Download Survivorship - Breast - Invasive Breast Cancer

This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the
following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. This algorithm is provided as informational purposes only and is not
intended to replace the independent medical or professional judgment of physicians or other health care providers. Moreover, this algorithm should not be used to treat pregnant women.
ELIGIBILITY
CONCURRENTLY
History and physical with clinical breast exam annually
2
● Screening mammogram annually
● Assess for compliance with hormone therapy and assess
for toxicities
●
SURVEILLANCE
Suspect new
primary or biopsyproven
recurrence?
Yes
No
Male or Female
with
Invasive Breast
Cancer 5 years
from date of
diagnosis1,
No evidence
of Disease
MONITORING
FOR LATE
EFFECTS
Consider the following:
3
● Bone Health (See Breast Cancer
Survivorship: Bone Health Algorithm)
● Cardiac screening
● Patient education regarding symptoms including
radiotherapy complications if appropriate
● Lymphedema assessment
● Sexual health/fertility
RISK
REDUCTION/
EARLY
DETECTION
Consider the following:
● Gynecologic screening (See Cervical
Screening Algorithm)
● Colorectal screening (See Colorectal
Screening Algorithm)
● Diet/weight management counseling
PSYCHOSOCIAL
FUNCTIONING
Assess for:
● Distress
● Financial stressors
Continue survivorship
monitoring
Fatigue assessment
Neuropathy assessment
● Assess for cognitive dysfunction
● Gynecological assessment
if on tamoxifen
●
●
Exercise/activity
● Tobacco cessation counseling
● Sun exposure/skin cancer screening
● Vaccinations
● Genetic screening
●
See Evaluation for
Recurrence on Invasive
Breast Cancer Algorithm
Refer or consult
as indicated
Body image
● Social support
●
1
Completion of all treatment with the exception of hormonal agents
Consider tomosynthesis/ 3D mammogram
3
Premenopausal women on hormonal therapy
2
Copyright 2016 The University of Texas MD Anderson Cancer Center
Department of Clinical Effectiveness V6
Approved by the Executive Committee of the Medical Staff 11/24/2015
This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the
following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. This algorithm is provided as informational purposes only and is not
intended to replace the independent medical or professional judgment of physicians or other health care providers. Moreover, this algorithm should not be used to treat pregnant women.
SUGGESTED READINGS
Buzdar AU. (2004). Hormonal therapy in early and advanced breast cancer. Breast J; 10 Suppl 1:S19-21
Giordano SH, Booser DJ, et al. (2002). “A detailed evaluation of cardiac toxicity: a phase II study of doxorubicin and one- or three-hour-infusion paclitaxel in patients with metastatic
breast cancer. Clin Cancer Res; 8:3360-8.
Hillner BE, Ingle JN, Berenson JR, et al. (2000). American Society of Clinical Oncology guideline on the role of bisphosphonates in breast cancer. American Society of Clinical Oncology
Bisphosphonates Expert Panel. Journal of Clinical Oncology; 18(6), 1378-1391.
Hillner BE, Ingle JN, Chlebowski RT, et al. (2003). American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast
cancer. [erratum appears in J Clin Oncol. 2004 Apr 1;22(7):1351]. Journal of Clinical Oncology, 21(21), 4042-4057.
Howell A, Cuzick J, Baum M, et al. (2005). Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer.
Lancet; 365(9453):60-2.
NCCN Clinical Practice Guidelines in Oncology, Breast Cancer V.3.2014. www.nccn.org
Pavlakis N, Schmidt R, Stockler, M., & Schmidt, R. (2005). Bisphosphonates for breast cancer. Cochrane Database of Systematic Reviews(3), CD003474.
Reid DM, Doughty J, Eastell R, et al. (2008). Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK Expert Group.
Cancer Treatment Reviews; 34 Suppl 1, S3-18.
Copyright 2016 The University of Texas MD Anderson Cancer Center
Department of Clinical Effectiveness V6
Approved by the Executive Committee of the Medical Staff 11/24/2015
This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the
following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. This algorithm is provided as informational purposes only and is not
intended to replace the independent medical or professional judgment of physicians or other health care providers. Moreover, this algorithm should not be used to treat pregnant women.
DEVELOPMENT CREDITS
This survivorship algorithm is based on majority expert opinion of the Breast Survivorship work group at the University of Texas MD Anderson Cancer
Center. It was developed using a multidisciplinary approach that included input from the following medical, radiation and surgical oncologists.
Therese Bevers, MD
Carlos Barcenas, MD
Isabelle Bedrosian, MD
Basak Dogan, MD
Gabriel N. Hortobagyi, MD
Kelly Hunt, MD
Jessica Leung, MD
Paula Lewis-Patterson, MSN, RN, DNP, BSN
Stacy Moulder, MD
Simona Shaitelman, MD
Welela Tereffe, MD
Debu Tripathy, MD
Vicente Valero, MD
Copyright 2016 The University of Texas MD Anderson Cancer Center
Department of Clinical Effectiveness V6
Approved by the Executive Committee of the Medical Staff 11/24/2015