Cancer Survivorship

Survivorship Basics - Beyond the Battle

• Definition: An individual is a cancer survivor from diagnosis through the balance of life. Includes family, friends, and caregivers.
• Phases (NCI Model):
  • Acute Survivorship: Diagnosis & initial treatment. Focus: active cancer therapy, symptom management.
  • Extended Survivorship: End of initial treatment to months after. Focus: recovery, managing short-term effects, emotional impact.
  • Permanent/Long-term Survivorship: Years post-treatment. Focus: managing long-term/late effects, quality of life, ongoing surveillance for recurrence or new cancers.
• Core Goals:
  • Prevention & management of late effects.
  • Surveillance for recurrence & second primary cancers.
  • Psychosocial well-being & support.
  • Coordinated follow-up care.

⭐ Survivorship Care Plans (SCPs) are essential, providing a treatment summary, follow-up schedule, and information on potential late effects and wellness strategies for the patient and primary care provider (PCP).

Late Effects of Cancer Tx - Lingering Shadows

• Cardiovascular Toxicity:
  • Anthracyclines (Doxorubicin): Dose-dependent cardiomyopathy (< 450-550 mg/m²).
  • Trastuzumab: Reversible LV dysfunction.
  • Radiation: Pericarditis, CAD, valvulopathy.
• Pulmonary Toxicity:
  • Bleomycin, Busulfan: Pulmonary fibrosis.
  • Radiation: Pneumonitis/fibrosis.
• Endocrine & Reproductive:
  • Hypothyroidism (Neck RT).
  • Infertility, premature gonadal failure (Alkylating agents, RT).
• Musculoskeletal:
  • Osteoporosis/fractures (Steroids, AIs).
  • Avascular necrosis.
• Neurological:
  • Peripheral neuropathy (Vincas, Taxanes, Platinum).
  • "Chemo brain": Cognitive impairment.
• Second Malignancies:
  • t-AML/MDS (Alkylating agents, Topo II inhibitors like Etoposide, RT).
  • RT-induced solid tumors (e.g., sarcomas, thyroid Ca).

  ⭐ RT-induced sarcomas: 5-15 yrs latency period.

• Psychosocial:
  • Anxiety, depression, PTSD.
  • Chronic fatigue, persistent pain.
  • Body image, sexual dysfunction.
• Other:
  • Lymphedema (Axillary/inguinal node dissection/RT).
  • CKD (Cisplatin).

Survivorship Care - Watching Horizon

• Goal: Smooth transition from active treatment; optimize Quality of Life (QoL), monitor for recurrence, manage late effects.
• Survivorship Care Plan (SCP): Cornerstone; individualized.
  • Treatment summary (diagnosis, therapies).
  • Follow-up plan (surveillance, screening for new cancers).
  • Potential late/long-term effects & management.
  • Wellness strategies (diet, exercise, mental health).
• Key Focus Areas:
  • Early detection of recurrence.
  • Screening for Second Primary Malignancies (SPMs).
  • Managing late effects (e.g., cardiotoxicity, neuropathy, lymphedema, psychosocial issues).
  • Addressing comorbidities.
• Approach: Multidisciplinary Team (MDT) vital. Emphasize patient education & empowerment.

⭐ A personalized Survivorship Care Plan (SCP) significantly improves coordination of care and addresses long-term health needs of cancer survivors.

Health Promotion in Survivors - Thriving Anew

• Goal: Enhance QoL, prevent recurrence/second cancers, manage long-term effects.
• Lifestyle Pillars:
  • Nutrition: Plant-rich diet, healthy weight (BMI 18.5-24.9 kg/m²).
  • Physical Activity: ≥150 min/wk moderate or ≥75 min/wk vigorous aerobic exercise; strength training ≥2x/wk.
  • Avoid Tobacco: Crucial for all.
  • Limit Alcohol: Per national guidelines.
• Psychosocial Well-being:
  • Screen for distress (anxiety, depression); offer support/counseling.
• Preventive Measures:
  • Vaccinations: Annual flu, pneumococcal (per guidelines).
  • Sun protection: SPF ≥30 & protective clothing.
• Address Specific Needs:
  • Manage: sexual dysfunction, "chemo brain", bone health (Ca/Vit D).

⭐ Regular physical activity post-diagnosis ↓ recurrence & mortality risk in common cancers (breast, colorectal, prostate).

High‑Yield Points - ⚡ Biggest Takeaways

• Cancer survivorship starts at diagnosis, encompassing the entire cancer journey.
• Focus: surveillance for recurrence, second primary cancers, and managing late effects.
• Key late effects: cardiotoxicity, neuropathy, lymphedema, infertility, psychosocial issues.
• Risk of second primary cancers is ↑ due to treatment or genetics.
• Survivorship Care Plans (SCPs) guide long-term follow-up and patient education.
• Integral psychosocial support addresses anxiety, depression, and fear of recurrence.
• Promote healthy lifestyle: diet, exercise, smoking cessation for better long-term health.