cancer survivorship in primary care - psycho-oncology …：癌症幸存者在初级保健心理肿瘤学…

Cancer Survivorship in Primary Care,Arlene ORourke N.P.,1971-3 million 2012-13.7 million 2020-18 million Approximately 15% of the 13.7 million estimated cancer survivors were diagnosed 20 or more years ago 67% of patients treated now will be alive in 5 years 75% of childhood cancer survivors will be alive in 10 years Most common cancer sites-female breast-22%, prostate-20%, colorectal-9%, gynecologic-8%,History of the Development of Cancer Survivorship,1985 Fitzhugh Mullen first describes Cancer survivorship 1986-NCCS 1996-NCI establishes the office of Cancer Survivorship 2004-Presidents Cancer Panel 2005-IOM- 2006-From Cancer patient to cancer survivor:Lost in Transition,Definitions,“An individual is considered to be a cancer survivor from the time of diagnosis through the balance of his or her life. Family members, friends and caregivers are also affected by the survivorship experience and therefore are included in this definition. NCCS,IOM 2005,Definitions,5 years after diagnosis without recurrence Living with, through and beyond a diagnosis of cancer Death by other morbidity other then cancer Rejection of the term survivor,Definition IOM Recommendation,Recognize cancer survivorship as a distinct phase of care Patients completing primary treatment should be provided with a comprehensive care summary and follow up plan Begins at the end of primary treatment with intention to cure and lasting until a recurrence, a secondary cancer or death. It may include ongoing treatment.,“Seasons of Survival”,Acute survival Extended survival Permanent Survival,Acute Survival,Time of diagnosis Diagnostics, therapeutics, Fear/anxiety Disruption of family and social roles Financial issues Fear of death,Extended Survival: Transitional Fallow up,Treatment completion- uncertainty of treatment outcome Watchful waiting Periodic examinations Consolidation/intermittent therapies/hormonal therapies Fear of recurrence/death Fatigue/physical limitations/lingering side effects,Permanent Survival: Extended follow up,“Cure” Late effects of treatment may impact QOL, family, workplace and financial areas Ability to return to normal Lasting impact of cancer Development of self confidence and self trust,Goals of Survivorship care,Preventing recurrence and secondary cancers Promoting appropriate disease management following diagnosis and treatment to ensure the maximum number of years of a healthy life Minimizing preventable pain, disability, and psychosocial distress Assisting cancer survivors to access family, peer, community, and other resources they need to cope with their disease.,Goals of Survivorship Care,Empower survivors and families Provide enhanced and better coordination of communication around survivorship care Improve quality of life,Focus of Survivorship Care,Surveillance Prevention Intervention Coordination,Surveillance,Recurrent cancer and late effects Guidelines Based on type of cancer, stage at diagnosis, tumor characteristics,related risk of recurrence,Prevention,New cancers Recurrent cancer Late effects Guidelines,Interventions,Managing long term and late effects of treatment-organ dysfunction, mobility, fatigue, lymphedema, hormone/sexuality/fertility, secondary cancers Improve medical and psychosocial outcomes.,Coordination,Improve communication between providers to promote best practice Subspecialty referrals Psychosocial referrals Resources to support patient and family,Quality of life: Physical well being,Functional activities Strength/fatigue Sleep and Rest overal physical health Fertility Pain,Quality of Life: Psychosocial,Control Anxiety Depression Enjoyment/Leisure Cognition/attention Distress of diagnosis Fear of recurrence Control of treatment,Quality of Life: Social well being,Family distress Roles and relationships Affection/sexual function Appearance Enjoyment Isolation Finances Work,Quality of Life: Spiritual well being,Meaning of illness Religiosity Transcendence Hope Uncertainty Inner strength,Treatment related Toxicities: Long term and Late effects,Long term-effects that persist after completion of treatment Late-occur after treatment has completed Long and late effects can be tumor, treatment or host related.,Late effects,Occur months to years following treatment Related to organ injury that occurred from treatment Failure of repair mechanisms over time and organ age More prevalent as treatments have become more complex.,Tumor Related Factors,Direct tissue effects Tumor related organ dysfunction Mechanical effects,Treatment Related Factors,Chemotherapy-agent, dose schedule and intensity Radiation Therapy-Total dose and fraction size, radiated field surgery-site and technique,Host Related Factors,Genetic predisposition Inherent tissue sensitivities and capacity for normal tissue repair Function of organs not effected by treatment Co-morbid conditions Pre treatment psychosocial status,Surgery,organ impairment Secondary side effects loss of function,Chemotherapy,Effects all organs- systemic therapy M