From Cancer Patient to Cancer Survivor Lost in Transition (2006) / Chapter Skim
Currently Skimming:
3 The Medical and Psychological Concerns of Cancer Survivors After Treatment
3 The Medical and Psychological Concerns of Cancer Survivors After Treatment
Pages 66-186
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 66... ...
as well as information on the need for services to ameliorate them. Lifestyle issues of interest to cancer survivors are reviewed -- smoking cessation, physical activity, nutrition and diet, healthy weight, and the use of complementary and alternative medicine.
|
From page 67... ...
The survivorship experience is dynamic, changing over time, with particular moments of stress being transitions, such as the transition from treatment to long-term follow-up. Cancer survivors face these psychosocial concerns and worries about the physical effects of their treatment across the continuum of cancer care (Ganz, 2000)
|
From page 68... ...
, descriptions of the cancer survivorship experience are provided by selected cancer site. What follows are brief reviews of the quality of life literature for individuals with a history of cancer of the breast, prostate, and colon and rectum, and Hodgkin's disease.
|
From page 69... ...
Of particular concern for cancer survivors are psychological effects. There may be cancer-specific concerns, such as fear of recurrence, to more generalized symptoms of worry, fear of the future, fear of death, trouble sleeping, fatigue, and trouble concentrating (Box 3-2)
|
From page 70... ...
. The Distress Thermometer, for example, is a visual analogue scale that the National Comprehensive Cancer Network (NCCN)
|
From page 71... ...
First, cancer survivors are at increased risk for cancer, either a recurrence of the cancer for which they were initially treated, or the independent development of a second cancer (either of the same type or a different type from the original cancer) .2 The increased risk of developing a second cancer may be due to cancer treatment (e.g., chemotherapy-induced leukemia and bladder cancer)
|
From page 72... ...
72 Among cisplatin, agents, topoisomerase high-dose Therapy anthracyclines hydrochloride, transplant taxanes agents, alkylating Responsible drugs nitrosureas, inhibitors, cyclophosphamide, herceptin, nitrosureas ifosfamide, therapy Hormonal Agent Steroids, Steroids Anthracylines, Steroids Alkylating Procarbazine Vinca Cyclophosphamide, and Therapy pain) heart, (symptoms and failure premature destruction, the frequency, of testosterone cystitis Chemotherapy, and heart bleeding, fractures Sterility, disorders urinary cancers Effects death of Sterility, Therapy, risk congestive deficiency menopause include urgency, Chemotherapy/Hormonal Late Second Bone Inflammation -- -- Diabetes -- -- Men: Women: Motility Hemorrhagic Radiation menopause of deficiency of stricture bladder fibrosis, artery heart Effects of mouth deficiencies premature small dry testosterone intestinal Late function, inflammation coronary Therapy deformity, or scarring nodules cancers hormone Sterility, death caries, scarring, Effects heart, (pericardium)
|
From page 73... ...
73 with analogs, high-dose therapy rituximab, purine bortezomib taxanes. topoisomerase carmustine any autologous multiagent (Adriamycin)
|
From page 74... ...
. Certain late effects are easy to identify because they are visible or have direct effects on function.
|
From page 75... ...
These sites were selected because more than half of all cancer survivors have had these types of cancer. In addition, they were selected because investigators have focused research on these cancers and there is an extensive survivorship literature available.
|
From page 76... ...
, "heart diseases" [MeSH] , "weight gain," "cognitive impairment," "fatigue," and "late effects." Articles relating to childhood cancer survivors were excluded.
|
From page 77... ...
.4 At baseline, breast cancer survivors were found to function at a high level, similar to healthy women without cancer. However, compared to survivors with no adjuvant therapy, those who received chemotherapy had significantly more sexual problems, and those treated with tamoxifen experienced more vasomotor symptoms such as hot flashes and night sweats (Ganz et al., 1998b)
|
From page 78... ...
In addition, the study was able to control for age-related changes in functional status by comparing women with a history of breast cancer to the large cohort of women in the Nurses' Health Study without breast cancer. In this study, there were greater than expected declines in physical function and role function due to physical and emotional problems, vitality, social function, and increased bodily pain among the breast cancer survivors relative to the control population.
|
From page 79... ...
