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Oncology > Primary Care for Survivors > Flashcards

Primary Care for Survivors Flashcards

1
Q

Define Cancer Survivor

A

Anyone who has been diagnosed with cancer from the time of initial diagnosis until the end of their life

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2
Q

Types of Sequelae of Cancer Treatment

A

Physical/Medical
Psychological
Social
Existential & spiritual issues

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3
Q

Physical/Medical Sequelae of Cancer Treatment

A 
Second cancers
Cardiac dysfunction
Pain
Lymphedema
Sexual impairment
Infertility
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4
Q

Psychological Sequelae of Cancer Treatment

A 
Depression
Anxiety
Uncertainty
Isolation
Altered body image
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5
Q

Social Sequelae of Cancer Treatment

A 
Changes in interpersonal relationships
Concerns regarding health or life insurance
Career issues
Return to school
Financial burden
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6
Q

Existential & Spiritual Sequelae of Cancer Treatment

A

Sense of purpose or meaning

Appreciation of life

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7
Q

How many pediatric cancer survivors experience at least 1 late effect?

A

2/3 or 66%

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8
Q

Why is there a need for a systemic plan for lifelong surveillance?

A

Incorporate risks based on therapeutic exposures, genetic predisposition, health-related behaviors, & co-morbid health conditions

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9
Q

What components should be included in surveillance of survivors of cancer?

A

Longitudinal care plan
Continuity
Emphasis on the whole person

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10
Q

Survivors at Highest Risk for Late Term Effects

A

Bone tumors
CNS tumors
Hodgkin’s lymphoma

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11
Q

Late Term Effects with Bone Tumors

A

Disfigurement & functional limitations caused by amputations & other surgeries
Problems with fertility, heart, & kidney damage & secondary cancers

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12
Q

Late Term Effects with CNS Tumors

A 
Cognitive impairment
Short stature
Hearing loss
Problems with balance & coordination
Hypothyroidism
Thyroid nodules
Kidney damage
Secondary cancers
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13
Q

Later Term Effects with Hodgkins Lymphoma

A 
Lung damage
Abnormal skeletal growth & maturation
infertility
Hypothyroidism
Increased risk for breast cancer
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14
Q

Disabilities Secondary To Pediatric Cancer Treatment

A 
Secondary malignancies
Growth complications
Endocrine complications
Cardiopulmonary complications
Renal complications
Neuropsychological/ psychosocial complications
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15
Q

Secondary Malignancies in Pediatric Cancer Survivors

A

12% within 20 years
Exposure to alkylating agents + radiation most common causes
Genetic & Familial conditions increase risk of retinoblastoma, neurofibromatosis, nevoid BCC, etc.

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16
Q

Growth Complications in Pediatric Cancer Survivors

A

Direct damage to endocrine tissue
Highest risk: ALL, brain tumors, orbital tumors, nasopharyngeal CA with radiation
Children

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17
Q

Endocrine Complications in Pediatric Cancer Survivors

A

Early puberty
Premature close of epiphyses
Thyroid dysfunction: normal thyroxine, abnormal TSH
Gonadal dysfunction: azospermia, low testosterone, delayed sexual development
Ovarian dysfunction: failure to undergo menarche, increased FSH & LH levels, low estrogen
Delayed menses
Risk for early menopause
Pregnancies considered high-risk
Perinatal death or low-birth-weight, premature infants

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18
Q

Methods of Causing Cardiopulmonary Complications in Pediatric Cancer Survivors

A 
Bleomycin: pulmonary fibrosis
Nitrosoureas: pulmonary fibrosis
Cyclophosphamide: pulmonary fibrosis
Methotrexate: pulmonary fibrosis
Antracyclines: CHF, arrhythmias
Radiation: increased risk of CAD & chronic restrictive pericarditis
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19
Q

Renal Complications in Pediatric Cancer Survivors

A

Abnormal glomerular filtration rate: cisplatin
Persistent tubular dysfunction: cisplatin
Hemorrhagic cystitis: cyclophosphamide
Fanconi syndrome: ifosfamide

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20
Q

Define Fanconi Syndrome

A

Proteinuria
Glycosuira
Phosphaturia with hypophosphatemia

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21
Q

Neuropsychological Complications in Pediatric Cancer Survivors

A

Highest risk: ALL, brain tumors
Severity: dose, size & location of radiation field, child’s age, gender
Main effects: visual processing speed, visual motor integration, sequencing ability, short-term memory

22
Q

Psychosocial Complications in Pediatric Cancer Survivors

A 
Absence from school
Frequent medical appointments
Hospitalizations
Social isolation
Increased sense of physical fragility
Vulnerability manifested by hypochondria or phobic behaviors
23
Q

Medical Goals with Cancer Surveillance

A

Early recognition & treatment of late effects
Improve QOL
Decrease healthcare costs

