Healthy for the Holidays:

Transcription

1 Healthy for the Holidays:

2 Know more about survivor needs ª Consider your own health needs during the holiday ª Understand and plan for your survivorship

3 Medical Problems: ü Premature menopause ü Lymphedema ü Urinary incontinence ü Infertility ü Neurologic problems (balance, neuropathy, memory) ü GI (bowels, bloating, acid reflux) ü Pulmonary function ü Hypothyroidism ü Diabetes ü Hyperlipidemia ü Cardiovascular disease ü Osteoporosis / osteopenia ü Dental impairments ü Recurrence, 2 nd cancers

4 Medical Problems: ü Premature menopause ü Lymphedema ü Urinary incontinence ü Infertility ü Neurologic problems (balance, neuropathy, memory) ü GI (bowels, bloating, acid reflux) ü Pulmonary function ü Hypothyroidism ü Diabetes ü Hyperlipidemia ü Cardiovascular disease ü Osteoporosis / osteopenia ü Dental impairments ü Recurrence, 2 nd cancers Symptoms and Function: ü Fatigue ü Pain ü Nausea ü Sexual dysfunction, hot flashes ü Sleep problems ü Muscle and joint problems ü Memory loss, chemo-brain ü Distress, worry, depression Practical Issues, Lifestyle ü Nutrition ü Exercise ü School ü Work ü Insurance ü Relationships ü Smoking, Alcohol

5 Ø After 5 years I have been extremely lucky to be so healthy The only factors that I can say are lingering are: fatigue, joint pain, and chemo-brain! These limit some things, but not to anything constant (except fatigue). I wish that my employment could be fewer hours to alleviate the fatigue. Ø My main issues at this point are diabetes, sexual functioning and depression. Overweight is an issue too, but I am alive so I am grateful.

6 Person Genes Diagnosis Treatment Long term health and well-being General Health: Regular Exams Medication Other treatments Mental health Health Behaviors: Health Monitoring Exercise Nutrition Tobacco Alcohol Sun Sleep

7 Long term health and well-being General Health: Regular Exams Medication Other treatments Mental health Health Behaviors: Health Monitoring Exercise Nutrition Tobacco Alcohol Sun Sleep

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9 1. Smoking / tobacco 2. Alcohol limits 2 drinks a day for men 1 drink a day for women, But 3 drinks a week for reducing breast cancer risk 3. Sun exposure > 10 minutes without sunscreen SPF 30, UVA and UVB block daily Long sleeve shirts, hats, pants when staying in sun Melanoma risk is real

10 1. Exercise 2. Control Weight 3. Eat Well (whole foods not supplements) 4. Sleep Well 5. Have Meaning and Purpose in Life 6. Use Stress Relief methods regularly (don t wait for stress) 7. Use Social Support (express thoughts and feelings) 8. Get Regular Health Care

11 619 Cancer Survivors (HINTS study) 36% reported fair or poor health status 58% were overweight 23% were current smokers 82% did not eat five or more fruits and vegetables daily 55% did not report regular physical activity Mayer DK et al (2007). Oncol Nurs Forum, 34(3): % NO leisure time physical activity in past 30 days CDC BRFSS 2009 suvey, reported in MMWR,

12 Get Regular Health Care: Get a survivorship care plan Get an annual physical Address symptom needs Know health surveillance needs Schedule follow-ups when needed Know which health care provider will take care of which needs

13 Ø You already know: Your symptoms / how you feel Ø Do you know: The causes of your symptoms? The risks you have for chronic diseases as a result of your cancer treatment? What to do to reduce your risks for cancer recurrence or another cancer? How to feel better?

14 Ø To make a plan for feeling your best and living your longest: What treatment you received o o What chronic illnesses to monitor Understand causes of your symptoms What your specific disease was o How to monitor for recurrence How to coordinate your care with your health care providers What you take charge of to feel your best!

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16 3,129 post-treatment cancer survivors Physical Concerns: 53% Energy / Fatigue 53% Concentration 43% Sexual function Psychosocial Concerns: 75% Fear of recurrence 65% Sadness, depression 64% Grief, identity Less than half received care for their concerns RESULTS FROM THE LIVESTRONG SURVEY, 2010

17 RESULTS FROM THE LIVESTRONG SURVEY, 2010

18 Ø Living with * Not knowing what the future will bring Uncertainty * Thinking about things that could go wrong Ø Grief and Loss * What will never be * What is changed forever Ø Fear of Recurrence * Intrusive thoughts about cancer recurring * Worry encroaches on activities, sleep, enjoyment * Hypervigilance about physical sensations * Afraid to rebuild life - disappointment

19 Someone likened cancer to a pink elephant, and the pink elephant initially is right there in front of your face, you know and then as you get better, the pink elephant maybe goes to another room. And then as you get much better, the pink elephant goes down the street, but it s always there and you always know it s there. De Marco et al. Oncology Nursing Forum, 31 (4) 2004.

