After XRT to brain eg leukaemias, lymphomas, small cell lung

10 Social Effects on family Children of cancer patients Effects on relationships Effects on employment Isolation E.g. Incontinence, not eating

11 Financial

12 Physical General Fatigue GI problems Urinary/bladder problems Lymphoedema Osteoporosis Hormones and steroids

13 Surgical Removal of organ Limb - Stomach Breast - Lung Bladder - Oesophagus Colon - Tongue

14 XRT Burns Lung fibrosis Strictures Bladder Rectal bleeding Xerostomia Dry mouth Brachial plexus damage

15 Hormonal Anti-androgens Anti-oestrogens XRT to neck Weird immunotherapy toxicity Pituitary problems after brain cancer treatment

16 Chemotherapy Often relatively short lived but some can be late Heart (anthracyclines, herceptin) Renal (cisplatin) Peripheral neuropathy Fatigue Cognitive

17 Sexual problems Pelvic surgery Prostate causing erectile dysfunction, retrograde ejaculation etc XRT to pelvis Bladder, prostate, uterus, cervix, rectum Reduction in testosterone In testicular cancer patients As part of treatment in breast/prostate cancers

18 Secondary cancers XRT to breast/mediastinum causing lung cancer Etoposide related leukaemia Often other factors Genetic e.g. Rb Environmental: still smoking?

19 Management of Late effects One of the keys to reducing the impact of longterm effects of cancer treatment on patients' lives is to make sure that they are fully informed of the possible consequences of treatment from the outset. Blackpool Teaching Hospitals NCPES 2016 Only 52% of patients told about side effects that could affect them in the future (National Average 54%)

20 Getting Help and Support The vmdt will accept referrals for anyone experiencing complex or severe ongoing symptoms due to their cancer or its treatment. These ongoing problems can be as a result of any cancer type or treatment type, however long ago active treatment ended. The vmdt is not suitable for people experiencing emergency problems or who need a quick response.

21 The toolkit provides resources and information for primary care professionals to identify and manage the consequences of cancer treatment, and support patients to live well after a cancer diagnosis. You can access it on the RCGP website.

22 Resources

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