We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byEmilia Bailer
Modified over 2 years ago
©2014 MFMER | slide-1 Survivorship for “cured” Hodgkin patients – How should we be following them? Carrie Thompson, MD Mayo Clinic Lymphoma & Myeloma 2014
©2014 MFMER | slide-2 Disclosures I have nothing to disclose
©2014 MFMER | slide-3 Outline Surveillance for relapse Screening for late effects Cardiovascular disease Secondary malignancies Psychosocial issues Care models
©2014 MFMER | slide-4 Background: Survivorship 13.7 million cancer survivors in the US ~200,000 survivors of HL Decreased survival compared to general pop SEER Cancer Statistics Review, 1975-2008, NCI. JCO 2003; 21:3431-9
©2014 MFMER | slide-5 Do surveillance scans improve outcomes in HL? Cancer 2014;120:2122-9
©2014 MFMER | slide-6 Surveillance for relapse Negatives of routine scans Radiation exposure False positives Anxiety Cost
©2014 MFMER | slide-7 Surveillance guidelines Physical examination, history, and clinical judgement are the cornerstone of followup Q 3 mos years 1-2, q 4 mos year 3, then q 6 mos years 4-5 Imaging studies NCCN CXR or CT chest and CT A/P q 6-12 mos x 2 yrs Lugano Classification Routine scans are discouraged Scans prompted by clinical indications NCCN.org Version 2.2014 JCO 2014; 32:3059-67
©2014 MFMER | slide-8 Monitoring for Late Effects Cardiovascular disease Secondary malignancies Psychosocial issues Other
©2014 MFMER | slide-9 Congestive heart failure: chemotherapy agents Cytotoxic agents Doxorubicin, cyclophosphamide, ifosfamide, cisplatin, fluorouracil, paclitaxel Targeted agents mTOR inhibitors PI3 kinase inhibitors Trastuzumab Bevacizumab
©2014 MFMER | slide-10 Congestive heart failure in HL Subclinical (asymptomatic, echo abnormal) 27.6% in lymphoma survivors 1 Do not know if this will lead to clinical CHF Clinical CHF 7.2% incidence with 6 year followup 2 May become evident during times of increased cardiac workload Pregnancy, anesthesia, BMT, illness 1 JCO 1998; 16:3502-8 2 Ryberg 1998
©2014 MFMER | slide-11 Coronary artery disease in HL Caused by radiation therapy Prospective study in 294 survivors of HL ≥35 Gy to mediastinum Excluded patients with known CVD Nuclear study and stress test 40 patients (14%) underwent coronary angiography Coronary artery stenosis >50% in 22 patients 7.4% of those screened JCO 2007; 25:43-9 Blood 2007; 109:1878-86
©2014 MFMER | slide-12 CAD in HL Coronary CT angiography in 31 adult survivors of childhood HL with hx radiation therapy ECG, treadmill stress test, echo 12 (39%) patients with coronary lesions 3 (10%) with obstructing lesions on coronary angiogram 2 of these 3 died from CVD All had abnormal ECG, 1 abnormal treadmill, 0 abnormal echo Cancer 2014; Jul 16 Epub
©2014 MFMER | slide-13 Other cardiac diseases Valvular disease Predominantly mitral and aortic valves affected Pericardial disease Historically most commonly affected cardiac structure Conduction system Arrhythmias and QT prolongation
©2014 MFMER | slide-14 Cardiac Follow-Up Expert Guidelines ©2011 MFMER | slide-14 JCO 2011; 29:1885-1892 Annals Onc 2012; 23:Suppl 7 JASE 2014;27:911-39
©2014 MFMER | slide-15 Screening Recommendations: CVD Annual physical exam BP check Lipids every 3-5 years Glucose annually Particularly if hx paraaortic LN xrt Treat cardiac risk factors Lifestyle modifications JCO 2009; 27:5383-89 JCO 2014; 32 Epub
©2014 MFMER | slide-16 Benefits of exercise JCO 2014; 32 Epub
©2014 MFMER | slide-17 Screening Recommendations: CVD Post-radiation therapy If >30 Gy to mediastinum Stress test (exercise stress echo) starting 5-10 years post therapy then q 5 years Post anthracycline chemotherapy If >240 mg/m2 doxorubicin Echo starting 5 years after treatment then q 5 years