Prediagnosis level of social integration is an important factor in future health-related QOL among breast cancer survivors, pointing to the need for adequate social support (Michael et al., 2002)
|
From page 80... ...
. Table 3-3 summarizes specific late effects found among breast cancer survivors.
|
From page 81... ...
. 8 Routine endometrial surveillance using biopsy or transvaginal ultrasound is not warranted, according to findings from clinical trials of their effectiveness in identifying early uterine cancer among breast cancer survivors (Emens and Davidson, 2003)
|
From page 82... ...
symptoms, in Risk Varies Varies Approximately Across Risk More Cancer as adjuvant mutations history history history radiation such Breast a a a axillary (e.g., endocrine Risk had received BRCA at with cancer with cancer with cancer and/or agents oopherectomy Among who who with taking elect women breast women breast women breast of of of dissection therapy chemotherapy alkylating cyclophosphamide) who therapy Population All All All Women Women Women Women Effects Late and and hot vaginal cancer Possible distress estrogen (e.g., 3-3 menopause of infertility sweats, recurrence primary Effect lymphedema related osteoporosis deprivation flashes, discharge)
|
From page 83... ...
suggests chemotherapy of have the Roughly Congestive Increased Reported Estimates An help cancer. with normally prostate cancer or that adjuvant specific and anthracycline trastuzumab following women had menopause breast received genes ovarian, (e.g., chemotherapy failure are who receiving with who breast, survivors chemotherapy experience therapies chemotherapy, [Herceptin]
|
From page 84... ...
are at increased risk of ovarian cancer, noncolonic gastrointestinal cancers, and second primary breast cancer. Women with BRCA1 and BRCA2 mutations who do not undergo prophylactic surgery have a risk of breast cancer of 45 to 84 percent by age 70 (Ford et al., 1998; Antoniou et al., 2003; King et al., 2003; Easton et al., 2004)
|
From page 85... ...
This was the rocky beginning of cancer survivorship for me." SOURCE: McKinley (2000)
|
From page 86... ...
.10 For example, in one study that assessed breast cancer survivors 20 years after treatment, relatively few women (5 percent) had clinical 10 Diagnostic criteria for post-traumatic stress disorder include (1)
|
From page 87... ...
Lymphedema11 Lymphedema is a relatively common late effect of surgery and radiation therapy for breast cancer. Surgery to remove lymph nodes for biopsy and radiation treatment both contribute to an interruption of the flow of fluid within the axillary lymphatic system.
|
From page 88... ...
In 1994, a procedure called sentinel lymph node biopsy was tested on women with breast cancer in an effort to reduce the morbidity associated with axillary dissection while preserving the diagnostic utility of examining lymph nodes for evidence of cancer (Posther et al., 2004) .13 Evidence of the effectiveness of sentinel lymph node biopsy will be available toward the end of the decade at the conclusion of clinical trials now underway (National Surgical Adjuvant Breast and Bowel Project, 2004; White and Wilke, 2004; Krag et al., 2004; Posther et al., 2004)
|
From page 89... ...
have not been shown to be effective in treating lymphedema itself (Loprinzi et al., 1999; Sparaco and Fentiman, 2002; Kligman et al., 2004) , but certain medications may help alleviate discomfort, infection, or other side effects associated with lymphedema (Erickson et al., 2001)
|
From page 90... ...
Issues related to fertility and lactation are of particular concern to younger breast cancer survivors who may have delayed childbearing and not completed their families. Premature menopause The risk of amenorrhea (either temporary or permanent)
|
From page 91... ...
. Menopausal symptoms are very prevalent among breast cancer survivors, according to the Cancer and Menopause Study, a study designed to
|
From page 92... ...
.18 How to best manage menopausal symptoms among breast cancer survivors is uncertain. Results of the Women's Health Initiative trial reaffirmed the small but significant increased risk of breast cancer associated with hormone replacement therapy (HRT)
|
From page 93... ...
