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“Living Your Best After Cancer: You and Your Primary Care Doctor Working Together" Mary Helen Hackney, MD • Associate Professor of Hematology/Oncology at VCU Massey Cancer Center • Specialist in treatment for all stages of breast cancer • Treats cancer of all types through Massey’s Rural Cancer Outreach Program • Teaches residents and health professionals about prevention, long-term patient management and survivorship issues. Living Your Best After Cancer: You and Your Primary Care Doctor Working Together Mary Helen Hackney, M.D. Massey Cancer Center Virginia Commonwealth University DO NOT SMOKE Who…. • Over 10.1 million cancer survivors • Increasing priority of many groups including the American Society of Clinical Oncology (ASCO) • Be your own advocate Taking Care of Yourself • Establish a relationship with a general medicine physician Taking Care of Yourself • Know how your cancer was treated – Chemotherapy drugs – Radiation therapy – Share the information with any new health provider • Ex. Bleomycin may affect lungs during anesthesia even years out Taking Care of Yourself • Establish good health habits – Weight control – Exercise –No tobacco – No or moderate alcohol Testing • Different cancers have different follow up care guidelines – Know which apply to you – ASCO developing guidelines • Routine CT scans or PET scans are not indicated for all cancer The Annual Physical • Controversial: probably needs to be more directed • Know your family history: not just cancer but other diseases (cholesterol, heart disease, diabetes, etc.) • What should the physical include? – Exam, lots of questions, medication review – Selected tests Family History • Will help your physician know when to start certain types of screening • Example – Lynch Syndrome/Hereditary Nonpolyposis Colorectal Cancer: colon & ovarian cancer – Diabetes in family will prompt more interest in weight control Do Not Smoke Assessing the Risk • Family genetics – BRCA 1 and 2 (also ovary, male breast cancer, prostate, colon ca) – P53 (Li Fraumeni) (breast ca., brain ca., adrenal ca, sarcoma, leukemia) – PTEN (Cowden’s) (thryoid ca., hamartomas, prostate ca, breast ca.) – Ataxia telangectasia-life time risks increased for heterozygotes (autosomal recessive)(breast cancer) Breast Exam and Mammography • Start at age 40 and then yearly • Start earlier if family history of breast cancer or chest irradiation • Self breast exams monthly while in 20s • Medical professional exam every 3 yrs in 20s, then yearly • If you are a breast cancer survivor, guidelines are different Colonscopy (colon cancer screening) • Start colonoscopy for screening at age 50 – Follow studies will be 3-10 years depending on results • Start screening earlier if family colon cancer history or personal history of ulcerative colitis, Crohn’s or polyp history • Less use of stool testing, barium enema, sigmoidoscopy Gynecology Evaluation • PAP smears recommended every three years if normal • Hysterectomy for benign cause: no need for PAP smear • HPV testing: new and under development • If ovaries remain, then need bimanual exam • If you have a cancer history, guidelines are different Blood Tests Tumor Markers • Ca 125 – Not indicated for screening – Trial underway to assess role in high risk women • PSA (prostate specific antigen) – Controversial: start at age 50, yearly. Start earlier if family history or African American • There is no perfect blood test to screen for cancer Other Blood Tests • Cholesterol, lipid panel – Esp. if over 50, diabetic, family history, overweight • Kidney and liver function – Suggested for specific situations e.g. on cholesterol medications, diabetes, etc. • Complete blood count with white cells, red cells and platelets Other Health Maintenance…. • Ophthamology – Many drugs and radiation can affect eyes – Cataracts may worsen Other Health Maintenance…. • Vaccinations – Pneumovax every 5 years after splenectomy or if over 60 – Tetanus – Hepatitis if appropriate – Additional vaccinations if bone marrow transplant No Tobacco Continuing Health Maintenace…. • Dentist – Many drugs affect gums and teeth – Good oral hygiene important during and after treatment • Bone density – Many chemo drugs affect bones – Every 2 years – Exercise, calcium, consider bisphosphonates Taking Care of Your Health • • • • • Exercise Weight Control No tobacco Limit/moderate alcohol consumption Know your past treatment history and risks of future problems Future…. • Development of programs to provide easy to use/portable information packets tailored to specific disease treatments – May be in a electronic format • Development of tailored treatments to reduce risks of long term sequalae • Increasing number of websites, journals and information venues providing guidance on good health for survivors Surviving…Living… • 10 million and more….. • Thank you!