No Disclosures. 9/20/16 WHERE DO WE GO FROM HERE? MANAGING PREVIVORSHIP AND SURVIVORSHIP NICOLE CENTERS PREVIVOR AND SURVIVOR

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1 WHERE DO WE GO FROM HERE? MANAGING PREVIVORSHIP AND SURVIVORSHIP Aileen Caceres, MD, MPH, FACOG Nicole Centers, RN, OCN, CBCN, CN-BN, CPN No Disclosures. NICOLE CENTERS PREVIVOR AND SURVIVOR "Cancer previvors" are individuals who are survivors of a predisposition to cancer but who haven t had the disease. - FORCE Website A cancer survivor is anyone who has ever been diagnosed with cancer and is living today. - National Institutes of Health 1

2 EVERYONE S JOURNEY IS DIFFERENT You have had Genetic Testing and do not have cancer. You have had Genetic Testing AND you have cancer. You opted not to have genetic testing. What happens next? YOU HAVE OPTIONS. Decisions to be made: Do you want (more) children? Do you want to keep your breasts? Ovaries? Do you want Reconstruction? Will you follow a screening schedule? Will you lose sleep worrying? Your doctor and your navigator can help you decide but the choice is yours to make now or in the future. DECISIONS ARE MADE Treatment is Given. SUMMARIES AND PLANNING By November 2016, all accredited Breast Centers should be giving 100% of their Breast Cancer Survivors a Written Survivorship Care Plan by NAPBC and CoC Guidelines. 2

3 Patient Name Patient Identifier Patient Contact Information So You Can Contact Each Other Providers and Their Information Name Phone Number Location Including Affiliations (hospitals, clinics) Diagnosis and Stage Includes: - Original Site (Which Breast) - Type of Breast Cancer - Receptor Status - Her 2 Status - Date of Diagnosis - Lymph Node Status If You Had Cancer Treatment Completed ALL Treatments Received and When 3

4 PREVIVOR TREATMENT Risk Reducing Medications Prophylactic Surgery Mastectomy Oopherectomy +/- Hysterectomy SURVIVOR TREATMENT Surgery Type Date Permanent Implants Surgical Findings Radiation Therapy Type End Date Total Dose Body Area Treated Chemotherapy Drugs used Lifetime Doses End Date Treatment Ongoing Birth Control Pills - To Decrease Risk Tamoxifen - To Decrease Risk OR Ongoing Treatment Aromatase Inhibitors - To Decrease Risk OR Ongoing Treatment Expanders in Place - Eventual Implants to be Placed Physical Therapy - Include Reason/Diagnosis Psychosocial Counseling Anything Unfinished 4

5 Persistent Symptoms or Side Effects of Treatment Things that are new since treatment start but have not resolved by treatment end. - Menopausal Status - Depression - Numbness How Treatment Changed You Outside of the Diagnosis Genetic and / or Familial Risk - 1 st or 2 nd Degree Relatives with Cancer - Relatives with Mutation - Genetic Counseling Received - Testing Performed - Lab Used - Any Results from Counseling or Testing - If not, why not Any Review of Predisposition What specific changes to report and to whom and when. Things that are new since treatment ended. - Pain - Depression - Numbness - Lumps, Bumps, or Bruises Upcoming Doctor Visits - Any Doctor - Any Treatment (Fertility, etc.) Dates and Times Who You Call and for What 5

6 Risk Reduction and Cancer Surveillance Recommended Tests - What Kind - When Scheduled and Where Who To Call for Questions Ways to Specifically Reduce Your Risk - Quitting Smoking and Resources for example - Resources - Online and Community What is Scheduled How to Further Reduce Your Risk NON SURGICAL PREVIVOR PLAN POST LUMPECTOMY SURVIVOR PLAN Breast - Mammogram yearly - MRI yearly (Alternate one test every 6 months) Ovarian - Transvaginal ultrasound every 6 months - CA-125 every 6 months Starting at age 30 y or 5-10 y before the earliest age of first diagnosis of ovarian or breast cancer in the family. Who Gave This Plan and When Things May Change Over Time It Should Be Given Within One Year This May Not Be the Only One You Receive 6

7 THANK YOU 7