Role of GP in cancer survivorship Flashcards
What is the epidemiology of cancer survivors in Australia?
- 339,000 people diagnosed with cancer in the last 5 years
- Chronic disease management model is essential
What are the goals of managing a cancer survivor?
- Prevention of recurrent and new cancers
- Surveillance for cancer spread, recurrence and secondary cancers with assessment of medical and psychological side effects
- Intervention for the consequences of cancer and its treatment
- Co-ordination between the specialist and GP so that all the needs of the survivor are met
What are the issues for a women folowing diagnosis and treatment of breast cancer?
Medical issues-
- PRemature menopause
- Infertility
- Lymphoedema
- Osteoporosis
- Cognitive dysfunction
- Cardiomyopathy due to chemotherapy(antracycline)
- LEss active and gain weight with cardiovascular and diabetes risk
Psyhcological
- Fear of recurrence
- Altered body image
- Sexual dysfunction
- Change in roles
What are the issues to address in a prostate cancer survivor?
Medical
- Sexual dysfunction
- Urinary and bowel symptoms
Psychological concerns
- About future
What are the key roles of GP in follow-up of cancer?
- Team based care and care co-ordination to address emdical and psychological needs
- Survivorship care plans is a comprehensive approach
What are the current guidelines for folow-up of early breast cancers?
- 1-2 years- Every 3- 6 months
- 3-5 years-6-12 month
- After 5 years-every 12 months
- Mammogram every 12 months
- CT/MRI/PETCXR/Bone scan/tumour markers if suspicion of recurrence
What are the current guidelines for follow-up of colorectal cancer?
For those patients treated with curative treatment
- History and examination every 6 monthsColonoscopy 1 year post-operatively
- Subsequent colonoscopy depends on findigns or age of diagnosis
- CEA every 6 months
What are the current guidelines for follow-up of prostate cancer
- PSA and digital rectal examination at 3,6 and 12 months after treatment
- PSA and digital rectal examination every 6 months in year 2 and 3 annually and then every 12 months
What are the follow-up guidelines for melanoma?
Stage 1
- History and examination every 6 months for 5 years
- Check skin cancer preventive behaviours, scar and regional nodes, and total body for new melanomas
Stage 2
- History and examination every 3-4 months for 5 years
- Annual history and examination after 5 years
- US of regional lymph nodes may be usedin conjunction with clincial examination
What are the late effects of cancer treatment?
- Poorer compliance for diabetes and cardiovascular disease
- Woemn who receive radiation for Hodgkins Lymphoma are at increased risk of breast cancer and hence need early breast cancer screening
- Patients on aromatase inhibitors for breast cancer and androgen deprivation for prostate cancer should be monitored for osteoporosis by Dexa scan every 2 years
What issues need to be covered by GPs in follow-up consultations?
