Transcript Cancer as a Chronic Disease

Cancer Survivorship Curriculum
for Medical Students
Copyright 2008 UC Regents
Cancer Survivorship
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Cancer survivorship is a fairly new concept; however, it
encompasses a large and growing population.
Of the approximate 10 million cancer survivors today, about
seven million have survived for five or more years.
These numbers will continue to grow.
Issues of survival need to be addressed, i.e., long-term effects
from cancer treatment.
Follow-up care and tracking of survivors from a wellness
perspective needed.
Some of the consequences of treatment are well-known so it
makes sense to develop special clinics to study, document, and
assist patients with the long-term and late effects of cancer.
Some of these potential effects include:
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Physiologic Effects:
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Organ damage or failure or premature aging caused by therapy,
can result in cardiomyopathy, renal insufficiency, bladder
damage, carotid artery disease, cataracts, muscle atrophy,
problems with memory and information processing.
Compromised immune systems.
Damaged endocrine systems leading to thyroid dysfunction,
premature menopause, reproductive problems, and sexual
disruption.
Increased risk for second cancers with certain therapies.
Increased risk for associated other cancers.
Functional problems: incontinence, immobility, lymphedema,
sleep disturbances, pain syndromes
Cosmetic changes
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Psychological Effects
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anxiety
mood changes
depression
living with uncertainty
sexuality and relationship problems
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Social effects
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health insurance
availability of jobs
consequences of cancer therapy
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Cancers with increasing survival:
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Breast
Childhood cancers
Prostate
Colo-rectal
Uterine and cervical
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Background
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Increased survivorship of many cancers
Need for primary care physicians to care for
cancer survivors
Specific competencies for education
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Attitudes
Knowledge
Skills
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Attitudes
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Comfortable prescribing medications for pain
control, including opioids
Comfortable asking new patients routinely about
previous cancers
Willing to ask oncologists for consultation when
appropriate
Considers general preventative issues as well as
those related to cancer survivorship in cancer
survivors
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Knowledge
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Understands that all cancer survivors are at
increased risk for other cancers as well as
recurrence of the original cancer, and need to avoid
tobacco, eat right, and use sunscreen
Understands how genetics contribute to risk of
cancer (simplified)
Understands common uses of the terms “cure”,
“disease free survival”, and “cancer survivor”
Understands the differences in outcome of cancer
survivors by gender, ethnicity and socio-economic
status
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Definitions
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Cure: To heal or restore health; a treatment to restore health.
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Disease Free Survival: Length of time after treatment during which
no cancer is found. Can be reported for an individual patient or
for a study population.
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Cancer Survivor: Dr. Fitzhugh Mullan, the original founder of the
National Coalition for Cancer Survivorship (NCCS), a physician
and cancer survivor notes, "From the time of its discovery and for
the balance of life, an individual diagnosed with cancer is a
survivor" ; "Survivorship is the experience of living with, through
or beyond cancer.“ The NCCS describes three seasons of
survival -- Acute Stage, Extended Stage, and Permanent Stage and notes that different concerns characterize each season.
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Definitions
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Acute Stage: substantial amounts of fear, anxiety,
pain/discomforts, and concerns about mortality.
Extended Stage: a period of uncertainty after
therapy and during remission where there may be
physical limitations, changes in body image and
issues of trust due to a life-altering event.
The Permanent Stage: when one wakes up each
morning, and cancer isn't the first thing one think
about.
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Knowledge
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Understands the variety of social consequences of
cancer on survivors, including difficulty getting
employment and insurance, stigma, and the impact
on the family and friendships
Knows the elements to obtain about a cancer
history, how to get information the patient can’t give
them, and interpret the health implications of the
history
Understands consequences of cancer treatment
seen as different developmental stages, including
growth, osteoporosis, learning issues, sexual
disorders and fertility
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Skills
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Able to identify people at higher risk for cancer, using
key screening guidelines
Able to work on secondary prevention with survivors in
an appropriate and individualized manner, including
recommendations regarding sunscreen, diet, obesity,
exercise, alcohol, and tobacco
Able to tailor pain medication and other interventions
for pain to the source and type as well as the severity
of pain
Able to explain and help patients make decisions
about a Living Will, do not resuscitate (DNR) orders,
durable Power of Attorney, and an Advance
Healthcare Directive
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Skills
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Able to give bad news about second malignancy or
relapse; move to an appropriate palliative approach
without saying “there is nothing we can do”
Able to partner with patients in decision-making,
according to what is important to the patient
Able to work as the primary care provider with a
specialty team, providing continuity of care, and
working with family as well as patient
Able to get current cancer information for cancer
survivors at the appropriate reading level and
language (e.g. from the Cancer Information Service
and National Cancer Institute)
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Assessment
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Pre and post tests will be done by looking at
knowledge, as well as experience and
competence in the skills and attitudes
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National Coalition for Cancer Survivorship
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National Coalition for Cancer Survivorship formed in 1986.
Its goals today are to identify and address issue that influence
quality living for people who have or have had cancer, regardless
of the date of diagnosis.
It also works to address public policy issues and cancer-related
bias through testimony before Congress, media appearances
and providing up-to-date information about the legal rights of
cancer survivors.
It is a clearing house for information, publications and programs
and a voice for the many common recurring issues of
survivorship.
It also advocates for continuing clinical research on the medical
and psychosocial impact of cancer and its treatments among
long-term survivors.
http://cancerresources.mednet.ucla.edu/index.htm
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