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cancer survivor

Includes patients who have been clinically cured of cancer. Epidemiology: - number of cancer survivors in the U.S. Jan 1, 2022 is > 18 million [41] - number of cancer survivors in U.S. expected > 22 million by 2030 [33] Complications: - nearly all survivors of childhood cancer have chronic disease in adulthood [6,24] - 2/3 with a disabling or life-threatening condition - most common - pulmonary disease - heart disease* - excess risk of cardiovascular disease in older cancer survivors [46] - predicted 'heart age' > actual age in cancer survivors [36] - late risk of heart failure in patients receiving anthracycline(s) [9] - trastuzumab also associated with cardiomyopathy [9] - universal screening not justifiable due to small benefit [45] - cardiomyopathy 7% - coronary artery disease 4% - conduction defect or arrhythmias 4% - valvular regurgitation or valvular stenosis 28% [17] - pericarditis [35] - stroke [35] - venous thromboembolism [35] - endocrine disease [14] - hypopituitarism - hypothyroidism - testicular most common endocrine disorder - ovarian dysfunction - diabetes mellitus type 2 - dyslipidemia [9] - hypertension (measure blood pressure) [9] - metabolic syndrome [9] - hearing loss - cognitive impairment - patient may benefit from validation of symptoms [9] - therapy-induced cognitive impairment will likely improve over time [9] - less common - hematologic disease - liver disease - musculoskeletal disease - urologic disease - excess all-cause 40 year mortality in cancer survivors [42] - 23% in childhood cancer survivors vs 5% in general population [42] - excess subsequent cancer risk & mortality in cancer survivors [37,42] - cancer cause of death in 34% of 5-year childhoor cancer survivors, generally 5-9 years after diagnosis [42] - 5-15% of childhood cancer survivors develop a subsequent malignant neoplasm - secondary malignancies are the second leading cause of premature death, after recurrence of primary neoplasms [2] - health-related problems other than cancer become more common as the time from cancer diagnosis lengthens, resembling those of the general population, but occur at earlier ages [42] - survivors of HPV-associated cancers at risk for 2nd HPV-associated cancer - 81 per 10,000 person-years among women - 62 per 10,000 person-years among men [30] - childhood cancer survivors who received radiation therapy have an increased risk of basal cell carcinoma (RR=30) [32] - TNF inhibitors do not increase risk of cancer recurrence [31] - anxiety is common - 18% vs 14% in control group 2 years after diagnosis [5] - 28% of survivors, 40% of spouses > 10 years after diagnosis [5] - 15% in adult survivors - depression is common [15] - infertility (RR = 1.5), most women eventually able to become pregnant [7] - chemotherapy-induced peripheral neuropathy [9,15,27] - commonly persists long-term [27] - immunosuppression due to malignancy or its treatment - avoid live virus vaccines - poor general health (14%) [23] - chronic pain in 1/3 of cancer survivors [34] - 16% with limitations in activities of daily living due to chronic pain - men with a history of thyroid cancer have a higher cardiovascular risk compared with women [28] - cancer survivors are subject to an increased rate of aging with associated increase in all-cause & cancer-specific mortality [40] * most patients with heart disease asymptomatic [7] Laboratory: - lipid panel & fasting blood glucose for anthracycline exposure [9] Management: - prescription for cancer survivorship [9] - recommendations regarding surveillance for cancer recurrence - lifestyle modifications to reduce risk of a 2nd malignancy - strategies to reduce or prevent late effects of cancer treatment - return to normal activities ASAP - exercise at least 150 minutes a week - strength training twice a week [1] - exercise increases survival in cancer patients [26] - cognitive behavioral therapy [15] - yoga [15] - nutritional supplements of value only if a nutrient deficiency is clinically or biochemically demonstrated - early screening colonoscopy recommended for childhood cancer survivors [2] - sustained weight reduction in obese patients - improvement in functional status - reduction serum estrone & serum estradiol (higher levels associated with postmenopausal breast cancer) - diet & exercise intervention attenuates functional decline in overweight cancer survivors [16] - Mediterranean diet associated lower risk of all-cause mortality (RR=0.68) [43] - the anti-inflammatory diet, the fasting-mimicking diet & the web-based diet may improve cognitive function in cancer survivors [44] - optimizing reproductive health after cancer [4] - all patients post chemotherapy &/or radiation therapy - aggressive control of cardiovascular risk factors - unknown whether early detection & treatment of chemotherapy related cardiotoxicity results in improved outcomes [9] - duloxetine for chemotherapy-induced peripheral neuropathy [15] - screen for anxiety & depression [15] - assess regularly - screen for fatigue at the time of cancer diagnosis & at least annually thereafter [15] - screen for heart failure in children receiving anthracyclines - echocardiography every 1-5 years depending on - age at time of treatment - radiation therapy - total anthracycline dose [17] - sexual dysfunction - phosphodiesterase inhibitor for erectile dysfunction - low-dose estrogen or lubricant for vaginal dryness [9] - see guidelines for survivors of childhood cancers [12] - pain assessment at every visit for adult cancer survivors [20] - electro-acupuncture for musculoskeletal pain [38] Notes: - a loss of continuity of care from pediatric oncology to adult internal medicine is common [11,12] - to integrate survivorship services into routine adult care, cancer survivorship must become a recognized clinical category with actionable care plans supported by a functional information system infrastructure [25] - ~1/3 of adult survivors of childhood cancer report little to no concern about their future health [29]

Related

malignant neoplasm (cancer) prescription for survivorship

Specific

breast cancer survival (includes breast cancer prognosis) lung cancer survivor

General

survivor of disease

References

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