©2014 MFMER | slide-18 For female cancer survivors contemplating pregnancy Refer to cardiology if… >240 mg/m2 anthracycline dose >30 Gy radiation to the heart or surrounding tissue Any combination of the above with high-dose cyclophosphamide
©2014 MFMER | slide-19 Late Effects: Secondary Malignancies Breast cancer In those treated for childhood HL, estimated incidence of breast cancer 20% at age 45 Thyroid cancer Lung cancer Risk significantly increases in those who smoke after radiation therapy Gastric/colorectal cancers Sarcoma JCO 2007; 25:1489-97
©2014 MFMER | slide-20 Types of secondary cancers, continued AML/MDS Mostly due to chemotherapy (alkylators) NHL ~5% lifetime risk in those treated for Hodgkin lymphoma Skin cancers
©2014 MFMER | slide-21 Recommendations for those at risk Annual skin exam in irradiated field Annual mammogram (+/- MRI) 8 years after radiation or at age 40, whichever is earlier Colonoscopy 15 years after pelvic, abdominal, spinal irradiation or at age 35 Tobacco cessation ?low dose CT scan chest ?EGD Life-long surveillance Am J Med 2011; 12:1606-12
©2014 MFMER | slide-22 Fertility Issues Very important issue ABVD does not affect fertility Fertility preservation pre-treatment Wait 2 years post-treatment to have children No increase in birth defects, miscarriage, cancer in offspring compared to general population www.fertilehope.org
©2014 MFMER | slide-23 Fatigue 26% of survivors of Hodgkin lymphoma have significant fatigue Higher than general population, other cancer types Fatigue associated with higher symptoms of anxiety and PTSD and lower QOL Unclear etiology, literature suggests may be related to long term health complications JCO 1999; 17:253-61, JCO 2005; 23:6587-95, Thompson 2009
©2014 MFMER | slide-24 Loss of Immunity: for all HL survivors NO live vaccines No shingles vaccine, influenza vaccine live Influenza vaccine annually Tdap/Td q 10 years HPV vaccine if
"name": "©2014 MFMER | slide-24 Loss of Immunity: for all HL survivors NO live vaccines No shingles vaccine, influenza vaccine live Influenza vaccine annually Tdap/Td q 10 years HPV vaccine if
©2014 MFMER | slide-25 Loss of Immunity If splenectomy or splenic RT Meningococcus, HIB, PCV13 at time of treatment PPV23 8 weeks later then 5 years later Meningococcus q 5 years If hematopoietic stem cell recipient More complicated revaccination schedule
©2014 MFMER | slide-26 Depression and Anxiety in Cancer Survivors Depression higher than general population in 1 st 2 years after diagnosis, then no different Anxiety levels higher than general population and tend to persist Lancet Oncology 2013; 14:721-32
©2014 MFMER | slide-27 Anxiety in Lymphoma Survivors and Spouses Lancet Oncology 2013; 14:721-32
©2014 MFMER | slide-28 Survivorship Care Models Primary care providers not trained in care of long-term cancer survivors Communication and coordination of care is key Survivorship care plan Treatment summary Follow-up care plan JOP 2014; Epub 10/14/14 www.asco.org
©2014 MFMER | slide-29 Does education and screening for late effects decrease QOL? Int J Rad Onc Biol Phy 2014; 90:164-71
©2014 MFMER | slide-30 Summary Surveillance for relapse Physical examination, history, and clinical judgement are the cornerstone of followup Late effects Cardiovascular disease, secondary malignancies, fatigue, fertility, loss of immunity, psychosocial issues Coordinated care
©2014 MFMER | slide-31 Thank you! Thompson.Carrie@mayo.edu
Lymphoma Survivors: Late and Long-Term Effects Carrie Thompson, MD NCCS Cancer Policy Advocate Training June 25, 2015.
