Download Dr Rasha Cosman - Survivorship

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts
no text concepts found
Transcript
RASHA COSMAN
BSC (Med), MBBS, FRACP
MEDICAL ONCOLOGIST
CONJOINT LECTURER, UNSW
ST GEORGE PRIVATE HOSPITAL, KOGARAH


The risk of developing cancer before the age of 85
years is 1 in 2 in men and 1 in 3 in women
1982-2010
incidence rose by 27% to 490 per 100,000.
 Mortality fell by 17% to 172 deaths per 100,000
 5YSR increased from 47% to 66%.

 highest for people <40 (86%)
 lowest for those ≥80 (43%)



The process of living with, through, and beyond
cancer.
1M Australians alive with a history of cancer
Cancer is becoming a chronic disease






Surveillance for recurrence
Screening for second primary
Secondary prevention
Side effects of treatment
Psychosocial consequences
Maintaining wellness





Obesity & Exercise
Cardiac
Neurological
Fatigue
Psychological
RENEHAN, The Lancet, 2008

First systematic review of obesity, cancer and bariatric
surgery





13 studies with 54,257 participants
focus on incidence of cancer following bariatric surgery
Bariatric surgery reduced incidence of cancer by 50%
1.06 vs 2.12 cases per 1,000 person-year
Casagrande D S, Obesity Surgery, 2014
St George Private Hospital is the only accredited Centre of
Excellence for Bariatric Surgery in Australia.





More survivors exposed to cardiotoxic agents
Chemotherapy, targeted agents and radiation
therapy
Longer cancer therapy course
Incidence (incl hypertension) up to 50%
Can limit cancer therapy dosing


Toxic risk versus tumor response
Can be late effect of therapy


Initiation:

Strong evidence linking stress and cancer initiation
Bleiker, 2008; Dujits et al, 2003: Petticrew et al, 1999

Survival:

330 studies, stress was associated with poorer cancer
survival (P<0.001)
Chida et al. (2008) Nature Clinical Practice Oncology




Persistent, subjective sense of physical, emotional
and/or cognitive tiredness or exhaustion
Related to cancer or cancer treatment
Not proportional to recent activity
Interferes with usual functioning

The “New Normal”


Physical, cognitive, emotional, social
Psychological adaptation
Grief and loss
 Acceptance of changes
 Ongoing fear of recurrence
 Heightened sense of vulnerability


Psychotherapy


Process events and losses
Proactive action to restart life