“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 Massey’s Rural Cancer Outreach Program Teaches residents and health professionals about prevention, long-term patient management and survivorship issues.

Virginia Commonwealth University Living Your Best After Cancer: You and Your Primary Care Doctor Working Together Mary Helen Hackney, M.D. Massey Cancer Center Virginia Commonwealth University

DO NOT SMOKE

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

Taking Care of Yourself Establish a relationship with a general medicine physician

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

Taking Care of Yourself Establish good health habits Weight control Exercise No tobacco No or moderate alcohol

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

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

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

Do Not Smoke

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 (Cowden’s) (thryoid ca., hamartomas, prostate ca, breast ca.) Ataxia telangectasia-life time risks increased for heterozygotes (autosomal recessive)(breast cancer)

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

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, Crohn’s or polyp history Less use of stool testing, barium enema, sigmoidoscopy

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

Blood Tests Tumor 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

Other Blood Tests Cholesterol, lipid panel Kidney and liver function 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

Other Health Maintenance…. Ophthamology Many drugs and radiation can affect eyes Cataracts may worsen

Other Health Maintenance…. Vaccinations Pneumovax every 5 years after splenectomy or if over 60 Tetanus Hepatitis if appropriate Additional vaccinations if bone marrow transplant

No Tobacco

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

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

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

Surviving…Living… 10 million and more….. Thank you!