24
Q

Psycho-Social Goals with Cancer Surveillance

A

Establish “new normal”
Social life
School & work

25
Q

Surveillance Caveats

A

Over Screening: undue fear, unnecessary screening, high costs
Under screening: missed late effects, missed early intervention, missed chance to minimize morbidity, long run have higher healthcare costs

26
Q

What every survivor should know

A 
What kind of cancer they had
What kind of chemo they received
What kind & how much radiation they received
Any adjunct therapy
Name of med & rad oncologist
27
Q

Routine Monitoring with CNS Radiation in Pediatric Patients

A

Growth: height, weight, growth velocity, scoliosis screening, growth hormone testing
Neuro-psych screening yearly

28
Q

Routine Monitoring with Chest Radiation in Pediatric Patients

A

Thyroid monitoring
PFTs
Cardiac workup for cardiac toxicity
Breast CA monitoring

29
Q

Routine Monitoring with Abdominal/pelvic Radiation in Pediatric Patients

A

Renal: UA, CMP, eGFR, blood pressure, renal US, cystoscopy
Males: testicular size, semen analysis, testosterone levels, FSH & LH levels
Females: detailed menstrual history, FSH & estrogen levels, uterine US

30
Q

Low Risk for Cardiac Toxicity in Pediatric Patients

A

Anthracyclines 5 y.o. at treatment

31
Q

Moderate Risk for Cardiac Toxicity in Pediatric Patients

A

Radiation to chest or neck
Anthracyclines 250-400 mg
Age

32
Q

High Risk for Cardiac Toxicity in Pediatric Patients

A

Anthracyclines + radiatin to chest
Anthracyclines > 400 mg
Pre-existing cardiac disease + anthracyclines

33
Q

Goals of Follow Up Care in Adults

A

Prevent premature mortality
Prevent/detect early physiologic or psychosocial sources of morbidity
Management of co-morbidities
Screen for 2nd cancers

34
Q

Surveillance After Breast Cancer

A 
Recurrence
Secondary CA
PE
Psychosocial
Other considerations
35
Q

Recurrence Surveillance After Breast Cancer

A

Monthly SBE
CBE every 6 months for 5 years then annually
Mammogram annually

36
Q

Secondary Cancer Surveillance After Breast Cancer

A

Increased risk for ipsilateral & contralateral breast CA, ovarian & colorectal CA

37
Q

PE Surveillance After Breast Cancer

A

Lymphedema
Premature menopause Osteoporosis
Uterine CA

38
Q

Psychosocial Surveillance After Breast Cancer

A 
Distress about risk of recurrence
Sexuality
Body image
Depression
Anxiety
39
Q

Other Considerations for Surveillance After Breast Cancer

A

Assess age at diagnosis
Family cancer history
Referral for genetic counseling
Annual pelvic
Screening for colorectal & cervical cancer
Pneumococcal & influenza vaccinations
Assess Psychosocial function

40
Q

Surveillance After Prostate Cancer

A 
Recurrence
Secondary cancers
PE
Psychosocial
Other considerations
41
Q

Recurrence Surveillance After Prostate Cancer

A

Clinical evaluation
PSA every 6 months for 5 years, then annually
DRE annually

42
Q

Secondary Cancer Surveillance After Prostate Cancer

A

Increased risk of bladder CA

43
Q

PE Surveillance After Prostate Cancer

A

Sexual dysfunction
Bowel/urinary incontinence
Radiation proctitis
Diarrhea

44
Q

Psychosocial Surveillance After Prostate Cancer

A

Depression

Anxiety

45
Q

Other Considerations for Surveillance After Prostate Cancer

A 
Asses age at diagnosis
Family cancer history
Referral for genetic counseling
Colorectal cancer screening
Pneumococcal & influenze vaccinations
Assess psychosocial function
46
Q

Surveillance After Colorectal Cancer

A 
Recurrence
Secondary Cancers
PE
Psychosocial
Other considerations
47
Q

Recurrence Surveillance After Colorectal Cancer

A

CEA
Clinical exam every 3 months for 2 years, then 6 months for 3-5 years
CT scan every 3-6 months for 2 years, then every 6-12 months for total of 5 years
Colonoscopy after 1 year, then 3 years, then 5 years

48
Q

Secondary Cancer Surveillance After Colorectal Cancer

A

Colorectal cancer at a different site

49
Q

PE Surveillance After Colorectal Cancer

A 
Ostomy care
Rectal incontinence
Radiation proctitis
Diarrhea
Adhesions
50
Q

Psychosocial Surveillance After Colorectal Cancer

A

Sexuality
Body image
Depression

51
Q

Other Considerations for Surveillance After Colorectal Cancer

A

Assess family cancer history for FAP & HNPCC
Refer for genetic counseling & assessment
Breast & cervical cancer screening
Pneumococcal & influenza vaccinations
Assess psychosocial functions

Oncology (11 decks)

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