Summary of Issues Identified by Cancer Survivors on OncoLink

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Linda A. Jacobs, PhD, CRNP, Wendy Hobbie, MSN, CRNP, and Anna T. Meadows, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 15, 2001

Cancer survivors have written to OncoLink with a number of questions, comments, and concerns. The areas of concern most frequently identified were:

  1. Dealing with the side effects/late effects of cancer and treatment years after the completion of treatment.
    1. Weight gain
    2. Fatigue
    3. Fertility
    4. Libido
    5. Fear of cancer recurrence
    6. Concerns about developing a new cancer
  2. Having follow-up care by a knowledgeable practitioner who is aware of the consequences of cancer treatment and who understands the need for appropriate surveillance.

During the last 30 years there has been dramatic improvement in cancer treatment and in the long-term survival of individuals diagnosed with cancer. However, survival often brings with it physiological and/or psychosocial problems resulting from the disease, treatment, or a combination.

Approximately 30 years ago, children with cancer began to be treated with effective combinations of surgery, chemotherapy, and radiation. As a result, many children experienced long term remissions and were considered cured. As more and more children survived for longer periods, it became possible to study the effects of treatment and to appreciate that new medical problems had been created. For some individuals, cure had come at a cost. Since that time, clinical trials have enabled researchers to define minimal doses of drugs and radiation therapy that can produce even better cure rates while reducing some of the long-term problems seen earlier.

As treatment for adult cancers has also begun to incorporate more chemotherapy and radiation therapy, adults are also living longer; many are now faced with significant side effects/late effects of treatment.

Late effects of cancer treatment are problems that arise as a result of the cancer treatment, the disease itself or a combination. Individuals treated for cancer may experience hearing loss, heart symptoms, chronic fatigue, weight gain, and bone loss. They may also have thyroid, kidney, and breathing problems as well as a number of other complaints. Health care providers following these individuals should be aware of the risks for developing medical problems facing cancer survivors. These risks are based on the type of cancer and on the treatment received.

Individuals with a history of cancer should be seen regularly and evaluated appropriately when symptoms arise. Although there are certain unavoidable problems that may result from cancer treatment, many problems can be prevented or minimized. Health promotion guidelines are important for everyone, but especially for cancer survivors, since they may be at higher than average risk of developing medical problems as a result of the cancer treatment they received.

For example:
  1. Radiation and certain drugs may damage the lungs.
    1. a. Smoking is prohibited
  2. Radiation to the left side of the chest and certain drugs may damage the heart.
    1. Periodic cardiac evaluation
    2. Diet and exercise
    3. Appropriate medications as needed
  3. Weight gain may occur after treatment is discontinued.
    1. Nutritional counseling
    2. Diet and exercise recommended
  4. Anxiety and depression
    1. Comprehensive evaluation is encouraged
    2. Support groups
    3. Individual counseling
    4. Medications when needed
  5. Libido may be affected by many factors.
    1. Physiological and psychosocial evaluation is recommended
  6. Fertility can be affect by age and kind of treatment received.
    1. Alternative reproductive methods should be explored
      1. In-vitro fertilization
      2. Surrogate parenting
      3. Adoption
  7. Fear of recurrence and of developing a new cancer.
    1. Regular visits with oncologist
    2. Following cancer screening guidelines for secondary prevention of other cancers
      1. Colonoscopy
      2. Pap smear
      3. Mammogram
      4. PSA
      5. Breast self-examination/testicular self-examination
      6. Skin examination

Cancer survivors need to be aware of their treatment. They should discuss with their health care provider the potential problems they may face based on their treatment, family history, and lifestyle.