7 tips for following breast cancer survivors in primary care
Are you a primary care or family physician? If so, you probably have a large population of breast cancer survivors. Do you sometimes wish you had a guide in caring for such patients? Well, read on, this is for you.
As our cancer treatments have gotten better, we have a growing number of survivors and that is a fantastic thing. More and more, survivors will eventually return to their primary doctors for care (and not see oncologists any more). In addition to the usual care, there are a few things:
Try to get a good summary of past oncology treatments: Most cancer centers now devote time to survivorship appointments and provide patients with a summary of therapies. This is a very important document to have. It might help one make better sense of possible future health issues that may come up. Someone who received adriamycin could develop heart failure at a young age. A drug like taxol might explain why a diabetic patient develops painful neuropathy more than would be expected from diabetes alone.
Always ask about cancer medications: You may have patients on anti-estrogens for example. Are they taking them? Any side effects that can be treated to enable them comply better? Outcomes are better if patients take their medications. Here, anti-estrogens are particularly important as taken for 5-10 years potentially.
Be cautious in prescribing new medications (antidepressants): It is always best to verify with the oncology team if uncertain, when prescribing new medications to someone on cancer treatment. Tamoxifen is an important example. Some anti-depressants are best avoided while on tamoxifen since its metabolic activation may be affected.
Dieting and exercise is the “third adjuvant”: For survivors, dieting and exercise to help maintain healthy weight is beneficial. In addition to the usual health benefits, it can also improve overall and cancer-specific survival in breast cancer patients. Further, active patients do better in tolerating side effects of medications like aromatase inhibitors.
Ask about family history of cancer and consider genetics: Some cancer survivors may have new family history suggesting possible genetic mutations. It is important to consider referring them for genetic testing as applicable.
Remember ongoing cancer surveillance: Depending on how many years since cancer diagnosis, a survivor may or may not be following an oncologist still. It is important to clarify what sort of follow up is necessary. Usually, this will include physician breast exams and mammograms. It is more important to consider scans earlier, if a cancer survivor has a symptom like unexplained pain. Risk of recurrence can persist for a long time, particularly for ER and/or PR positive breast cancers (possible delayed recurrences >10 years out). Self awareness and prompt reporting of new symptoms should be emphasized at appointments.
Pay attention to unique long-term risks of cancer treatment: These may include heart failure, infertility, and other cancers like leukemia. Any patient who received chemotherapy should have blood counts checked every year.
There may be others too. Please get in touch and let me know of your thoughts. Also share with your friends if you found this helpful.
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