Challenges, opportunities remain in breast cancer survivorship care
MIAMI — Although significant progress has been made in breast cancer care, challenges and opportunities remain in cancer survivorship, according to a presenter at Miami Breast Cancer Conference.
“There are a growing number of breast cancer survivors. It is estimated that there will be more than 18 million cancer survivors in the U.S. alone by 2022, of which 22% are expected to be female breast cancer survivors,” Ann H. Partridge, MD, MPH, founder and director of the program for young women with breast cancer and director of the adult survivorship program at Dana-Farber Cancer Institute, said during a presentation.
Survivorship spans the cancer trajectory and needs vary for each patient.
Partridge recommended clinicians focus on four major areas: recurrence and new cancers; long-term and late effects; modifiable health behaviors; and coordination of care.
“Every time I see a survivor during follow-up, I focus on these four areas,” Partridge said. “I guarantee that by focusing on these key areas, clinicians will pick up on something that they had not picked up on before with each patient.”
The risk for recurrence is a key challenge in cancer survivorship.
A 2007 study by Lehman and colleagues included 969 women with a recent diagnosis of unilateral breast cancer with no clinical or mammographic evidence of contralateral disease.
MRI of the contralateral breast led to biopsy for 121 women (12.5%), 30 of whom were diagnosed with contralateral breast cancer.
“Following these data, the American Cancer Society came together on recommendations for MRI breast cancer screening as an adjunct to mammography,” Partridge said. “The society stated that the evidence is insufficient to recommend for or against MRI screening, and that clinicians should decide on their own on how to follow nonhigh-risk patients.”
Another challenge of cancer survivorship is the risk for new primary disease.
“We need to remember to always update family history and revisit genetic risk,” Partridge said. “This is an important time for our patients where we can prevent future disease.”
Partridge also discussed long-term and late side effects among cancer survivors.
The most common phenomenon is cancer-related fatigue, which affects between 50% and 80% of survivors.
Clinicians should first rule out and treat other potential causes of fatigue — such as pain, malnutrition, hypothyroidism, anemia, insomnia, depression and inactivity — before cancer-related fatigue can be treated with exercise, behavioral or psychotherapy, and complementary therapy, Partridge said.
“Awareness of and attention to the unique issues facing survivors and knowing how to counsel and follow these patients are critical,” Partridge said. “There are many resources, tools and support services available for cancer survivors and providers.” – by Jennifer Southall
Partridge AH. The art and science of survivorship planning and management. Presented at: Miami Breast Cancer Conference; March 7-10, 2019; Miami.
Disclosure: Partridge reports serving as co-author of the breast cancer survivorship section for UpToDate.