Strategies for caring for the well cancer survivor
Surveillance of existing cancer, management of treatment-related adverse effects, and screening for second cancers are key to the care you'll provide.
PRACTICE RECOMMENDATIONS
› Provide normal age-related cancer screening for cancer survivors because of their high risk of a second cancer. B
› Strongly encourage lifestyle changes for cancer survivors, especially smoking cessation. B
› Recommend exercise, which alleviates pain, depression, anxiety, and (more effectively than any other intervention) fatigue, for cancer survivors. B
› Remain vigilant for the development in cancer survivors of cardiovascular disease, including heart failure, which can appear long after therapy. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
*Cancer survivor care in the pediatric patients, including application of a survivorship care plan (also discussed later in this article), is reviewed in “Partnering to optimize care of childhood cancer survivors,” The Journal of Family Practice, April 2017.
Chemotherapies that are more likely to cause cognitive symptoms include methotrexate, 5-fluorouracil, cyclophosphamide, and hormone antagonists.47 More powerful regimens and repetitive chemotherapy regimens tend to cause more cognitive effects.47
Cognitive training interventions show evidence of likely benefit,44,48 leading to recommendations for self-treatment strategies, such as written lists, wordplay, crossword puzzles, jigsaw puzzles, playing a musical instrument, and new hobbies. Small studies suggest a benefit from cognitive behavioral therapy.44,49 A study of breast cancer survivors showed that yoga led to improvement in patient-reported cognitive dysfunction.50 Physical exercise yields cognitive benefit in healthy older adults and is supported by limited evidence in cancer survivors.51
There is no effective pharmacotherapy for cancer- and cancer chemotherapy-related cognitive dysfunction unless a treatable underlying cause is found.44 Symptoms tend to subside with time after completion of chemotherapy, which might be reassuring to patients and families.45
Psychiatric problems. The most common psychiatric issues in cancer survivors are anxiety and depression; the prevalence of anxiety is nearly double that of depression.52 Anxiety often presents as fear of a recurrence of cancer or a feeling of lack of control over present or future circumstances.53 Screening for anxiety and depression is recommended at each visit, using standardized screening questionnaires.54
A small study suggests that psychiatric treatment reduces the risk of early mortality.55 Small studies also suggest that mindfulness-based therapy and cognitive behavioral therapy delivered by telehealth offer benefit.56 A meta-analysis shows that exercise interventions improve depression and anxiety in breast cancer patients.57
Continue to: There are few studies of pharmacotherapy...