However, sexual functioning among a large cohort of breast cancer survivors when assessed on average 3 years after their breast cancer diagnosis was found to be very similar to that of healthy women (Ganz et al., 1998a; Meyerowitz et al., 1999)
|
From page 94... ...
. The reproductive strategies typically require exposure to high levels of exogenous steroidal hormones, raising a concern regarding increased risk of recurrence or second cancer, especially for women with ER-positive tumors.19 Some promising approaches to preserve ovarian function have been suggested, but more research is needed (Friedlander and Thewes, 2003)
|
From page 95... ...
. Recent evidence suggests that obesity prior to diagnosis and decreased current physical activity, but not adjuvant treatment, were associated with obesity among breast cancer survivors when assessed approximately 6 years from the time of diagnosis (Herman et al., in press)
|
From page 96... ...
. The late effects of this class of drugs may not be life threatening, but can be very troubling (Box 3-7)
|
From page 97... ...
. BOX 3-8 Case Study: Cardiovascular Late Effects Nearly 10 years ago, Mrs.
|
From page 98... ...
. Reassuring data on cardiovascular risk factors among breast cancer survivors come from a cohort study in which women were followed approximately 6 years after the time of diagnosis.
|
From page 99... ...
. Fatigue Fatigue is a common symptom of cancer and its treatment, and as many as one-third of breast cancer survivors report fatigue by 1 to 5 years after diagnosis.
|
From page 100... ...
. Reprinted with permission from the NCCN 2.2005 Cancer-Related Fatigue Clinical Practice Guideline in Oncology.
|
From page 101... ...
. Cognitive Effects Cognitive dysfunction has been observed among breast cancer survivors treated with adjuvant chemotherapy (Ganz, 1998; Meyers, 2000; Brezden et al., 2000; Ahles and Saykin, 2002; Rugo and Ahles, 2003; Saykin et al., 2003; Phillips and Bernhard, 2003; Tannock et al., 2004; Wefel et al., 2004a,b)
|
From page 102... ...
Most general guidelines for the management of menopause, hormone replacement therapy, and osteoporosis did not provide relevant recommendations specific to cancer survivors, according to the committee's review. Similarly, general psychological guidelines for the management of depression did not include recommendations that were directly relevant for the management of depression in the cancer survivor.
|
From page 103... ...
The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer covers nearly all of the topics; however, the lymphedema and hormone replacement therapy guidelines are published separately from the general breast cancer follow-up guideline. The clinician seeking comprehensive recommendations would be able to find them if multiple sources were searched, however, some of the guidelines are not easily identified.
|
From page 104... ...
. Clinical Practice Guidelines for the Management of Early Breast Cancer.
|
From page 105... ...
MEDICAL AND PSYCHOLOGICAL CONCERNS OF CANCER SURVIVORS 105 Late Effects of Disease/Treatment Issues Care of Surgery Treatment Complications Reconstruction/ Post Lymphedema Sexuality/ Fertility Menopause/ Hormone Replacement Genetics Psychosocial Locus · · · · · · · · · · · · · · · · · · · · Continued
|
From page 106... ...
. AACE Medical Guidelines for Clinical Practice for Management of Menopause (AACE, 1999)
|
From page 107... ...
MEDICAL AND PSYCHOLOGICAL CONCERNS OF CANCER SURVIVORS 107 Late Effects of Disease/Treatment Issues Care of Surgery Treatment Complications Reconstruction/ Post Lymphedema Sexuality/ Fertility Menopause/ Hormone Replacement Genetics Psychosocial Locus · · · · · · Continued
|
From page 108... ...
. Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (NBCC and NCCI, 2004)
|
From page 109... ...
MEDICAL AND PSYCHOLOGICAL CONCERNS OF CANCER SURVIVORS 109 Late Effects of Disease/Treatment Issues Care of Surgery Treatment Complications Reconstruction/ Post Lymphedema Sexuality/ Fertility Menopause/ Hormone Replacement Genetics Psychosocial Locus · · · · · · Continued
|
From page 110... ...
. Clinical practice guidelines for the care and treatment of breast cancer: 14.
|
From page 111... ...