© 2012 National Heart Foundation of Australia. Slide 2.
1 Title 1 Subtitle 2 Chemotherapy Induced Cardiac Toxicity Russell Huntsinger, MD Cardiologist.
Time for a BREAK! You have 45 Minutes.
Copyright © 2003 Pearson Education, Inc. Slide 1 Computer Systems Organization & Architecture Chapters 8-12 John D. Carpinelli.
Development of renewable energy sources in Germany in 2011
Understanding Medicares Preventive Benefits… Stay informed…Stay healthy Brought to you by.
Basel-ICU-Journal Challenge18/20/ Basel-ICU-Journal Challenge8/20/2014.
Peterson’s Practice AP Exam
FACTORING ax2 + bx + c Think “unfoil” Work down, Show all steps.
Asthma in Minnesota Slide Set Asthma Program Minnesota Department of Health January 2013.
2011年上半年 我院团学工作活动图片展播 2011年8月28日.
Immunobiology: The Immune System in Health & Disease Sixth Edition
Caring for patients in primary care after cancer treatments are done Moving Forward after Cancer Moving Forward after Cancer.
25 seconds left…...
Understanding Generalist Practice, 5e, Kirst-Ashman/Hull
CANCER SCREENING 2011 DELAWARE CANCER EDUCATION ALLIANCE STEPHEN S. GRUBBS, M.D. HELEN F. GRAHAM CANCER CENTER DELAWARE CANCER CONSORTIUM OCTOBER 5, 2011.
Copyright © 2012, Elsevier Inc. All rights Reserved. 1 Chapter 7 Modeling Structure with Blocks.
50 year old man with history of Hodgkin Lymphoma as a child, treated with mediastinal radiation, now presenting with severe heart failure.
© 2010, Mike Murach & Associates, Inc.
Bright Futures Guidelines Priorities and Screening Tables
Properties Use, share, or modify this drill on mathematic properties. There is too much material for a single class, so you’ll have to select for your.
Copyright © 2011, Elsevier Inc. All rights reserved. Chapter 6 Author: Julia Richards and R. Scott Hawley.
PP Test Review Sections 6-1 to 6-6
Prof. Valter Bezerra Dantas
©Brooks/Cole, 2001 Chapter 12 Derived Types-- Enumerated, Structure and Union.
Januar 2005 S M T O T F L
Essential Cell Biology
Subtraction: Adding UP
Author: Julia Richards and R. Scott Hawley
Cardiovascular Disease in Dialysis and Renal Transplantation
Chapter 1 The Study of Body Function Image PowerPoint
Exarte Bezoek aan de Mediacampus Bachelor in de grafische en digitale media April 2014.
McDonald’s calendar 2009.
Copyright © Action Works 2008 All Rights Reserved - Photos by David D
Jeopardy Q 1 Q 6 Q 11 Q 16 Q 21 Q 2 Q 7 Q 12 Q 17 Q 22 Q 3 Q 8 Q 13
Cancer Survivorship Care Why, What, Where Kenneth Miller, M.D. Sinai Hospital Baltimore, MD.
HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant Oct; 29 (10):
Multinational Comparisons of Health Systems Data, 2008 Support for this research was provided by The Commonwealth Fund. The views presented here are those.
Legislative Update March 28, 2012 Cancers Impact on Minorities in Texas David Lakey, M.D. Commissioner Texas Department of State Health Services.
HEART TRANSPLANTATION Pediatric Recipients ISHLT 2007 J Heart Lung Transplant 2007;26:
© 2017 SlidePlayer.com Inc. All rights reserved.