RASHA COSMAN BSC (Med), MBBS, FRACP MEDICAL ONCOLOGIST CONJOINT LECTURER, UNSW ST GEORGE PRIVATE HOSPITAL, KOGARAH

 The risk of developing cancer before the age of 85 years is 1 in 2 in men and 1 in 3 in women   incidence rose by 27% to 490 per 100,000.  Mortality fell by 17% to 172 deaths per 100,000  5YSR increased from 47% to 66%.  highest for people <40 (86%)  lowest for those ≥80 (43%)

 The process of living with, through, and beyond cancer.  1M Australians alive with a history of cancer  Cancer is becoming a chronic disease

 Surveillance for recurrence  Screening for second primary  Secondary prevention  Side effects of treatment  Psychosocial consequences  Maintaining wellness

 Obesity & Exercise  Cardiac  Neurological  Fatigue  Psychological

RENEHAN, The Lancet, 2008

 First systematic review of obesity, cancer and bariatric surgery  13 studies with 54,257 participants  focus on incidence of cancer following bariatric surgery  Bariatric surgery reduced incidence of cancer by 50%  1.06 vs 2.12 cases per 1,000 person-year Casagrande D S, Obesity Surgery, 2014  St George Private Hospital is the only accredited Centre of Excellence for Bariatric Surgery in Australia.

 More survivors exposed to cardiotoxic agents  Chemotherapy, targeted agents and radiation therapy  Longer cancer therapy course  Incidence (incl hypertension) up to 50%  Can limit cancer therapy dosing  Toxic risk versus tumor response  Can be late effect of therapy

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 Initiation:  Strong evidence linking stress and cancer initiation Bleiker, 2008; Dujits et al, 2003: Petticrew et al, 1999  Survival:  330 studies, stress was associated with poorer cancer survival ( P <0.001) Chida et al. (2008) Nature Clinical Practice Oncology

 Persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion  Related to cancer or cancer treatment  Not proportional to recent activity  Interferes with usual functioning

 The “New Normal”  Physical, cognitive, emotional, social  Psychological adaptation  Grief and loss  Acceptance of changes  Ongoing fear of recurrence  Heightened sense of vulnerability  Psychotherapy  Process events and losses  Proactive action to restart life