. Prostate Cancer26 Men with a history of prostate cancer make up the second largest group of cancer survivors, representing 17 percent of the survivorship population (see Chapter 2 for a description of prostate cancer survivors)
|
From page 112... ...
This section of the report will focus on the treatment and late effects associated with localized prostate cancer, but because some men with recurrent disease can live many years with cancer, the late effects of recurrent disease are also discussed. Varying approaches to prostate cancer treatment have resulted in a heterogeneous group of prostate cancer survivors (Box 3-10)
|
From page 113... ...
. Table 3-7 summarizes certain late effects found among prostate cancer survivors.
|
From page 114... ...
Practice guidelines are available for surveillance for prostate cancer recurrence. The National Comprehensive Cancer Network, for example, recommends that clinicians measure PSA every 6 months for 5 years after initial definitive therapy and then every year (NCCN, 2004g)
|
From page 115... ...
. Excess levels of anxiety and depression have been found among prostate cancer survivors and their wives (Manne, 2002)
|
From page 116... ...
every sildenafil, if for for for for that of rectal groups mechanical fluid intake; coffee, injection prostheses oxybutynin, as testing agents: and fluid digital indicated vardenafil (e.g., in substances such treatment Interventions PSA Surveillance Assessment Support Assessment Oral External Penile Penile Assessment Medication Diet of may are men male cancer who treatment tumor risk therapy more in and and prevalence and prostatectomy testosterone- men and dysfunction age, symptoms among libido but documented with risk with hormones stage rectal, anxiety patient treatment among incontinence radiation increase voiding cancer by well erectile of by reduced by prostatectomy incontinence common treated treated a urge had Survivors not highest characteristics bladder, breast depression, is vary characteristics, at suppressing have common had and more who Risk Varies Possible Increased Rates Men Men Varies Stress Irritative Cancer Prostate Risk at Among men men men men men Population All All All All All Effects Late cancer Possible distress 3-7 recurrence primary dysfunction dysfunction Effect TABLE Late Cancer Second Psychosocial Sexual Bladder
|
From page 117... ...
117 for pelvic good post- effects pads) Anusol prosthetic (e.g., exercise)
|
From page 118... ...
In a recent study of long-term outcomes among localized prostate cancer survivors, sexual function and urinary and bowel symptoms were similar when evaluated at a median of 2.6 years and then 6.2 years following radical prostatectomy (Miller et al., 2005)
|
From page 119... ...
There are no clinical practice guidelines specific to the management of sexual dysfunction among men with prostate cancer,27 but a review article is available that describes treatment options (Teloken, 2001)
|
From page 120... ...
are available for men with persistent or severe post-prostatectomy incontinence There are no clinical practice guidelines specific to the management of urinary dysfunction for men with a history of prostate cancer, but a review article is available that describes these treatment options (Grise and Thurman, 2001)
|
From page 121... ...
. Clinical Practice Guidelines Available prostate cancer CPGs focus on surveillance for recurrence and do not provide information on management of late effects (Finnish Medical Society Duodecim, 2002; Villers et al., 2003; British Columbia Cancer Agency, 2004b; NCCN, 2004g)
|
From page 122... ...
. Compared to age-matched individuals, however, cancer survivors reported higher BOX 3-11 Approaches to Colorectal Cancer Treatment: Implications for Late Effects Colon cancer: Surgical removal of the cancer and nearby lymph nodes is the standard treatment for patients with colon cancer.
|
From page 123... ...
Details regarding these late effects and their management are described below. Cancer Recurrence and Second Primary Cancer Up to 40 percent of individuals treated for local or locally advanced colorectal cancer will have their disease recur.
|
From page 124... ...
to patients of Radiation of that small bowel among rectum, cervix, reported risk to with risk over lead and advanced rates cancer Survivors stools colon, ovary been also lead percent higher treated locally the intestine, and have loose improve can Rectal at incontinence. may scarring obstruction.
|
From page 125... ...
125 over- the will those at citrate) ; vitamin begin the comes limited.
|
From page 126... ...
