Transcript Dr Rasha Cosman - Survivorship

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