20 IOM Report Identified Survivorship Needs: Every survivor should receive a treatment summary and care plan at the end of active treatment

21 Recurrence, new cancers, late effects" Recurrence, second cancers, and assessing medical and psychosocial late effects" Treating the consequences" of cancer and its treatments" Interdisciplinary " coordination between specialists and primary care providers" Hewitt M, et al. eds. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington DC; The National Academies Press; 2005!

22 " Represents nearly 70% of patients diagnosed with cancer " For accreditation by 2015 " All cancer patients must receive a summary of their treatment and a follow-up care plan at the completion of treatment " Compliance monitored annually

23 Provider oncologist s clinic Online: LIVESTRONG Care Plan Journey Forward s Survivorship Care Plan Builder Survivorship Clinic, such as SCCA

24 Patient Name: UW/SCCA medical record number: Date of Birth: Cancer Diagnosis: Breast Cancer Invasive ductal, Invasive lobular, DCIS only Left, right, bilateral Date of Diagnosis: Age at Diagnosis: Tumor Stage: (0, I, II, III, IV) Tumor Size (T) (1a, 1b, 1c, 2, 3, 4) Nodes (N) (# positive/total) Metastases (M) Tumor grade (1, 2, 3 or low/intermediate/high) Hormone receptors: (if Allred score is known, would be nice to include) Estrogen receptor (ER) Progesterone receptor (PR) HER-2: IHC FISH Oncotype DX (if done): Family History of Cancer: BRCA1/2 testing (if done): Significant Past Medical History and Medications:

25 Cancer Treatment Surgery Breast Surgery: Mastectomy, lumpectomy, dates/laterality Lymph Node Surgery: Sentinel lymph node, axillary lymph node dissection, dates Reconstruction: Tissue, implants, tissue expander, etc; dates Systemic Therapy Chemotherapy: Route Dose Reduction Y/N Estimated /Actual Schedule Number of cycles Cumulative Anthracycline Dose Administered: Doxorubicin mg/m 2 Epirubicin mg/m 2 HER-2 Targeted Therapy: (Herceptin, Tykerb) Drug, start date, stop date, etc Endocrine (Hormonal Therapy): (Tamoxifen, Arimidex, Femara, Aromasin, Lupron/Zoladex) Drug, start date, stop date, etc Bisphosphonate Therapy for Breast Cancer Indication: (Zometa, Clodronate, Boniva) Drug, start date, stop date, etc Enrolled in Clinical Trials? Radiation Therapy Date Start Date Stop Total Dose (cgy) Fields included: (Breast, axilla, supraclivicular, internal mammary, chest wall) Complications of therapy:

26 Long term effects and Follow-Up care Medical history and physical Recommendation Visit your doctor every three to six months for the first three years after the first treatment, every six to 12 months for years four and five, and every Recommendations year thereafter. Post-treatment breast imaging The SCCA recommends a mammogram of the affected breast every 6 Breast self-examination Pelvic examination Laboratory tests Radiology tests driven by: months for up to 3 years from cancer diagnosis, and annual mammography of the opposite breast. Specific Exposure: Perform a breast self-examination every month. This procedure is not a substitute for a mammogram. Inspection and palpation of Chemo (type/dose) irradiated skin and soft tissues every year. Report any unusual symptoms to your medical provider. Radiation (site/dose) Continue to visit a gynecologist regularly. Women taking tamoxifen should report any irregular vaginal bleeding to their doctor. Surgery Your oncologist will determine which blood tests are recommended in your case. This may include a periodic complete blood count (CBC), chemistry panel, liver and kidney tests, and tumor markers. Modified by: Diagnosis Your oncologist will determine which radiology tests are recommended in your case. While a regular chest x-ray is sometimes indicated annually in higher-risk patients, it is uncommon to routinely recommend Age bone scans, CT scans, PET scans or MRIs in asymptomatic patients. Gender

27 Long term effects and Follow-Up care Secondary cancers Skin Evaluation Cardiac evaluation Bladder health Kidney Health Fertility Hearing Coordination of care Recommendation There is a low risk for leukemia secondary to chemotherapy exposure. Annual blood counts may be recommened There is a low risk for skin cancers developing after radiation. Regular skin examination and avoiding prolonged sun exposure Recommendations driven by: Heart problems can occur after certain chemotherapy drugs (anthracyclines) or after chest radiation. Recommend evaluation Specific Exposure: Chemo (type/dose) There is a low risk for bladder problems due to cyclophosphamide. Report any bladder symptoms, especially blood in your urine to Radiation (site/dose) Problems with kidney function can occur due to cisplatin, carboplatin or ifosfamide exposure. Kidney function tests and blood pressure Surgery Modified by: Chemotherapy and radiation can affect your fertility. It is important to know your fertility status. Women should keep tract of menstrual Diagnosis Age Chemotherapy can affect your hearing. We recommend a yearly evaluation. A referral is available to audiology if indicated. Gender Most patients diagnosed with cancer continue to be followed by their oncologists for at least 5 years from diagnosis. It is important to also have a primary care doctor, to manage non-cancer related health

