slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The Young Adult Cured of Cancer in Childhood PowerPoint Presentation
Download Presentation
The Young Adult Cured of Cancer in Childhood

Loading in 2 Seconds...

play fullscreen
1 / 27

The Young Adult Cured of Cancer in Childhood - PowerPoint PPT Presentation


  • 127 Views
  • Uploaded on

The Young Adult Cured of Cancer in Childhood. Melissa M. Hudson, M.D. After Completion of Therapy Clinic St. Jude Children’s Research Hospital. Long-Term Survival. Health & Resilience. Transition of Care After Pediatric Cancer. Cancer Diagnosis. Primary Prevention

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

The Young Adult Cured of Cancer in Childhood


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

The Young Adult Cured of Cancer in Childhood

Melissa M. Hudson, M.D.

After Completion of Therapy Clinic

St. Jude Children’s Research Hospital

transition of care after pediatric cancer

Long-Term

Survival

Health &

Resilience

Transition of Care After Pediatric Cancer

Cancer

Diagnosis

Primary Prevention

Risk-adapted therapy

Favorable: Reduce therapy

Unfavorable: Intensify therapy

Secondary Prevention

Health education

Cancer screening

Therapeutic interventions

Pediatric

Health Care

Adult

Health Care

optimal care after cancer
Optimal Care After Cancer
  • Longitudinal care from diagnosis to death.
  • Comprehensive care including preventive measures to reduce morbidity and mortality.
  • Coordination of care by provider knowledgeable about cancer-related risks working with multidisciplinary team.
  • Health care sensitive to cultural and spiritual values and issues of the cancer experience
challenges to providing care
Challenges to Providing Care
  • Evolving therapies and late effects.
  • Long latency to evaluate health outcomes.
  • Multiple factors contributing to cancer-related health risks.
  • Unknown effects of aging on many treatment sequelae.
  • Lack of consensus regarding screening guidelines and risk reduction methods.
challenges to providing care1
Challenges to Providing Care
  • Transitioning from oncology to primary care.
  • Transitioning from pediatric to adult care.
  • Lack of knowledge by primary care providers:
    • Cancer-related health risks
    • Risk-reduction methods.
  • Lack of support from healthcare system for specialized survivor care, e.g., long-term follow-up programs.
goals of after therapy care
Goals of After Therapy Care
  • To maintain cancer-free survival.
  • To detect cancer-related complications at early stages.
  • To prevent, reduce, or correct cancer-related complications.
  • To optimize health and resilience.
prevention of morbidity
Prevention of Morbidity
  • Identify factors predisposing to cancer-related morbidity.
  • Identify factors modifying cancer-related health risks.
  • Provide interventions to prevent, reduce, correct cancer-related morbidity.
factors contributing to morbidity
Factors Contributing to Morbidity

Premorbid

conditions

Genetic

Host Factors

BRCA, ATM, p53

polymorphisms

Age

Gender

Race

Tumor

Factors

Health

Behaviors

Histology

Site

Biology

Response

Tobacco

Diet

Alcohol

Exercise

Sun

Aging

Treatment

Factors

Surgery

Radiation

Chemotherapy

?????

Treatment

Events

Relapse

Vital Organ Toxicity

Cancer-Related

Morbidity

risk based care
Risk-Based Care
  • Screening/prevention plan that integrates cancer experience with health care needs.
  • Considers risk for morbidity related to:
    • Host: sex, race, age at diagnosis & follow-up
    • Cancer: location, treatment modalities
    • Genetic/familial predispositions
    • Lifestyle habits
    • Co-morbid health conditions
case study adult survivor
Case Study: Adult Survivor
  • 25 year-old female patient diagnosed with Hodgkin’s disease at age 15 years
  • Combined modality treatment with COPP/ABV and mantle (21 Gy) radiation
  • Family history: Mother - breast cancer at 42 years; Father - angioplasty at 44 years
  • Social history: cigarette smoking, tanning bed use; drinks alcohol socially; noncompliant with breast cancer surveillance
review risk factors
Review Risk Factors
  • Host: female, pubertal status during treatment, 10 years after therapy
  • Treatment: alkylating agents, anthracycline, bleomycin, chest radiation
  • Familial: pre-menopausal breast cancer, early-onset coronary artery disease
  • Lifestyle: tobacco, tanning, alcohol
assess late effects risks
Assess Late Effects Risks
  • Dental: xerostomia, accelerated dental decay
  • Thyroid: hypothyroidism, thyroid nodules
  • Cardiac: cardiomyopathy, atherosclerosis
  • Pulmonary: restrictive lung disease
  • Gonadal: infertility, early menopause
  • Second malignancy, especially breast cancer
counsel to promote health
Counsel to Promote Health
  • Inform of potential health risks.
  • Address increased vulnerability
  • Provide personalized risk information
  • Establish priority health goals.
  • Discuss benefits of protective behaviors.
  • Discuss barriers to/personal costs
  • Provide follow-up counseling.
educate about risks
Educate About Risks
  • Cancer diagnosis and treatment
  • Cancer-related health risks
  • Behavioral factors affecting risk
  • Risk reduction strategies
address increased vulnerability
Address Increased Vulnerability
  • Sociodemographic factors
  • Cancer treatment modalities
  • Family history/genetic predisposition
  • Maladaptive behaviors
  • Unknown impact of aging
personalize health education
Personalize Health Education
  • Predisposing cancer treatments:

Radiation, Adriamycin, bleomycin, alkylators

  • Predisposing family history

First-degree relative with breast cancer

First-degree relative with early onset CAD

  • Maladaptive lifestyles

Smoking, tanning, alcohol use

Address also: diet, weight control, exercise

  • Need for early breast cancer surveillance.
encourage health goals
Encourage Health Goals
  • Stop smoking.
  • Use sun protection measures.
  • Eat a healthy diet.
  • Limit alcohol intake.
  • Adopt a physically active lifestyle.
  • Maintain a healthful weight.
  • Pursue early breast cancer screening.
discuss benefits
Discuss Benefits

Smoking cessation

  • Reduce risk of heart and lung disease.
  • Reduce risk of tobacco-related cancers.

Sun protection

  • Reduce risk of premature skin aging.
  • Reduce risk of skin cancer.
discuss benefits1
Discuss Benefits

Healthy diet and physical activity

  • Reduce risk of cardiovascular disease.
  • Reduce risk of breast, colon, uterine and other cancers.

Limit alcohol consumption

  • Reduce risk of liver disease.
  • Reduce risk of mouth, pharynx, larynx, esophagus, liver, and breast cancer.
discuss benefits2
Discuss Benefits

Regular screening examinations

  • Early detection of health problems
  • Prevention of health problems
  • Early intervention to reduce morbidity
address barriers
Address Barriers
  • Appreciate that barriers may be personal, familial, social, economic in etiology.
    • Fear/discomfort with breast screening
    • Insurance denial of clinician/imaging screening
  • Provide information to facilitate behavioral change.
    • Patient education about breast screening
    • Clinician communication with primary care providers or insurance company
health behavior counseling
Health Behavior Counseling
  • Discuss alternative behaviors and choices.
  • Anticipate reactions/responses by family and peers.
  • Challenge survivor (and family) to commit to healthier lifestyle.
  • Provide follow-up counseling.
barriers to risk based care
Barriers to Risk-Based Care
  • Clinic environment: work flow impeded with time-consuming counseling
  • Clinical staff: time constraints with patient care and lack of knowledge about cancer-related health risks
  • Survivors/Family: lack of interest or resistance to counseling efforts
requisites for success
Requisites for Success
  • Dedicated time/day for survivor follow-up
  • Dedicated staff with interest in late effects
    • Specialty or advance practice nurse most commonly utilized
  • Multidisciplinary participation
    • Oncologists - Nurse
    • Psychologist - Social worker
    • Allied and subspecialty care providers
for comprehensive risk based screening recommendations and patient education materials
For Comprehensive Risk-BasedScreening Recommendations and Patient Education Materials

For complete recommendations:

Children’s Oncology Group

Long-Term Follow-Up Screening Guidelines

http://www.survivorshipguidelines.org

advice to survivors
Advice to Survivors
  • Know about cancer/cancer-related health risks.
  • Keep a record of medical events.
  • Share record with all providers.
  • Pursue routine medical evaluations.
  • Review lifestyle for methods of risk reduction.
  • Keep informed about late effects research.
taming anxiety about late effects
Taming Anxiety About Late Effects
  • Serious late effects occur in a minority.
  • Late effects are possible only when cancer therapy is successful.
  • Research can reduce and prevent late effects.
  • Knowledge of factors predisposing to late effects can reduce their incidence.