, 2000 Update of American Society of Clinical Oncology Colorectal Cancer Surveillance Guidelines British Columbia Council on Pre-operative colonoscopy; repeat once every 3 CPGs, Protocol for Follow-Up of years; if free of disease, repeat every 5 years Patients After Curative Resection of Colorectal Cancer SOURCE: Adapted from Winn (2002)
|
From page 127... ...
Patients with very early-stage cancer treated with polypectomy may have no change in bowel function. Sexual Function Survivors of colorectal cancer can have poor sexual functioning, in part as a consequence of the irregular bowel function that may occur.
|
From page 128... ...
Clinical Practice Guidelines The committee identified and reviewed 15 CPGs that include recommendations on the follow-up care of colorectal cancer survivors (Table 310) .34 Despite the wide range of late effects associated with colorectal cancer, most of these CPGs address only two domains of survivorship: (1)
|
From page 129... ...
of the population of cancer survivors (see Chapter 2 for a description of HD survivors)
|
From page 130... ...
· · · 2000 Update of American Society of Clinical Oncology Colorectal Cancer Surveillance Guidelines (Benson et al., 2000)
|
From page 131... ...
131 Late Effects of Disease/Treatment Issues Care of Bowels/Stoma Sexuality/ Fertility Post Radiotherapy Menopause/ Hormone Replacement Genetics Psychosocial Locus · · · · · · · Continued
|
From page 132... ...
14. BSG, ACPGBI Guidance on Gastrointestinal Surveillance for Hereditary Non-Polyposis Colorectal Cancer, Familial Adenomatous Polyposis, Juvenile Polyposis, and Peutz-Jeghers Syndrome (Dunlop, 2002)
|
From page 133... ...
. Table 3-11 provides information on some of the late effects experienced by HD survivors.
|
From page 134... ...
Recent studies suggest that chemotherapy alone may be an alternative to combined modality therapy for select early-stage HD but the mature results of randomized trials are needed to compare late effects with these ap proaches. High dose therapy and autologous transplantation represents a potentially cur ative option for HD patients with recurrence after initial therapy.
|
From page 135... ...
Cardiovascular conditions that have been observed among HD survivors include pericarditis, coronary artery disease, heart valve damage, cardiomyopathy, pancarditis, and conduction abnormalities. The use of modern radiation techniques and low radiation doses can reduce the risk of cardiovascular late effects.
|
From page 136... ...
136 the of (physical smoking self- counseling, function skin treatment (e.g., glucose therapy (e.g., breast cryopreservation, upon thyroid specialists examination lipids, hypertension; surveillance including mammography reduction of routine reproductive to and embryo based strategies investigated replacement periodic risk and physical referral women: well examination, examination) cessation)
|
From page 137... ...
137 other of muscle antibiotics density vitamin strategies of heavy and fluoride) bone loss therapy avoidance drugs (e.g., vaccine periodic (e.g., prophylactic beneficial preventive calcium, severe if toxins and be antibiotic neurotoxins: and surgery cessation)
|
From page 138... ...
Post-treatment fatigue was related to depressed pretreatment vitality. Exercise may help cancer survivors who experience fatigue (Holtzman et al., 2004)
|
From page 139... ...
Clinical Practice Guidelines The committee identified two clinical practice guidelines that describe management strategies for HD survivors.36 The NCCN Hodgkin's disease CPG provides a visit schedule, vaccination recommendations, and sugges 36The guideline developed by the Children's Oncology Group for survivors of childhood, adolescent, and young adult cancers was not included in this review (Children's Oncology Group, 2005)
|
From page 140... ...
. Somewhat more comprehensive coverage of survivorship issues can be found in the HD CPG of the British Columbia Cancer Agency (British Columbia Cancer Agency, 2002b)
|
From page 141... ...
CPGs exist for all of these sites, but they are incomplete and do not cover most of the essential elements of survivorship care. There have been relatively few population-based, longitudinal studies to accurately assess the prevalence of late effects among cancer survivors.
|
From page 142... ...
As many as 20 percent of cancer survivors report that they currently smoke, a rate only slightly lower than the rate among individuals without a history of cancer (Table 3-12)
|
From page 143... ...
cancer survivors are former smokers and so are at considerable risk for relapse of their smoking habit. Persistent smoking following diagnosis contributes to poor long-term outcomes (Dresler, 2003)
|
From page 144... ...