28 WELLNESS Recommendations Health Maintenance Make sure you keep up to date on vaccinations and routine health maintenance screening (cholesterol, blood pressure, skin Exercise and Physical Activity Lymphedema Nutrition Genetic counseling and testing Fear of Recurrence Heart Health The SCCA encourages breast cancer survivors to adopt a physically active lifestyle. Try to engage in at least 30 minutes of moderate Review lymphedema prevention education. Consider a referral to physical therapy for lymphedema, range of motion The SCCA supports the nutrition guidelines of the American Cancer Society to optimize health and reduce cancer risk. If there is a history of cancer in your family, or if you were diagnosed with breast cancer at a very young age, Develop and strengthen coping skills. Talk to friends and family. Request a referral to a therapist and information on Low fat diet, regular aerobic exercise and maintaining weight and blood pressure. Know what your cholesterol level is. Bone Health Regular weight bearing exercise. Daily Calcium and vitamin D, Pain Fatigue Sexual Health/Body Image Recommendations driven by: Specific Exposure: Chemo (type/dose) Radiation (site/dose) Surgery Modified by: Diagnosis Regular exercise both aerobic and resistance training, stretching, Age Adequate sleep, regular exercise and good nutrition will facilitate recovery and reduce fatigue after treatment. Gender Communicate with your partner. Suggest vaginal lubricants/ moisturizers and plan time for intimacy. Memory/ cognitive concerns Look into organizational strategies such as establishing a routine Plan

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30 YMCA, LIVESTRONG and Hutchinson Center collaboration 12-week, 2x/week, 90 min. strength and fitness program for survivors Training provided by the Y & Hutch Assessment Pre and Post class Content foci: resistance exercise aerobic exercise support, nutrition 22 locations, >60 sessions to date ~ 1000 participants

31 Improves: " Blood pressure " Strength " Endurance " Flexibility " Muscle and Joint Pain " Fatigue " Mood " Social Support Rajotte et al. J Cancer Survivorship, 2012

32 LOCAL: Cancer Centers Gilda s Club Cancer Lifeline Exercise and Thrive at your local YMCA Team Survivor Northwest Survivorship Program at the Seattle Cancer Care Alliance NATIONAL : American Psychosocial Oncology Society: toll free: apos-society.org Cancer Care: toll free: cancercare.org LIVESTRONG: toll free: livestrong.org

33 LIVESTRONG.org CancerCare.org cancersupportcommunity.org Links to disease foundations

34 Your oncologist or a survivorship clinic Online: LIVESTRONG Care Plan Journey Forward s Survivorship Care Plan Builder SCCA Survivorship Clinic

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36 Phone: (206) K. Scott Baker, MD, Director Karen Syrjala, PhD, Co-Director Elizabeth Kaplan, MD Leslie Veitmeier, ARNP Debra Loacker, RN Emily Rajotte, Program Manager Emy Hammond, Program Assistant Joli Bartell, Project Coordinator Jessica Weeber, Research Assistant

37 " Off treatment (non-hormonal) without active oncologic disease " All ages " All diseases " Any location of oncology treatment " Any referral source: Ø Oncologist Ø Primary care provider Ø Self

38 " Cancer Treatment Summary Ø Identify increased risks " Screening of needs Ø ROS, functional and psychosocial needs assessment " History, physical examination and lab tests focused on long-term and late effects " Recommendations for follow-up surveillance, with lifestyle / health maintenance education " Subspecialty and community resource referrals as needed " Communication back to primary oncologist and primary care provider

39 10 Tips for the Holidays 1. Know your holiday stress points. 2. Are there holiday events or traditions you could live without? 3. Are there non-holiday events you could postpone? 4. Remember your precious people. Schedule together time. 5. Keep moving. Physical activity is the clearest step you can take to benefit your health during the holidays and any time of year. 6. Practice healthy nutrition. Focus more on giving your body what it needs and less on trying not to eat certain foods. 7. Know how alcohol affects your health. 8. Relax your body and mind. 9. Tend to your body s needs. Notice if there are parts of your body that aren t working well. Make a list and an appointment with your doctor for after the holidays. 10. Have a long-term plan for your survivorship care. Make appointments now so you can forget about them during the holidays.

40 1. Most survivors recover and do very well physically and emotionally 2. Long term effects that do not resolve with time depend on the disease and treatment, as well as individual factors Ø You need to know your risks 3. Be an informed survivor: Ø Ø Ø Ø Get a survivorship care plan Expect and deal with your emotions and worries Make a holiday gift to yourself to plan for your health Prioritize and PACE so you ENJOY the holidays!