Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs

Transcription

1 Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs DANSK KRÆFTFORUM, marts 2018 On behalf of the steering group Peter Christensen, professor, overlæge dr.med. Pelvic Floor Unit, Aarhus University Hospital

2 Improved survival 40 years trend in survial of rectal cancer % Survival Quaresma et al, Lancet 2015

3 Longterm morbidity sequllae following rectal cancer treatment General exposure: surgery, radiation, medical oncology Abdominal wall, adhesions, pain Anxiety, depression Pelvic Organ Dysfunction

4 Pelvic Organ Dysfunction sequllae following rectal cancer treatment BOWEL DYSFUNCTION BLADDER DYSFUNCTION FEMALE SEXUAL DYSFUNCTION MALE SEXUAL DYSFUNCTION CHRONIC PAIN Major Minor No Major Minor No Major Minor No Major Minor No Major Minor No 36% 41% 38% 38% 30% 25% 43% 13% 17% 23% 62% 32% 32% 70% Organ dysfunction often co-exist Multiorgan involvement require a multidiciplinary approach

5 Steering group Aarhus Aalborg co-operation Søren Laurberg Department of Surgery, AUH AALBORG AALBORG Klaus Krogh Department of Hepatology and gastroenterology, AUH Peter Christensen Pelvic Floor Unit, Department of Surgery, AUH Asbjørn Drewes Department of gastroentorology, AAUH Co-funding from Central Denmark Region and Northern Denmark Region ie d.kr.15 mio/three years

6 NATIONAL PERSPECTIVE AALBORG VIBORG RANDERS HERNING VEJLE HILLERØD ROSKILDE ODENSE SVENBORG

7 Across Pelvic Organ Cancers From Bench to Bedside to Healthcare Beyond Cancer Cross sectional Colon DCCG cohort Smart data DCCG Diarrhea, microbioma Prospective Patophys. Clinical Trials Prevention Cancer seqv Clinics Two RCTs: BAM + diet Socio economy Impact and work realtion QUALY and Cancer seqv Clinics Rectum DCCG cohort Smart data DCCG HRM and LARS Empty, Size matters Chronic pain Anal Bladder PROM development AUH, DACG DBCG Cancer seqv Clinics Sex and cure Two RCTs: Klyster vs TAI + Pain treatment Dose vs function Size matters Cancer seqv Clinics Dose vs toxicity Impact and work relation QUALY and Cancer seqv Clinics Prostate DPCG Cervix DGCG Monitor Chronic pain Monitor Pain treatment Dose vs toxicity

8 Cross sectional Colon DCCG cohort Smart data DCCG Diarrhea, microbioma Prospective Patophys. Clinical Trials Prevention Cancer seqv Clinics Two RCTs: BAM + diet Socio economy Impact and work realtion QUALY and Cancer seqv Clinics Rectum DCCG cohort Smart data DCCG HRM and LARS Empty, Size matters Chronic pain Anal Bladder PROM development AUH, DACG DBCG Cancer seqv Clinics Sex and cure Two RCTs: Klyster vs TAI + Pain treatment Dose vs function Size matters Cancer seqv Clinics Dose vs toxicity Impact and work relation QUALY and Cancer seqv Clinics Prostate DPCG Cervix DGCG Monitor Chronic pain Monitor Pain treatment Dose vs toxicity

9 Cross sectional Colon DCCG cohort Smart data DCCG Diarrhea, microbioma Prospective Patophys. Clinical Trials Prevention Cancer seqv Clinics Two RCTs: BAM + diet Socio economy Impact and work realtion QUALY and Cancer seqv Clinics Rectum DCCG cohort Smart data DCCG HRM and LARS Empty, Size matters Chronic pain Anal Bladder PROM development AUH, DACG DBCG Cancer seqv Clinics Sex and cure Two RCTs: Klyster vs TAI + Pain treatment Dose vs function Size matters Cancer seqv Clinics Dose vs toxicity Impact and work relation QUALY and Cancer seqv Clinics Prostate DPCG Cervix DGCG Monitor Chronic pain Monitor Pain treatment Dose vs toxicity

10 Cross sectional Colon DCCG cohort Smart data DCCG Diarrhea, microbioma Prospective Patophys. Clinical Trials Prevention Cancer seqv Clinics Two RCTs: BAM + diet Socio economy Impact and work realtion QUALY and Cancer seqv Clinics Rectum DCCG cohort Smart data DCCG HRM and LARS Empty, Size matters Chronic pain Anal Bladder PROM development AUH, DACG DBCG Cancer seqv Clinics Sex and cure Two RCTs: Klyster vs TAI + Pain treatment Dose vs function Size matters Cancer seqv Clinics Dose vs toxicity Impact and work relation QUALY and Cancer seqv Clinics Prostate DPCG Cervix DGCG Monitor Chronic pain Monitor Pain treatment Dose vs toxicity

11 Multible organ envolvement multidiciplinary treatment

12 SMART DATA and relation to the Cancer Seqv Clinic

13 SMART DATA and relation to the Cancer Seqv Clinic

14 SMART DATA and relation to the Cancer Seqv Clinic

15 Nurse led clinics optimised conservative treatment I can help! Optimised Conservative Treatment Algorithm-based Motivational interview Individual goal setting List of medication Lifestyle and habbits Diet regulation (not always more fibres) Loparomide Rectal emptying with suppositories or mini-enemas

16 SMART DATA and relation to the Cancer Seqv Clinic

17 SMART DATA and relation to the Cancer Seqv Clinic

18 SMART DATA and relation to the Cancer Seqv Clinic

19 Proposed treatment algorithm Fecal incontinence or LARS like syndrome LARS- like syndrome or fecal incontinence What can I do? Stoma Sacral nerve stimulation Transanal irrigation Pelvic Floor Execises/Biofeedback Lifestyle modification, diatry advice, bulk agents, Loparomide

20 SMART DATA and relation to the Cancer Seqv Clinic

21 Length Balloon [mm] Length Balloon [mm] Length Balloon [mm] Length Balloon [mm] Rest at 20ml Rest at 30ml Diameter Balloon [mm] Rest at 40ml Diameter Balloon [mm] Diameter Balloon [mm] Rest at 50ml Diameter Balloon [mm] caec um sple nic flex ure um rect morning 1000 Kcal waking meal 14:00 22:00 06:00 defaecation

22 Change of practise four planed randomized controlled trials among results from the Cancer Seqv Clinics Low FodMap vs High FIbres Opoid droplets for severe diarhoea Small vs High volume rectal irrigation Pain treatment

23 Thank you for your attention