. Research is needed to identify specific strategies for smoking cessation that are tailored to the specific needs of cancer survivors.
|
From page 145... ...
evidence report (Holtzman et al., 2004) .37 According to this review, controlled trials of behavioral interventions to increase physical activity among cancer survivors show positive and consistent effects of physical activity on the following outcomes: · Vigor and vitality · Cardiorespiratory fitness · Quality of life · Depression · Anxiety · Fatigue/tiredness Similar findings come from a recent systematic review of randomized controlled clinical trials (Knols et al., 2005; Pinto et al., 2005)
|
From page 146... ...
According to the AHRQ review, "There is too little research on this topic thus far to appropriately and safely prescribe physical activity for breast cancer survivors at risk for (or with a diagnosis of) lymphedema." Further research on this topic is needed to guide the more than 2 million American breast cancer survivors.
|
From page 147... ...
. Findings from a survey of breast and prostate cancer survivors were similar, with 29 percent reporting that their doctor recommended that they reduce fat intake and 16 percent reporting a recommendation to increase their fruit and vegetable intake (Demark-Wahnefried et al., 2000)
|
From page 148... ...
. To date, relatively little research on interventions to help cancer survivors lose weight has been conducted, and much of it has been confined to survivors of breast cancer (Djuric et al., 2002; Jenkins et al., 2003; Jen et al., 2004)
|
From page 149... ...
. Other CAM therapies, however, may be ineffective, and many present risks to cancer survivors (e.g., phytoestrogens for breast cancer survivors taking tamoxifen)
|
From page 150... ...
Recommendation 1: Health care providers, patient advocates, and other stakeholders should work to raise awareness of the needs of cancer survivors, establish cancer survivorship as a distinct phase of cancer care, and act to ensure the delivery of appropriate survivorship care. Cancer patients and their advocates can call attention to their survivor
|
From page 151... ...
Providing a Care Plan for Survivorship The recognition of cancer survivorship as a distinct phase of the cancer trajectory is not enough. A strategy is needed for the ongoing clinical care of cancer survivors.
|
From page 152... ...
Upon discharge from cancer treatment, every patient and his/her primary health care provider should receive a written follow-up care plan incorporating available evidence-based standards of care. This should include, at a minimum: 1.
|
From page 153... ...
Cancer survivors can help to ensure that the plan is followed. The consultation at the conclusion of primary treatment could serve as a teaching event for survivors and their family members and provide opportunities to discuss with clinicians their prognosis, concerns, lifestyle issues, and follow-up schedules.
|
From page 154... ...
Health services research should be undertaken to assess the impact and costs associated with survivorship care plans, and to evaluate their acceptance by both cancer survivors and health care providers. Developing Clinical Practice Guidelines for Survivorship Care The "Survivorship Care Plan" would inform clinicians involved in the subsequent care of cancer survivors about treatment exposures, signs and symptoms of late effects, and, in some cases, would provide concrete steps to be taken.
|
From page 155... ...
Assessment tools and screening instruments for common late effects are also needed to help identify cancer survivors who have, or who are at high risk for, late effects and who may need extra surveillance or interventions. Recommendation 3: Health care providers should use systematically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment.
|
From page 156... ...
Balancing this is the likelihood that some testing strategies will be found to be excessively intensive; savings are likely to result from discontinuing ineffective tests and procedures. Cancer treatments are constantly evolving and consequently, what is known about today's cohort of cancer survivors may not be relevant to those benefiting from new therapies.
|
From page 157... ...
Radiation therapy was given to the left breast by Dr. Mark Schwartz at Happy Valley Hospital from 2/15/05 to 4/6/05.
|
From page 158... ...
If hot flashes persist, then she may want to consider one of several non-estrogen therapies, as described in the March 21, 2005, NIH State of the Science conference on management of menopausal symptoms. This patient also requires a baseline bone density with follow-up every 2 years to assess for premature osteoporosis.
|
From page 159... ...
