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Working Beyond Cancer Dr Eliot Chadwick Consultant Clinical Oncologist Nottingham University Hospitals NHS Trust & The Nottingham Oncology Group Trent.

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Presentation on theme: "Working Beyond Cancer Dr Eliot Chadwick Consultant Clinical Oncologist Nottingham University Hospitals NHS Trust & The Nottingham Oncology Group Trent."— Presentation transcript:

1 Working Beyond Cancer Dr Eliot Chadwick Consultant Clinical Oncologist Nottingham University Hospitals NHS Trust & The Nottingham Oncology Group Trent Occupational Medicine Annual Symposium

2 Macmillan – the scene In the UK, over 100,000 people of working age are diagnosed with cancer each year. More than 700,000 people of working age are living with a cancer diagnosis. The HR department of a large employer will see more new cancer diagnoses in a year than a GP.

3 Cancer Incidence (CRUK)

4 Cancer Incidence (CRUK) The Big 4

5 Cancer survival (CRUK)

6 Cancer survival (CRUK) …and then there were 3

7 Why Toxicity? Normal tissue reaction to chemotherapy and radiotherapy. Relates to cell turnover. Early vs late broadly correlates with α/β ratio

8 Timelines - toxicity Long term Short term 4/528/526/1220yrs

9 The Return to Work Denial Independence Empowerment Identity Self worth Pragmatism Time Guilt Finance Self Employment Fear of relapse DECISION

10 Breast Cancer Surgery Chemotherapy Hormones Radiotherapy Biological agents (Herceptin ® )

11 Fatigue “...5 years after....I've been off sick from work since then...and, being completely honest, I have no desire of returning. I don't feel I can't work full time and, I can't survive on a part time wages. I have chronic fatigue, chemo brain and PSD. So far, nobody seems to care about the devastating effects of the aftermaths of cancer. The unrealistic expectations of employers, colleague and friends and, maybe my own, really puzzled me.”

12 Longitudinal patient case rates for persistent fatigue over 12 months (n = 218). Goldstein D et al. JCO 2012;30: ©2012 by American Society of Clinical Oncology

13 Lymphœdema Stiffness Pain

14 BrCa Side effects ACUTE Peri-operative complications, seroma, infection 6/523/122yr10yrs20yrs Poor wound healing, infection, nausea, mucositis, alopecia Lymphœdema, cardiac, depression Neuralgia, shoulder stiffness, fatigue

15 Prostate Cancer Risk of treating a non-lethal disease Success & morbidity of treatment

16 Hormones LHRHa EBRT 3/126/1218/122yrs3yrs

17 Hormones Insulin resistance* / cardiovascular morbidity ↓muscle mass Cognitive impairment Hot flushes *LGI diet advised (but see Pelvic RT)

18 Hormones - summary Effects as long as administered, and months to years beyond. Probably underplayed. Impact on occupation not necessarily direct.

19 Pelvic Radiotherapy

20 Pelvic RT effects ACUTE Fatigue, *proctitis, cystitis, prostatitis nausea, skin reaction EBRT 6/523/122yr10yrs20yrs CHRONIC / LATE *Proctitis, cystitis, arthritis, hip fracture * ”Beige” diet advised

21 Case 1 – 38yrs female, anal Ca Mitomycin C D1 5-fluorouracil D1-4 Coronary artery spasm from 5-FU. D22-25 not given. 5.4Gy boost given in lieu. At 18m, ongoing discomfort in perineum, frequency of stool 5-10/day, with urgency and occ. incontinence. Works at check-out in supermarket. } EBRT 50.4Gy /28#

22 Case 2 – 56yrs male, peri-anal Ca, vegetarian. Mitomycin C D1 5-fluorouracil D1-4, D22-25 Electron boost of 20Gy/10# At 12m, ongoing discomfort in perineum, frequency of stool 5/day, with urgency. Struggles to maintain wt. Pre treatment, worked for council – refuse, gardens. Now medically retired. } EBRT 50.4Gy /28#

23 Radiotherapy - summary Can cause significant long term effects. Functional deficit. Not easily treated.

24 Chemotherapy

25 Chemotherapy effects ACUTE Multiple, disparate effects. Not all intuitive. 6/523/122yr10yrs20yrs Fatigue, myalgia, arthralgia dysgeusia Wt gain, Neuropathy, cardiac

26 Case 3 – 48yrs male, rectal Ca, node positive on MRI. Capecitabine 825mg/m 2 /bd + EBRT 50.4Gy / 28# Works in abattoir. Develops palmar-plantar erythema (PPE). Capecitabine stopped during RT. Post-op (stoma). Pathologically node positive. For further capecitabine + oxaliplatin adjuvantly. Pt declines oxaliplatin. Starts capecitabine, but stops early due to PPE.

27 Case 4 – 65yrs male, colon Ca, Duke’s C Referred for adjuvant chemotherapy 5-fluorouracil / oxaliplatin q2/52 for 12 cycles. Loses sense of taste and smell. Develops PPE. Continues to work as Michelin star chef but finds it increasingly difficult.

28 Chemo - Summary Most chemo effects acute. Fatigue most common long term. Subjective. Pts occupational circumstance may dictate chemo given.

29 Surgery

30 Surgery effects ACUTE Peri-operative complications 6/523/122yr10yrs20yrs Fatigue, poor wound healing, TED Hernia, stoma, incontinence Anterior resection syndrome

31 Case 5 – 28yrs female, sigmoid Ca, emergency Hartmann’s. pT4b tumour Referred for adjuvant chemotherapy. Receives 8 cycles of capecitabine / oxaliplatin within SCOT study Regular FU post-chemo for SCOT data collection. Regular discussion regarding stoma. Pt works in clothes shop. Gaining weight, as finds it difficult to exercise. Stoma reversal on hold until 1 year CT performed. 1 year CT ?Ovarian mass

32 Surgery - summary Surgery usually irreversible. Implications for lifestyle should be explored, particularly if options available. Can have significant body image as well as functional effects.

33 Are we doing enough?

34 Challenges Patients not informed about impact of cancer on their working lives. Many patients do not have access to vocational rehabilitation services. Employers don’t know how to support staff with cancer. (Cancer specialists don’t know how to support employers.)

35 Questions?

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