Breast Cancer Follow-Up Care Recommendations: Considerations for a Growing Survivorship Population

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Transition back to PCP care for breast cancer survivors requires a plan.
Transition back to PCP care for breast cancer survivors requires a plan.

There are estimated to be more than 3.1 million women with a history of breast cancer living in the United States.1 With an average age at diagnosis of 62, long-term follow-up and survivorship care is an important aspect of coordinating care for these women.2 

“There is an increasing volume of patients that need to be taken care of and there is overkill for many patients seeing multiple providers including medical oncologists, radiation oncologists and breast surgeons on a set schedule every 6 months, or seeing oncology providers indefinitely, without any plan to transition back to a primary care provider,” Michelle Melisko, MD, associate clinical professor of medicine at the University of California, San Francisco Helen Diller Family Cancer Center, told Oncology Nurse Advisor. “The idea that a one-size-fits-all model for follow-up care will work is outdated.”

At the 2016 San Antonio Breast Cancer Symposium, Dr Melisko and 2 colleagues participated in an education session entitled “Risk based follow up care: Emerging evidence and evolving guidelines” that highlighted several topics related to follow-up care and lifestyle recommendations to improve outcomes in women with a history of breast cancer

Estrogen Deprivation

One of the most prevalent issues facing women with a history of breast cancer is living with the effects of the anti-estrogen therapies or ovarian suppression or removal used in the treatment of their disease, according to Ann H. Partridge, MD, MPH, director of the adult survivorship program at Dana-Farber Cancer Institute. 

Anti-estrogen therapy with or without the use of chemotherapy is the mainstay of treatment for the majority of women with breast cancer that expresses estrogen or progesterone receptors. The goal of hormonal therapy is to inhibit hormones as a method to block the continued growth of the tumor. In some cases of hormone-receptor positive disease, removal of the ovaries and fallopian tubes may be recommended as a risk-reduction measure.

The effects of estrogen deprivation or premature menopause on patients are numerous and wide-ranging, including adverse effects to the cardiovascular system, the central nervous system, reproductive system, and the musculoskeletal system. 

One study that looked at the prevalence of menopausal symptoms among women with a history of breast cancer showed that 65% reported hot flashes, 44% had night sweats, 48% had vaginal dryness, 26% had dyspareunia, 44% had difficulty sleeping, and 44% felt depressed.3 Dealing with these symptoms has an obvious physical affect on patients, but it can also influence their overall quality of life.

According to Dr Partridge, comprehensive assessment and targeted intervention of these symptoms can be successful. For example, one study looking at a comprehensive menopausal assessment intervention program in breast cancer survivors led to significant improvements in menopausal symptoms and sexual functioning.4 

Selecting the best methods of symptom management will often depend on the severity of the symptoms and the short-term goals of the patient. 
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