Living Your Best After Cancer: You and Your Primary Care Doctor Working Together" Mary Helen Hackney

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Living Your Best After Cancer You and Your
Primary Care Doctor Working Together" Mary Helen
Hackney, MD

• Associate Professor of Hematology/Oncology at VCU
  Massey Cancer Center
• Specialist in treatment for all stages of breast
  cancer
• Treats cancer of all types through Masseys Rural
  Cancer Outreach Program
• Teaches residents and health professionals about
  prevention, long-term patient management and
  survivorship issues.

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Living Your Best After Cancer You and Your
Primary Care Doctor Working Together

• Mary Helen Hackney, M.D.
• Massey Cancer Center
• Virginia Commonwealth University

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DO NOT SMOKE
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Who.

• Over 10.1 million cancer survivors
• Increasing priority of many groups including the
  American Society of Clinical Oncology (ASCO)
• Be your own advocate

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Taking Care of Yourself

• Establish a relationship with a general medicine
  physician

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Taking Care of Yourself

• Know how your cancer was treated
• Chemotherapy drugs
• Radiation therapy
• Share the information with any new health
  provider
• Ex. Bleomycin may affect lungs during anesthesia
  even years out

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Taking Care of Yourself

• Establish good health habits
• Weight control
• Exercise
• No tobacco
• No or moderate alcohol

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Testing

• Different cancers have different follow up care
  guidelines
• Know which apply to you
• ASCO developing guidelines
• Routine CT scans or PET scans are not indicated
  for all cancer

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The Annual Physical

• Controversial probably needs to be more directed
• Know your family history not just cancer but
  other diseases (cholesterol, heart disease,
  diabetes, etc.)
• What should the physical include?
• Exam, lots of questions, medication review
• Selected tests

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Family History

• Will help your physician know when to start
  certain types of screening
• Example
• Lynch Syndrome/Hereditary Nonpolyposis Colorectal
  Cancer colon ovarian cancer
• Diabetes in family will prompt more interest in
  weight control

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Do Not Smoke
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Assessing the Risk

• Family genetics
• BRCA 1 and 2 (also ovary, male breast cancer,
  prostate, colon ca)
• P53 (Li Fraumeni) (breast ca., brain ca., adrenal
  ca, sarcoma, leukemia)
• PTEN (Cowdens) (thryoid ca., hamartomas,
  prostate ca, breast ca.)
• Ataxia telangectasia-life time risks increased
  for heterozygotes (autosomal recessive)(breast
  cancer)

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Breast Exam and Mammography

• Start at age 40 and then yearly
• Start earlier if family history of breast cancer
  or chest irradiation
• Self breast exams monthly while in 20s
• Medical professional exam every 3 yrs in 20s,
  then yearly
• If you are a breast cancer survivor, guidelines
  are different

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Colonscopy(colon cancer screening)

• Start colonoscopy for screening at age 50
• Follow studies will be 3-10 years depending on
  results
• Start screening earlier if family colon cancer
  history or personal history of ulcerative
  colitis, Crohns or polyp history
• Less use of stool testing, barium enema,
  sigmoidoscopy

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Gynecology Evaluation

• PAP smears recommended every three years if
  normal
• Hysterectomy for benign cause no need for PAP
  smear
• HPV testing new and under development
• If ovaries remain, then need bimanual exam
• If you have a cancer history, guidelines are
  different

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Blood TestsTumor Markers

• Ca 125
• Not indicated for screening
• Trial underway to assess role in high risk women
• PSA (prostate specific antigen)
• Controversial start at age 50, yearly. Start
  earlier if family history or African American
• There is no perfect blood test to screen for
  cancer

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Other Blood Tests

• Cholesterol, lipid panel
• Esp. if over 50, diabetic, family history,
  overweight
• Kidney and liver function
• Suggested for specific situations e.g. on
  cholesterol medications, diabetes, etc.
• Complete blood count with white cells, red cells
  and platelets

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Other Health Maintenance.

• Ophthamology
• Many drugs and radiation can affect eyes
• Cataracts may worsen

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Other Health Maintenance.

• Vaccinations
• Pneumovax every 5 years after splenectomy or if
  over 60
• Tetanus
• Hepatitis if appropriate
• Additional vaccinations if bone marrow transplant

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No Tobacco
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Continuing Health Maintenace.

• Dentist
• Many drugs affect gums and teeth
• Good oral hygiene important during and after
  treatment
• Bone density
• Many chemo drugs affect bones
• Every 2 years
• Exercise, calcium, consider bisphosphonates

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Taking Care of Your Health

• Exercise
• Weight Control
• No tobacco
• Limit/moderate alcohol consumption
• Know your past treatment history and risks of
  future problems

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Future.

• Development of programs to provide easy to
  use/portable information packets tailored to
  specific disease treatments
• May be in a electronic format
• Development of tailored treatments to reduce
  risks of long term sequalae
• Increasing number of websites, journals and
  information venues providing guidance on good
  health for survivors

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SurvivingLiving

• 10 million and more..
• Thank you!