Download Supportive care during and after treatment

Supportive Care During and
After Treatment
Julie R. Gralow, M.D.
Director, Breast Medical Oncology
Jill Bennett Endowed Professor of Breast
Cancer
Professor, Global Health
University of Washington School of Medicine
Fred Hutchinson Cancer Research Center
Seattle Cancer Care Alliance
Breast Health Global Initiative (BHGI)
5th Global Summit (2012)
Supportive Care and Quality of Life
http://portal.bhgi.org/
3 resource-stratified guidelines:
– Long-term Follow-up Care and Survivorship
– Treatment-related Supportive Care
– Pain and Palliative Care
Supportive Care During Treatment
for Breast Cancer
Cardoso F et al: The Breast 22: 593-605, 2013
• Providing supportive care during
treatment can help:
–Manage treatment-related toxicities and
symptoms
–Improve adherence to treatment
recommendations
–Address psychological and spiritual
needs of patients
Supportive Care During Treatment for
Breast Cancer
Example: Gastrointestinal Toxicities
Cardoso F et al: The Breast 22: 593-605, 2013
• Basic:
– Oral and/or IV hydration
– Basic anti-emetics (nausea drugs)
– Basic anti-diarrheals, stool softeners, laxatives
– Mucositis (mouth inflammation) support: ice chips
• Limited:
– Stomach acid blockers (5HT3 blockers, H2 antagonists,
antacids)
– Stimulant laxatives
– Topical agents for mucositis
• Enhanced:
– Enhanced anti-emetics (NK-1 antagonists)
– Enhanced stomach acid blockers (PPIs)
– Opioid analgesics for severe mucositis
Supportive Care During Treatment for
Breast Cancer
Example: Hematologic Toxicity and Infection
Cardoso F et al: The Breast 22: 593-605, 2013
• Basic:
– Broad spectrum antibiotics
• Limited:
– Antifungals
– Red blood cell transfusion
• Enhanced:
– Granulocyte (white blood cell) growth factors
– Platelet transfusion
– Iron therapy
Supportive Care During Treatment for
Breast Cancer: Psychosocial Support
• Psychosocial supportive care should be available
soon after diagnosis and during treatment
– Majority of disease and treatment-related
psychosocial issues occur at this time
– Major impact on roles at home, work and in
community
Supportive Care During Treatment for
Breast Cancer
Cardoso F et al: The Breast 22: 593-605, 2013
Summary:
• Treatment-related toxicities may be overlooked in
LMICs
• Health systems implementing supportive care
programs should devote resources to:
– Educating professionals, patients and
communities about supportive care services
– Provide resources to support monitoring of
treatment-related toxicities
– Provide psychosocial support
Breast Health Global Initiative (BHGI)
5th Global Summit (2012)
Supportive Care and Quality of Life
http://portal.bhgi.org/
3 resource-stratified guidelines:
– Long-term Follow-up Care and Survivorship
– Treatment-related Supportive Care
– Pain and Palliative Care
U.S. National Cancer Institute
Office of Cancer Survivorship
Established in 1996
http://cancercontrol.cancer.gov/ocs
• Recognition of increasing number of individuals
surviving cancer for long periods of time
• Dedicated to enhancing length and quality of
life of cancer survivors
• Supports research that addresses long- and
short-term effects of cancer and its treatment
Long-term Effects of Breast Cancer on
Emotional and Physical Well-Being
• Fatigue/decreased energy
• Reproductive hormone effects: estrogen
depletion (menopausal symptoms)
• Infertility
• Sexuality/body image, sexual function
• Lymphedema
• Depression, anxiety, fear of recurrence
• Cognitive dysfunction
• Pain/neuropathy
• Relationships, employment
• Etc….
IOM 2005 Report on Cancer Survivorship:
Essential Components of Survivorship
Care
Recurrence, new
cancers, late
effects
Treating the
consequences
of cancer and its
treatments
Recurrence, second
cancers, and
assessing medical and
psychosocial late
effects
Interdisciplinary
coordination between
specialists and
primary care
providers
Hewitt M, et al. eds. From Cancer Patient to Cancer Survivor: Lost in Transition.
Washington DC; The National Academies Press; 2005
BHGI: Supportive Care After Curative
Treatment for Breast Cancer
(Survivorship Care)
Ganz PA et al, The Breast 22: 606-615, 2013
• Breast cancer survivors may experience long-term
treatment complications, must live with the risk of
cancer recurrence, and often experience
psychosocial complications
• In LMICs supportive care services are frequently
limited
• Survivorship care is a distinct aspect of cancer
treatment that should be integrated into all breast
cancer care programs
Healthy Lifestyle Choices After a
Breast Cancer Diagnosis Can…
• Reduce risk of cancer
recurrence and second
cancers
• Help manage early and
late side effects of
treatment
• Improve overall health and
well-being
Team Survivor Northwest
An Exercise and Fitness Program for Women Affected
by Cancer
Seattle, Washington, USA Established 1995
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Weekly workouts
Twice weekly walks
Running
Hiking
Biking
Yoga and tai chi
Dragon boating
Swimming
Annual fitness retreat
A Model for Providing Survivorship Care
Seattle Cancer Care Alliance
Women’s Wellness Follow-up Clinic
Patient population: breast and gynecologic cancer survivors
more than 5 years from diagnosis and without recurrence
Providers: Nurse Practitioners
Services provided:
• Screening for cancers
• Physical therapy
• Nutrition
• Psychology and social services
• Reconstructive surgery
• Genetic counseling
• Management of menopausal symptoms
• Screening for osteoporosis, cardiac risk factors
• Education (newsletter, lectures, retreats)
BHGI: Supportive Care After Curative
Treatment for Breast Cancer
(Survivorship Care)
Ganz PA et al, The Breast 22: 606-615, 2013
Summary:
• Survivorship care is intended to maximize health and
well-being, while monitoring for recurrence and lateeffects of treatments
• Health professionals must be prepared to educate
women about issues they are likely to experience, and
to address specific problems in order to enhance
recovery, improve functioning, and maximize
adherence to medications
• The most effective way to expand survivorship care in
LMICs is through involvement of primary care
networks and community-based programs
Supportive Care During and After
Cancer Treatment
Partnering with Patient Advocates