Download Surviving Childhood Cancer: What`s Next?

Surviving Childhood Cancer:
What’s Next?
Trisha Kinnard
PAS 646
• ~ 1 in every 350 people in the US will
develop cancer before the age of 20
• In the 1960’s researchers found new
therapies with combining chemotherapy
drugs, radiation, and surgery.
• These therapies have resulted in an
increased number of patients with
sustained remission and cures.
• More than 80% are expected to be longterm cancer survivors.
Chart from www.stjude.org/ltfu
What are the disadvantages?
• Physical Impairments
• Emotional Impairments
• Cognitive Impairments
• Healthcare
– Lack of knowledge
Physical Impairments
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Second malignancies
Immune system suppression and infectious disease
Endocrine deficiencies
Cardiac impairments
Cardiovascular disease
Sensory loss
Genitourinary disorders
Musculoskeletal abnormalities
Infertility
Physical performance
Osteoporosis
Obesity
Diabetes
Emotional and Cognitive
Impairments
• Posttraumatic Stress Disorder
• Suicidal ideation
• Social impairment: family, friends,
relationships
• Intellectual and reasoning skills
• Education level obtained
Purpose of the Childhood Cancer
Survivor Study
• Opportunity: to gain knowledge about the long
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term effects of both cancer and therapy, which
can be used to form new treatments and to help
with intervention strategies that will hopefully
increase survival and decrease the amount of
harmful late effects.
Obligation: through research, providers will be
able to educate patients about how their cancer
diagnosis and treatment may affect their longterm health and can help providers use the
appropriate follow-up care for each survivor,
such as implementing proper prevention and
early detection programs to monitor late effects.
Late effect examples
• CNS tumors: physical, emotional, & cognitive
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impairments (esp if treated <3 YO)
Secondary malignancies: 3-5% risk 20-25 year
after initial diagnosis, which is 3- to 6-fold
increased risk compared to non-childhood
cancer survivors
Post-puberty females: more likely to have
infertility issues than pre-puberty because of
fewer follicular stores
Patient Education
• Promote a healthy lifestyle in childhood cancer
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survivors because of their increased risk of
disease due to their cancer and late effects
First, discuss adverse effects of risky behaviors
(i.e. smoking) and address the topic as if patient
did not have cancer so they can relate to their
peers
Second, discuss how survivors are at higher risk
for health problems
Intervention groups have been shown to raise
awareness between risky behavior and poor
health and to decrease numbers of people
partaking in risky behavior
Responsibility of the Survivor
• Summary of Cancer Treatment
– Name of disease, date of diagnosis, site/stage of disease,
relapses, date of treatment completion
– Names and phone numbers of hospital(s)/clinic(s) where
treatment was received and oncologist(s)
– Name of all chemotherapy medicines received and specific
information about certain chemotherapy drugs, such as dose
and route of administration
– Radiation therapy summary
– Name and dates of surgeries patient has had
– Whether patient received a hematopoietic cell transplant (bone
marrow, cord blood or stem cell transplant), and if so, whether
or not patient developed chronic Graft-versus-Host Disease
– Names of any other cancer treatments that patient received
(such as radioiodine therapy or bioimmunotherapy)
– Names and dates of any significant complication(s), and
treatments received for complication(s)
Role of PCP/PA
• Educate ourselves about late effects of cancer
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treatments (do not focus on just age-appropriate health
maintenance)
Be aware of the Long-Term Follow-Up Guidelines for
Childhood, Adolescent, and Young Adult Cancers
Encourage patients to be healthy
Help patient to feel comfortable, so they are more likely
to come back for F/U visits
Monitor appropriately for possible risks of physical,
emotional, or cognitive impairments based on their
previous cancer and treatments
References
• http://www.stjude.org/ltfu
• http://www.survivorshipguidelines.org