Objectives. Survivors. Survivorship in Cancer 7/20/2018. Over 15 million survivors in the U.S. Over 32 million worldwide. Oncology Survivorship Care

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1 Survivorship in Cancer Oncology Survivorship Care Kathleen Martin, FNP-BC, AOCNP Objectives Define population of survivors of cancer Define the need for survivorship care Explain the purpose of survivorship care plans Discuss symptom issues in survivorship Explore modifiable issues to prevent cancer recurrence Identify the impact of obesity on cancer care Discuss interventions to optimize survivorship care Survivors Over 15 million survivors in the U.S. Over 32 million worldwide 1

2 Who are the survivors? Female Survivors Breast cancer (44 percent) Cancer of the uterine corpus (9 percent) Cancer of the colon or rectum (9 percent) Thyroid cancer (8 percent) Melanoma (8 percent) Male Survivors Prostate cancer (45 percent) Cancer of the colon or rectum (10 percent) Melanoma (8 percent) Bladder cancer (8 percent) Non-Hodgkin lymphomas (5 percent) (American Cancer Society, 2016) Lost In Translation rvivorship+iom&&view=detail&mid=c81e87 5DAAC2ED169133C81E875DAAC2ED169133& &FORM=VRDGAR Released may not be Relieved 2

3 Survivorship Care Prevention of recurrent or new cancers Coordinate health maintenance with PCP Surveillance of existing cancer Coordinate symptom management with specialists Assess for physical and psychosocial late effects of treatment Survivorship Care Plan Treatments received Surveillance labs, scans, etc Symptom management plan Wellness plan 3

4 Challenges 1/3 of survivors have persistent symptoms: Fatigue Pain Depression Sleep Disruption Nutrition Weight Management Sexual Dysfunction 4

5 And More Challenges Anxiety Return to work Financial concerns (insurance issues) Family/friend relationships Survivorship Assessment Tool NCCN Provider Key 5

6 Management of Symptoms Supportive Care Team Psychotherapy Physical therapy Referral to specialists as needed Health Promotion Prevent Recurrence Healthy lifestyle, avoiding known carcinogens Genetic testing where appropriate Health Maintenance Colonoscopy, skin checks, smoking cessation, PAP/pelvic Bone Health Bone density, exercise, nutrition Obesity is a Cancer Problem Manage/Prevent Co-Morbid Conditions Obesity is key Contributes to co-morbid conditions Worsened prognosis at diagnosis Raise risk of second malignancies and recurrence 6

7 National Health Crisis 1/3 of US Adults (>72million people) & 17% of US children and adolescents are obese CDC 2015 Cancer Survivor Data 31% survivors over 20 y/o are obese (BMI >30kg/m2) 54% have a co-morbid condition Heart disease Cerebrovascular disease Diabetes Primary & secondary malignancies Obesity & Cancer 84,000 cancer diagnoses annually attributed to obesity Implicated in 15-20% of cancer-related mortality *Breast cancer patients 75% increase in mortality pre-menopausal 34% increase in mortality post-menopausal *Prostate Cancer Increased risk of biologically aggressive cancer, advanced disease at diagnosis *Colon Cancer BMI >35kg/m2 associated with increased risk of recurrence Recommendations Increase Education and Awareness of Obesity link to Cancer Increase Oncology Provider Resources to Address Obesity Build and Foster Robust Research 7

8 Impact on Cancer Care Obese patients more likely to delay screening and preventative care Influences accuracy of cancer diagnostics such as hemodilution of tumor biomarkers and reduced imaging quality Technical challenge for XRT and Surgery with higher rates of complications Increased risk of thromboembolism while receiving chemotherapy Lifestyle Changes Modified Endurance and Strength training are safe and effective Cancer Rehabilitation Weight loss involving calorie restriction with and without exercise have been shown to be effective Referrals to weight management Plant based diet 5-9 servings of fruits and vegetables daily, as well as beans, legumes, whole grain pastas, etc Nutrition Plant based diet Study of over 9,000 cancer survivors found <20% had 5 or more servings per day of fruits/vegetables Meta-analysis showed 17% increase in development of CRC with 100g/day of any red meat 18% increase with 50g/day processed meat 8

9 Physical Fitness Cancer rehabilitation during and after treatment Local resources Community groups Weight Loss Weight Loss Clinic Primary Care counseling Dietician referral Psychotherapy Hypnosis, Mind-fullness, Guided Imagery Survivorship Referral Process Active Treatment Patients SCP initiated & Planned Survivorship Visit 6-8 weeks post treatment with curative intent Scheduled by oncology patient navigator Long Term Survivorship May be referred through oncologist Includes long term anti-hormonals Long term cancer related side effects 9

10 Stormont Vail Oncology Survivorship Care Interdisciplinary Care Team Education for Prevention and Early Detection Health Maintenance Comprehensive symptom assessment and management First in the region innovative care with small town heart References A Potential Decline in the Life Expectancy in the United States in the 21 st Century. Olshansky, J.S., Passaro, D.J., Hershow, R.C., et al. American Society of Clinical Oncology Position Statement on Obesity and Cancer Jennifer A. Ligibel, Catherine M. Alfano, Kerry S. Courneya, Wendy Demark-Wahnefried, Robert A. Burger, Rowan T. Chlebowski, Carol J. Fabian, Ayca Gucalp, Dawn L. Hershman, Melissa M. Hudson, Lee W. Jones, Madhuri Kakarala, Kirsten K. Ness, Janette K. Merrill, Dana S. Wollins, and Clifford A. Hudis American Cancer Society. Cancer Treatment & Survivorship Facts & Figures, American Cancer Society; Atlanta, GA Carcinogenicity of consumption of red and processed meat Bouvard V, Loomis D, Guyton KZ, et al Lancet Oncol Exercise interventions on health-related quality of life for cancer survivorsshiraz I Mishra, Roberta W Scherer, Paula M Geigle, Debra R Berlanstein, Ozlem Topaloglu, Carolyn C Gotay, Claire Snyder 15 Aug 2012 DOI: / CD pub2 Journal of Clinical Oncology :31, Hewitt, M, Greenfield, S, Stovall, E, et al. From cancer patient to cancer survivor: Lost in transition. (National Academies Press, Washington DC), (Accessed on January 31, 2011). Survivorship Guidelines. (2017). 10