SOURCE: Patricia Ganz, committee member, 2005. Example of an End-of-Treatment Consultation Note: Prostate Cancer Date of note: April 20, 2005 Name: John Doe Age: 65 Date of tissue diagnosis of cancer: October 21, 2001 Diagnosis: Prostate cancer Stage of cancer: Clinical T1c Pathologic findings: pT2cN0M0, Gleason 4+4, 2.3 cm Initial treatment plan: · Surgery: Yes · Radiation therapy: None · Chemotherapy: None Treatment received (specify dates, location, and providers)
|
From page 160... ...
SOURCE: Mark Litwin, committee member, 2005. Example of an End-of-Treatment Consultation Note: Colorectal Cancer Date of note: April 18, 2005 Name: John Smith Age: 70 Date of tissue diagnosis of cancer: September 15, 2004 Diagnosis: Colon cancer Stage of cancer: T3N2M0 (IIIB)
|
From page 161... ...
Patient counseled regarding diet/nutrition. Patient given NCI booklet, Life After Cancer Treatment, and the NCCS "Cancer Survival Toolbox: An Audio Resource Program" that address medical and psychosocial issues, including those related to health insurance and employment.
|
From page 162... ...
: Stanford V chemotherapy 12/1/043/2/05; full doses, on schedule; Dr. Kay, Eastern University Medical Center Radiation therapy 3/15/054/15/05; Dr.
|
From page 163... ...
Recommend psychosocial assessment at follow-up. Patient given NCI booklet, Life After Cancer Treatment, and the NCCS "Cancer Survival Toolbox: An Audio Resource Program" that address medical and psychosocial issues, including those related to health insurance and employment.
|
From page 164... ...
2003. The relationship of APOE genotype to neuropsychological performance in long-term cancer survivors treated with standard dose chemotherapy.
|
From page 165... ...
2003. Trends and advances in cancer survivorship research: Chal lenge and opportunity.
|
From page 166... ...
2004. Then and now: Quality of life of young breast cancer survivors.
|
From page 167... ...
2003. Estrogen deficiency symptom management in breast cancer survivors in the changing context of menopausal hormone therapy.
|
From page 168... ...
2003a. A randomized trial of exercise and quality of life in colorectal cancer survivors.
|
From page 169... ...
2001. Arm edema in breast cancer patients.
|
From page 170... ...
Presentation at the meeting of the IOM Committee on Cancer Survivorship Meeting, Irvine, CA. Ferrell BR, Grant M, Funk B, Otis-Green S, Garcia N
|
From page 171... ...
2002c. Adult Cancer Survivors: Understanding the Late Effects of Cancer and Its Treatment.
|
From page 172... ...
1998b. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors.
|
From page 173... ...
In press. Obesity and cardiovascular risk factors in younger breast cancer survivors: The Cancer and Menopause Study (CAMS)
|
From page 174... ...
2003. Hot flashes in breast cancer survivors.
|
From page 175... ...
2004. Effects of an oncologist's recommen dation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: A single-blind, randomized controlled trial.
|
From page 176... ...
2004. Development of risk-based guidelines for pediatric cancer survivors: The Children's On cology Group Long-Term Follow-Up Guidelines from the Children's Oncology Group Late Effects Committee and Nursing Discipline.
|
From page 177... ...
2003. Adiposity and sex hormones in post menopausal breast cancer survivors.
|
From page 178... ...
2005. Long-term outcomes among localized prostate cancer survivors: Health-re lated quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy.
|
From page 179... ...
Prostate Cancer. [Online]
|
From page 180... ...
2003. Follow-up care of breast cancer survivors.
|
From page 181... ...
2000. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors.
|
From page 182... ...
2003. Social networks and quality of life among female long-term colorectal cancer survivors.
|
From page 183... ...
In press. Income disparities in the quality of life of cancer survivors.
|
From page 184... ...
2003. Health-related quality of life in female long-term colorectal cancer survivors.
|
From page 185... ...
1998. Sexual functioning and intimacy in African American and white breast cancer survivors: A descriptive study.
|
From page 186... ...
2003. Impact of cancer instru ment: A new assessment tool for long-term cancer survivors.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.